Newly Funded Study Aims To Improve Outcomes For More Than One In 10 New Zealand Births
New Zealand researchers are about to undertake the largest-ever trial of corticosteroids in women having planned caesareans, to assess the treatment’s benefit and potential harm in newborns.
Associate Professor Katie Groom from The University of Auckland’s Liggins Institute has just been awarded $1.43 million by the Health Research Council of New Zealand (HRC) to lead a nationwide placebo-controlled, randomised trial into the effects of maternal corticosteroid use prior to planned caesarean at between 35 to 39 weeks of pregnancy.
She says the trial will address a serious evidence gap and will reliably inform future practice across New Zealand and globally.
In New Zealand, birth by planned caesarean section continues to rise and now accounts for more than one in 10 births (7,500 babies a year). To counter the increased risk of breathing problems that can occur with planned caesareans, mums are often given corticosteroids at near to full-term stages of pregnancy; however, there is surprisingly limited evidence about the benefits or harm of this fairly common practice.
While corticosteroids administered in earlier stages of pregnancy have well-established benefits for babies born prematurely, little is known about their use at near or full-term, says Associate Professor Groom.
“There is low-quality evidence on respiratory benefits, minimal evidence on long-term effects, and no evidence of their effect on blood-sugar levels.
“The steroids might help babies with breathing, but they might also disrupt glucose control, which could be detrimental in the long-term, so our trial will look at the balance of benefit versus potential harm.”
She says high-quality evidence is required to allow women with planned caesareans to make informed decisions about their treatments.
The C*STEROID Trial will take place in at least 14 hospitals across New Zealand and include 2548 babies and their mothers.
“This will be a national effort to answer an important question. Findings aim to be definitive and will inform clinical practice in New Zealand and across the world,” she says.
Another benefit of the trial will be the opportunity to follow-up a cohort of the children when they reach the age of six or seven and can be assessed for long-term impacts, such as childhood executive function, body size, and respiratory, cardiovascular and metabolic wellbeing.
The HRC’s chief executive, Professor Sunny Collings, says clinical trials like this are imperative to ensuring patient care is informed by strong, reliable evidence – not just the ‘best available’ evidence which is often low quality.
“Interventions in pregnancy and infancy can have long-lasting effects. This trial will find out what happens in the short-term, but maintaining contact with the cohort to allow assessment of the longer-term effects will be a major contribution in its own right,” she says.
Associate Professor Groom’s study is one of 47 new studies awarded a total of $71.58 million in the Health Research Council’s latest funding results released today.
Of that total, $19.88 million was awarded to four research ‘programmes’ that will take up to five years to complete; $47.73 million was awarded to 39 research projects, including $4.87 million for four Rangahau Hauora Māori projects; and another $3.97 million was awarded to four Pacific research projects.
See below for the full list of 2020 Programme, Project, and Pacific Project recipients. To read lay summaries about any of these studies (after the embargo lifts), go to hrc.govt.nz/resources/research-repository and filter by proposal type: ‘Programmes’ and year ‘2020’; ‘Projects’ and year ‘2020’; and ‘Pacific Projects’ and year ‘2020’.
2020 HRC Project and Programme grants:
Professor Richard
Beasley, Medical Research Institute of New Zealand
RCT
budesonide-formoterol vs salbutamol reliever therapy in
childhood asthma
36 months,
$1,439,100
Professor Laura Bennet, The University of
Auckland
Circadian patterns of fetal heart rate
predict impaired fetal oxygenation
36 months,
$1,199,998
Professor Ian Bissett, The University of
Auckland
Randomised trial of a novel chyme reinfusion
device for temporary ileostomies
36 months,
$1,433,127
Associate Professor Mark Bolland, The
University of Auckland
Zoledronic acid and fracture
prevention in early postmenopausal women
48 months,
$1,192,556.85,
Dr Amohia Boulton, Whakauae Research
Services
Te Ao Rauropi: Mapping the biosphere of
Rongoā Māori
36 months, $1,199,837
Professor
Winston Byblow, The University of Auckland
Enhancing
Spontaneous Recovery after Stroke Study (ESPRESSo)
48
months, $1,421,459
Professor Gregory Cook, University
of Otago
Unlocking antimicrobial tolerance in
bacterial pathogens to overcome AMR
36 months,
$1,197,343
Professor John Dalrymple-Alford, University
of Canterbury
Brain biomarkers for future cognitive
health in Parkinson's disease
48 months,
$1,189,160
Professor Catherine Day, University of
Otago
Time for destruction - switching immune
responses off
36 months, $1,197,433
Dr Janak de
Zoysa, Waitemata District Health Board
ACHIEVE - New
Zealand
60 months, $1,061,052
Dr Justin Dean,
The University of Auckland
Treatment of GABAergic
interneuron dysfunction in preterm brain injury
36
months, $1,186,646
Professor Paul Glue, University of
Otago
Ketamine therapy for neurotic disorders: Is
there a single mechanism?
36 months,
$1,438,829
Professor David Grattan, University of
Otago
A neural circuit required for maternal
adaptation to pregnancy
36 months,
$1,199,971
Associate Professor Katie Groom, The
University of Auckland
Safely improving outcomes for
babies after birth by planned caesarean section
48
months, $1,433,915
Associate Professor Nigel Harris,
Auckland University of Technology
Implementing high
intensity interval training in school
36 months,
$1,362,262
Professor Greg Jones, University of
Otago
The Metformin Aneurysm Trial
48 months,
$1,325,323
Dr Kelly Jones, Auckland University of
Technology
BIONIC2: TBI incidence, causes, costs over
time and service access in New Zealand
36 months,
$1,192,610
Associate Professor Peter Jones, University
of Otago
Role of ryanodine receptors in Alzheimer’s
disease
36 months, $1,189,936
Professor
Beverley Lawton, Research Trust of Victoria University of
Wellington
He Tapu Te Whare Tangata: Empowering rural
solutions
36 months, $1,293,194
Dr Khoon Lim,
University of Otago, Christchurch
Smart delivery of
growth factors for treating osteonecrosis of the femoral
head
24 months, $730,435
Dr Colin McArthur,
Medical Research Institute of New
Zealand
Erythropoietin to improve outcomes for
critically ill trauma patients
48 months,
$1,199,019
Dr Melissa McLeod, University of Otago,
Wellington
Prioritising Māori health and equity: a
critical approach to modelling
36 months,
$1,199,300
Dr Matthew McNeil, University of
Otago
Combating antimicrobial resistance with
high-throughput bacterial genetics
36 months,
$1,199,272
Dr Nicole Moreland, The University of
Auckland
Understanding the role of IgG3 in acute
rheumatic fever
36 months, $1,187,148
Dr Marama
Muru-Lanning, The University of Auckland
Ngā
Kaumātua ō Tātou Taonga: Supporting kaumātua health in a
changing world
36 months, $1,181,194
Professor
Gavin Painter, Research Trust of Victoria University of
Wellington
Designing a scalable vaccine to induce
liver resident T cells against malaria
36 months,
$1,195,993
Professor Julian Paton, The University of
Auckland
Novel potential anti-arrhythmic
target
36 months, $1,171,620
Professor Anthony
Phillips, The University of Auckland
Reducing organ
failure in critical illness
36 months,
$1,189,800
Dr Raewyn Poulsen, The University of
Auckland
Turning off the cellular energy supply to
treat osteoarthritis
36 months, $1,180,501
Dr
Frederik Pruijn, The University of Auckland
Enabling
clinical development of a novel hypoxia-targeted anti-cancer
agent
36 months, $1,199,945
Dr Rohit
Ramchandra, The University of Auckland
Respiratory
modulated pacing to improve outcomes in heart
failure
36 months, $1,191,072
Dr Jackie
Robinson, The University of Auckland
Dying as a health
and social justice issue: exploring the impact of
deprivation
36 months, $1,199,999
Associate
Professor llva Rupenthal, The University of
Auckland
Tackling the vicious circle of dry eye
disease
36 months, $1,195,446
Professor Lynette
Sadleir, University of Otago, Wellington
Genetic
discoveries for unsolved developmental and epileptic
encephalopathies
36 months,
$1,199,869
Associate Professor Ivan Sammut, University
of Otago
A novel therapeutic to protect hearts in
acute ischaemic procedures
36 months,
$1,143,638
Dr Caroline Shaw, University of Otago,
Wellington
Seeking the transport sweet spot: health,
equity and zero carbon
36 months,
$1,199,695
Professor Paul Smith, University of
Otago
Galvanic vestibular stimulation as a treatment
for neurological disorders
36 months,
$1,188,357
Dr Genevieve Walls, Middlemore Clinical
Trials
Staphylococcus aureus network adaptive platform
trial (SNAP)
60 months, $1,190,216
Dr Paul
Young, Medical Research Institute of New Zealand
A
mega randomised registry trial comparing two approaches to
oxygen therapy
60 months, $1,438,369
2020 Pacific Project grants
Dr Sunia Foliaki, Massey
University
Barriers and facilitators to
self-management of asthma in Pacific children
36
months, $971,541
Dr Jesse Kokaua, University of Otago,
Wellington
Lighted paths and connecting pathways:
Education, health and Pacific families
36 months,
$1,199,999
Associate Professor Vili Nosa, The
University of Auckland
A study of Samoan, Tongan, Cook
Island Māori, and Niuean infant care practices
36
months, $1,155,335
Dr Seini Taufa, Moana
Research
Responding to Pacific maternal mental
health
36 months, $599,082
2020 Programme grants
Professor Michael Baker, University of Otago,
Wellington
SYMBIOTIC: Integrated prevention of
infectious diseases and long-term conditions
60
months, $4,951,982
Professor Paul Donaldson, The
University of Auckland
Regulation of lens water
transport: A strategy to treat presbyopia and
cataract
60 months, $4,936,997
Professor
Valery Feigin, Auckland University of
Technology
Measuring and reducing stroke burden
in New Zealand
60 months,
$4,996,868
Associate Professor Nevil Pierse,
University of Otago, Wellington
Research to
maximise the health and wellbeing gains from
housing
60 months,
$4,996,214