International pioneering neonatal study

A pioneering neonatal study has reported its two-year findings, confirming that a novel approach developed in Australia can improve the lung health of extremely premature infants born with breathing difficulties.

The multi-centre OPTIMIST-A trial, in which Murdoch Children’s Research Institute (MCRI) was a key collaborator, enrolled 486 premature babies from 33 neonatal intensive care units around the world during their first hours of life.

Researchers compared the use of a novel delivery of surfactant medication, via a flexible thin catheter, to the airways to a ‘sham’ treatment, in tiny premature babies requiring active breathing support in the first hours of life.

This less invasive Hobart Method was developed in 2009 by Professor Dargaville, who holds concurrent roles at MCRI, Menzies Institute for Medical Research and Royal Hobart Hospital. He led this research alongside Royal Women’s Hospital’s Professor Peter Davis and Dr Omar Kamlin.

This research was also supported by Professor John Carlin, who was MCRI’s head of Clinical Epidemiology and Biostatistics Unit (CEBU) for 21 years until 2022 and played a leading role in setting up the study.

Senior biostatistician Francesca Orsini was also closely involved in the trial, taking in design decisions through to final data analyses. This specialised work considered numerous characteristics of the babies recruited and allowed for variation in outcomes across more than 50 hospitals internationally.

Primary results of this study were published in the Journal of the American Medical Association (JAMA) in 2021 and the team have now published new results in the same journal. These numbers show that infants who received the new treatment in the OPTIMIST-A trial had improved respiratory health at age two when compared to the control group.

Babies who received active treatment experienced a one-third reduction in respiratory-related hospitalisation, reduced wheezing or breathing difficulty and were less likely to need bronchodilator therapy or be diagnosed with asthma. There were no differences in neurodevelopment between the two groups.

“The infants in this trial were born between 25 and 28 weeks’ gestation and are some of the most vulnerable when it comes to experiencing long-term lung damage,” said Professor Carlin.

“Validating a minimally invasive technique like the Hobart Method has been reassuring for clinicians and for families with preterm infants, and should help us to reduce rates of lifelong lung complications in this group.”

The OPTIMIST-A trial remains one of only a few blinded studies of its kind and one of very few to report follow-up outcomes for surfactant therapy.

This valuable research was supported by the Royal Hobart Hospital Research Foundation and the Australian National Health and Medical Research Council (NHMRC).* Relevant NHMRC Grant Application number 1049114.

*The content of this communication is the sole responsibility of the Murdoch Children’s and does not reflect the views of the NHMRC.