Therapy tool helps premature babies fight chronic lung disease

Baby Clementine, a participant in the OPTIMIST-A trial at the Women's.
13 December 2021 |

The eight-year long OPTIMIST-A trial, taking in the Royal Women’s Hospital, has found a reduction of bronchopulmonary dysplasia (BPD) in premature babies thanks to a new, simple way of delivering lung-saving medication.

Tiny babies, born between 25 and 28 weeks and weighing less than 1000 grams, have been the brave participants in a global study seeking to limit the development of BPD – a chronic lung disease worsened by long-term use of oxygen and mechanical ventilation which has life-long implications.

Close to 500 premature babies were enrolled into the OPTIMIST-A trial between 2011 and 2020, beginning at the Royal Hobart Hospital and expanding to the Women’s Neonatal Intensive Care Unit (NICU) in 2012. Major hospitals in the UK, USA, Canada, Israel, New Zealand and the Netherlands also took part.

Researchers wanted to know if babies would benefit from a less-invasive delivery of surfactant, a substance that naturally lines human lungs and makes breathing easier. The randomised trial saw the use of a thin, light-weight catheter, developed by Tasmanian specialist Professor Peter Dargaville.

“Our results suggest that the use of the ‘Hobart method’ for giving surfactant on day one will translate into a healthier start to life for premature infants around the world,” Professor Dargaville said.

The study found the risk of BPD in babies who received this minimally-invasive therapy developing BPD fell from 45 per cent to 37 per cent. They were also half as likely to need to be mechanically ventilated (with a breathing tube in the windpipe) in the first three days, and the need for oxygen therapy at home was reduced by one third.

“The findings have absolutely cemented the idea that using a minimally-invasive technique to give surfactant can give these babies an advantage,” Professor Dargaville said.

“The eight per cent difference between the groups in the rate of bronchopulmonary dysplasia, the chronic lung disease of the premature infant, is an important effect.”

The Women’s, which cares for up to 2,000 premature and sick babies annually in its NICU and Special Care Nursery, recruited the highest number of infants to the trial.

One of the 83 babies born at the Women’s to take part was Clementine (pictured), who was born at 27 weeks gestation alongside her twin brother Felix in 2012.

“Giving birth to premature twins was an incredibly stressful time. We are grateful for the exceptional medical care that both Clementine and Felix received at the Women’s,” Mum Georgia Widdup said.

“Our children benefitted from the medical research done by these outstanding hospitals and clinicians. We feel like we were standing on the shoulder of others, and are so pleased Clementine was able to play a role in the next generation of babies having even greater opportunities.”

Professor of Neonatal Medicine at Women’s, Peter Davis, said the findings had already been translated into practice.

“We’ve worked for many years to develop therapies which avoid the need for a breathing tube and these results represent a breakthrough in achieving that aim. Now, many more of our tiniest babies will survive to lead full and healthy lives,” he said.

The OPTIMIST-A trial has been published in the prestigious Journal of the American Medical Association (JAMA).