A matter of life or death

From the first breaths 

Effie and Georgie Koufalus could not hold their precious baby girl Madelin for the first three weeks of her life. 

Born on 22 February 2016, Madelin weighed only 480 grams when she arrived at 23 weeks and three days and was taken to the Women’s and Children’s Hospital Neonatal Intensive Care Unit (NICU). 

“She was my third pregnancy, the first was born still at 20 weeks and our second had anencephaly,” said Effie. “After seven rounds of IVF, Madelin was our miracle baby.” 

Madelin spent 150 days in hospital, and like many babies within the NICU, was part of life-saving trials through the University of Adelaide’s Robinson Research Institute. 

“Of course we said yes, we wanted to help any other families that we could,” Effie says. “It’s also one of the reasons I started volunteering at the hospital cafe – I wanted to give back.” 

The Robinson Research Institute (RRI) is opposite the Women’s and Children’s Hospital. The researchers in the Institute focus on solving the puzzle of healthy human reproduction and child development. 

Professor Michael Stark is the leader of RRI’s Neonatal Medicine Group, as well as the Head of Neonatal Services at the hospital. “I’ve been here for 15 years now and, over that time, advances in our ability to care for the most pre-term babies means delivery at 23 weeks is now not uncommon,” he says. 

“For us, the first 5 to 10 minutes after delivery is crucial. We’ve done some pretty great stuff with patients, but we still lose some. I deliver a lot of those messages to families because it is quite a tough specialty.” 

As RRI’s almost 50 research groups focus on different aspects of early life, Professor Stark leads a multidisciplinary team centred on improving neonatal survival free of neurodevelopmental impairments. 

There are 14 intensive care beds and 35 special care beds for babies born at, or transferred to, the WCH. For some, the treatments they receive as part of their care double as trials for RRI. 

“Some of the babies in the unit might be in a couple of trials at once,” Professor Stark says. 

“Sometimes, time doesn’t allow to seek permission before we deliver treatment for a condition, so we’ll deliver the treatment and then go back and explain to the parents what we did, an approach called deferred consent. 

The parents want to be involved, they want the best for their own kids, but they also want to help the next people coming through, so recruiting is never a problem.

“We also explain that we’re working on a trial in this space and offer the opportunity to participate. The parents want to be involved, they want the best for their own kids, but they also want to help the next people coming through, so recruiting is never a problem.” 

The trials are taking things back to the fundamentals, exploring the impact of changes using information from other demographics. 

“One of the big trials we’re working on is about blood use in transfusions. We are hoping to answer questions, such as the optimal timing for transfusion, who the blood should come from, and whether it should be washed. We know there’s evidence in other demographics that using donors with certain demographics creates better results – what we’re doing is bringing that to neonatology.” 

It was 100 days before Madelin Koufalus (pictured above) had her first bath in the WCH NICU. 

“We formed such a good relationship with the nurses and doctors, especially Professor Stark and Dr Chad Anderson, in that time, we have this beautiful photo of Madelin in a bath with balloons behind her to mark the moment,” Effie says. 

“Now, she’s a happy nine-year-old who loves to swim, she goes three times a week.”

Ageing on TRAC 

The Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, based at the Queen Elizabeth Hospital in Woodville and Resthaven in Paradise, is all about best practice care for the older generation, through innovative research and training in partnership with clinical and aged care services. 

“We needed to strengthen our teaching, training and research program not only in our hospitals but also in the community,” explains Professor Renuka Visvanathan, Head of University of Adelaide’s G-TRAC and the Head of Unit of the Aged and Extended Care Services (Geriatric Medicine) at the Queen Elizabeth Hospital. “At the same time, it was acknowledged that we needed to partner with our consumers and other primary and aged care stakeholders.” 

Through the development of innovative academic programs, external funding and partnerships, G-TRAC was formed to explore frailty, falls, under-nutrition, and the genetic links to healthy ageing. 

“My PhD completed at the University of Adelaide was in nutritional frailty; I recognised there was a big gap in healthy ageing research and the need to continue to learn, to teach it and to develop academic capacity for the future,” Professor Visvanathan says. 

“No matter what age someone is, they want to age well, to be able to do what they want and value without any additional barriers because of their age. Healthy ageing is about keeping people healthy for longer, something which is necessary as we have an ageing demographic.” 

By 2050 it is estimated that up to 4 million older Australians will be at risk of frailty or be frail. Frailty increases vulnerability to acute illnesses, which in turn increases the risk of falls, hospitalisation and loss of independence. Research to inform programs that prevent, or better manage frailty, is crucial if we are going to help people age well moving forward. 

University of Adelaide alumni Jasmine Beger and Isobel Marshall are also exploring ways to help women live stronger through midlife and beyond. “On hospital placement over the past few years, we have seen the disproportionate impact of muscle loss and frailty experienced by female patients, and how this leads to poor health outcomes and loss of independence into older age,” former Young Australian of the Year, Isobel, a recent medical graduate, says. 

“Watching our mums go through menopause, we were spending time educating them on the importance of a high-protein diet and resistance training to protect their health into the future. We created Acro Health to offer a very simple, clean way for women to ensure they are reaching their new, higher protein requirements after menopause, and to create a platform from which we can share evidence-based information to help women protect their health into the future, and help them separate fact from fiction amidst the chaos of social media marketing.”

Fighting against frailty 

At the Adelaide University Judo Club in Thebarton, 12 people move in synchronisation with grace and control. It’s not an uncommon sight; it is an active sport after all. But these participants were all introduced to judo through a trial designed to help them age safely. 

Dr Agathe Daria Jadczak is a Research Fellow and Exercise Scientist with the Adelaide G-TRAC Centre, based at the Basil Hetzel Institute, Woodville. “We were first approached in 2019 by Adelaide University Judo Club coaches Meera Verma and Michael Headland,” she says. 

“They’d been doing judo their whole lives and were starting to notice their friends and relatives were having falls and getting hurt. In the sport of judo, safe landing techniques are crucial to minimise harm and injury from falling and so they’ve developed a safe landing program for older adults based on their extensive experience and skills. They came to us with the idea that teaching safe landing to older adults could be a good research program with the potential to make a huge difference.” 

There are awareness campaigns around fall prevention, or how to get up, Dr Jadczak explains, but a scoping review of previous research literature found a gap around how to fall safely and how to minimise harm and injury from falls in older adults. 

“The most important thing to come out of the pilot study was the improvements these people had made after the trial hadfinished including better balance, physical performance and mobility, reducing their risk of frailty.” 

Funding through The Hospital Research Foundation Group enabled an extension of the program and more study participants to further explore the benefits of judo and its safe landing techniques. 

“We’ve just had so much interest from the community in this, groups across the State want to learn more. And we’re even training allied health professionals working in aged care in these skills to extend their capabilities of what we can do with older people in terms of falls and safe landing,” Dr Jadczak says. 

“All the safe landing techniques are slowed down and taught in micro progression, so the participants can take those skills and use them in the event of a fall. By teaching safer landings, we not only want to decrease the number of falls, but also minimise the impact and harm from falling, thus improving the quality of life in older people.” 

Jean Stacey, 73, Dr Alana Hansen, 69, and Helen Slater, 81, signed up to the first pilot trial. 

“I realised I could count 12 falls I’d had in a year without even thinking about it,” Helen, a University of Adelaide graduate (B Ed, 1986), says. “So, I joined a falls prevention group through the Council of the Ageing and one of the things that was mentioned was the first judo trial. I’m happy to know these skills and I haven’t had to use them, but I now find when I fall in class, I make choices of how to do it. I would go into shock when I fell. I’m more aware of my body now, of the strength and stability required.” 

By teaching safer landings, we not only want to decrease the number of falls, but also minimise the impact and harm from falling

For Alana, a titleholder with the School of Public Health (PhD 2010), judo was a far cry from anything she’d ever done. 

“At first I was hesitant, because I didn’t know anyone, but everyone is so supportive,” she says. “We’ve developed a really nice group, it’s also so good for memory, social skills and just how to keep safe. It’s given us more confidence in everyday life.” 

For Jean, judo is a reason to keep moving and learning. “We go to two sessions a week now, and then on Thursdays we go to Pilates,” she says. “My new goal is to get to my black belt.” 

The power of the brain 

Associate Professor Lyndsey Collins-Praino always thought she’d be working with people with neurological disease. An interest in understanding what happens in the brain, and a desire to improve life for those living with neurological disease, propelled her into behavioural and cognitive neuroscience. 

Her research now focuses on the brain mechanisms underlying cognitive decline in healthy ageing and in neurodegenerative diseases, including Alzheimer’s and Parkinson’s. 

“There’s just so much we don’t know about the brain,” she says. “Now is a really exciting time in neurodegeneration research in particular – we’ve got advances coming that 5, 10, 20 years ago we couldn’t imagine. This includes new treatment avenues for dementia and new techniques that may improve diagnosis of Parkinson’s disease. I think we’ll look back on 2024 as a landmark year.” 

And she is in a position to know, as head of the University’s Cognition, Ageing and Neurodegenerative Disease Laboratory (CANDL). 

“We have a bench-to-bedside approach to identifying novel predictors of the risk/rate of cognitive decline both in ageing and in neurological diseases. This means that our lab-based studies inform our research with clinical populations and vice-versa,” she says. 

“When people think of cognitive decline, they often think of ageing, but it can occur at any point in life, particularly for those living with certain types of neurological disease. 

Our lab is interested in how cognitive function changes across the lifespan, and how conditions like traumatic brain injury, stroke or neurodegenerative disease impact this. We’re especially focused on how we can predict who is at risk of cognitive decline.” 

In the case of neurodegenerative disease in particular, given that age is the biggest risk factor, and we have a rapidly ageing population, cases are expected to skyrocket in coming years. This makes it critical that we act now to identify and reduce risk. 

“We’re interested in how other lifestyle risk factors interact with age to either increase or decrease risk,” Associate Professor Collins-Praino explains. 

“To do this, we combine comprehensive cognitive/motor testing with analysis of biomarkers, neuroimaging measures and lifestyle factors in order to try to predict specific outcomes using machine learning. 

“Ultimately, identifying people at high risk of cognitive decline is the first step in developing novel strategies to treat or prevent it. We’re working towards a more personalised approach to cognitive health.” 

Rhiannon Koch is a Media Officer for the University of Adelaide. 

Images by Isaac Freeman, photographic editor of Lumen, and the Robinson Research Institute.