ORCID Profile
0000-0003-3913-0876
Current Organisations
University of Queensland
,
Universidad Complutense de Madrid
,
Universitat de Barcelona
,
Mater Medical Research Institute
,
National University of Singapore
,
University of Oxford
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 17-12-2020
Abstract: To compare clinical outcomes following induction of labour (IOL) using a balloon catheter and going home, versus prostaglandin (PG) as an inpatient. Randomised controlled trial. Eight Australian maternity hospitals. Women with uncomplicated term singleton pregnancies undergoing IOL for low-risk indications including post-term, advanced maternal age and 'social' reasons. Between September 2015 and October 2018, 347 women were randomised to a balloon outpatient group and 348 to a PG inpatient group. The PG group received Dinoprostone, either 2 mg gel or 10 mg controlled-release tape. The balloon group had a double-balloon catheter inserted and went home. The primary outcome was a composite neonatal measure comprising nursery admission, intubation/cardiac compressions, acidaemia, hypoxic ischaemic encephalopathy, seizure, infection, pulmonary hypertension, stillbirth or death. Clinical and process outcomes are reported. There were no statistically significant differences in the primary outcome comparing balloon with PG (18.6% versus 25.8% relative risk = 0.77, 95% CI 0.51-1.02 P = 0.070), cord arterial pH <7.10 (3.5% versus 9.2% P = 0.072), nursery admissions (12.6% versus 15.5% P = 0.379), neonatal antibiotic use (12.1% versus 17.6% P = 0.103), or mode of birth. Nulliparous women in the balloon group had lower rates of the primary outcome (20.4% versus 31.0% P = 0.032) Parous women were less likely to have an unassisted vaginal birth (77.6% versus 92.3% P = 0.045). Balloon catheters may be a superior method of cervical priming for nulliparous women, whereas this may not be the case for parous women. It is feasible that nulliparous women go home after commencing balloon catheter IOL, and the likelihood of adverse outcomes is low. Multicentre trial shows outpatient induction using balloon catheter is safe and feasible for nulliparous women.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Wiley
Date: 03-2022
DOI: 10.1002/UOG.26035
Abstract: Fetal growth restriction ( FGR ) is often secondary to placental dysfunction and is suspected prenatally based on biometric or circulatory abnormalities detected on ultrasound. The aims of this study were to compare the screening performance of the Society for Maternal–Fetal Medicine ( SMFM ) biometric criteria (estimated fetal weight ( EFW ) or abdominal circumference ( AC ) 10 th centile) with that of the International Society of Ultrasound in Obstetrics and Gynecology ( ISUOG )‐endorsed Delphi consensus criteria for late FGR for delivery of a small‐for‐gestational‐age ( SGA ) infant at term, emergency Cesarean section ( CS ) for non‐reassuring fetal status ( NRFS ), perinatal mortality and composite severe neonatal morbidity. We classified retrospectively non‐anomalous singleton infants as having late FGR (diagnosed ≥ 32 weeks) according to SMFM and ISUOG/Delphi criteria in a cohort of women who had been referred to the Mater Mother's Hospital, Brisbane, Australia and who delivered at term between January 2014 and December 2020. The study outcomes were delivery of a SGA infant (birth weight (BW) 10 th or 3 rd centile), emergency CS for NRFS, perinatal mortality (defined as stillbirth or neonatal death within 28 days of a live birth) and a composite of severe neonatal morbidity. We assessed the screening performance of various ultrasound variables by calculating the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, false‐positive and false‐negative rates, positive likelihood ratio (LR+) and negative likelihood ratio. The SMFM and ISUOG/Delphi consensus criteria collectively classified 1030 cases as having late FGR. Of these, 400 cases were classified by both SMFM and ISUOG/Delphi criteria, whilst 548 cases were classified using only SMFM criteria and 82 cases were classified only by ISUOG/Delphi criteria. Prenatal detection of late FGR by SMFM and ISUOG/Delphi criteria was associated with increased odds of delivery of an infant with BW 10 th centile (SMFM: adjusted odds ratio (aOR), 133.0 (95% CI, 94.7–186.6) ISUOG/Delphi: aOR, 69.5 (95% CI, 49.1–98.2)) or BW 3 rd centile (SMFM: aOR, 348.7 (95% CI, 242.6–501.2) ISUOG/Delphi: aOR, 215.4 (95% CI, 148.4–312.7)). Compared with the SMFM criteria, the ISUOG/Delphi criteria were associated with lower odds (aOR, 0.5 (95% CI, 0.3–0.8)) of predicting a SGA infant with BW 10 th centile, but higher odds of predicting emergency CS for NRFS (aOR, 2.30 (95% CI, 1.14–4.66)) and composite neonatal morbidity (aOR, 1.22 (95% CI, 1.05–1.41)). Both SMFM and ISUOG/Delphi criteria were associated with high LR+, specificity, PPV and NPV for the prediction of infants with BW 10 th and BW 3 rd centile. However, both methods functioned much less efficiently for the prediction of composite severe neonatal morbidity or emergency CS for NRFS, with LR+ 10. The SMFM biometric criteria alone, particularly AC 3 rd centile, had the highest LR+ values for the prediction of perinatal mortality. Both the SMFM and ISUOG /Delphi criteria had strong screening potential for the detection of infants with BW 10 th or 3 rd centile but not for adverse neonatal outcome. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Publisher: MDPI AG
Date: 23-03-2021
DOI: 10.3390/JCM10061319
Abstract: Although the risk of neonatal mortality is generally low for late preterm and early term infants, they are still significantly predisposed to severe neonatal morbidity (SNM) despite being born at relatively advanced gestations. In this study, we investigated maternal and intrapartum risk factors for early SNM in late preterm and early term infants. This was a retrospective cohort study of non-anomalous, singleton infants (34+0–38+6 gestational weeks) born at the Mater Mother’s Hospital in Brisbane, Australia from January 2015 to May 2020. Early SNM was defined as a composite of any of the following severe neonatal outcome indicators: admission to neonatal intensive care unit (NICU) in conjunction with an Apgar score at 5 min, severe respiratory distress, severe neonatal acidosis (cord pH 7.0 or base excess −12 mmol/L). Multivariable binomial logistic regression analyses using generalized estimating equations (GEE) were used to identify risk factors. Of the total infants born at 34+0–38+6 gestational weeks, 5.7% had at least one component of the composite outcome. For late preterm infants, pre-existing diabetes mellitus, instrumental birth and emergency caesarean birth for non-reassuring fetal status were associated with increased odds for early SNM, whilst for early term infants, pre-existing and gestational diabetes mellitus, antepartum hemorrhage, instrumental, emergency caesarean and elective caesarean birth were significant risk factors. In conclusion, we identified several risk factors contributing to early SNM in late preterm and early term cohort. Our results suggest that predicted probability of early SNM decreased as gestation increased.
Publisher: Informa UK Limited
Date: 17-09-2019
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.PLACENTA.2016.12.017
Abstract: The physiological mechanisms that confer different outcomes in morbidity and mortality of the fetus exposed to stressful environments may be driven by significant differences in the expression and function of the placental glucocorticoid receptor (GR). The recent discovery that the placenta contains at least 8 different isoforms of the GR raises questions about the regulation and physiological relevance of the many GR variants expressed in the placenta. The current data also highlights that in idual differences in glucocorticoid sensitivity, variations in the effect of different complications of pregnancy on birth outcomes and sex differences in the response to stress, may all be dependent on a specific GR isoform expression profile. This review will investigate the current state of knowledge of GR isoforms in the placenta and discuss the potential role of these multiple isoforms in regulating glucocorticoid sensitivity.
Publisher: Wiley
Date: 04-05-2023
DOI: 10.1111/AJO.13689
Abstract: While a male infant is usually born with a higher birthweight than his female counterpart, he is more at risk of variety of adverse perinatal outcomes. Indeed, throughout life, females exhibit a marked survival advantage compared to males. The aetiology for such pertinent sex disparity remains unclear and is likely multifactorial. The aim of this study was to investigate obstetric and perinatal outcomes by infant sex from 28 weeks in a contemporary, large Australian birth cohort. A 14‐year retrospective cohort study of 130 133 births over 28 weeks gestation from a single tertiary centre. Male infants had overall higher rates of neonatal mortality (0.12% vs 0.06%, P 0.001) and severe neonatal morbidity (12% vs 9.1%, P 0.001) (adjusted odds ratio (aOR) 1.41, 95% CI 1.35–1.47). The odds of overall perinatal mortality (stillbirth and neonatal death) were higher for male infants (aOR 1.30, 95% CI 1.08–1.56). The difference in severe neonatal morbidity when stratified by gestational age at birth only remained significant from weeks gestation. Regardless of infant sex, rates of neonatal mortality and morbidity were lowest at 39 weeks gestation. Rates of preterm birth and operative birth were also higher for male infants. Our study demonstrates significant disparities in clinical outcomes by infant sex with males at a disadvantage to female infants.
Publisher: Copernicus GmbH
Date: 19-08-2022
Abstract: Abstract. The stratosphere can be a source of predictability for surface weather on timescales of several weeks to months. However, the potential predictive skill gained from stratospheric variability can be limited by biases in the representation of stratospheric processes and the coupling of the stratosphere with surface climate in forecast systems. This study provides a first systematic identification of model biases in the stratosphere across a wide range of subseasonal forecast systems. It is found that many of the forecast systems considered exhibit warm global-mean temperature biases from the lower to middle stratosphere, too strong/cold wintertime polar vortices, and too cold extratropical upper-troposphere/lower-stratosphere regions. Furthermore, tropical stratospheric anomalies associated with the Quasi-Biennial Oscillation tend to decay toward each system's climatology with lead time. In the Northern Hemisphere (NH), most systems do not capture the seasonal cycle of extreme-vortex-event probabilities, with an underestimation of sudden stratospheric warming events and an overestimation of strong vortex events in January. In the Southern Hemisphere (SH), springtime interannual variability in the polar vortex is generally underestimated, but the timing of the final breakdown of the polar vortex often happens too early in many of the prediction systems. These stratospheric biases tend to be considerably worse in systems with lower model lid heights. In both hemispheres, most systems with low-top atmospheric models also consistently underestimate the upward wave driving that affects the strength of the stratospheric polar vortex. We expect that the biases identified here will help guide model development for subseasonal-to-seasonal forecast systems and further our understanding of the role of the stratosphere in predictive skill in the troposphere.
Publisher: Wiley
Date: 18-05-2023
DOI: 10.1111/AJO.13677
Abstract: There is growing evidence regarding the potential of closed incision negative pressure wound therapy (ci‐NPWT) to prevent surgical site infections (SSIs) in healing wounds by primary closure following a caesarean section (CS). To assess the cost‐effectiveness of ci‐NPWT compared to standard dressings for prevention of SSI in obese women giving birth by CS. Cost‐effectiveness and cost‐utility analyses from a health service perspective were undertaken alongside a multicentre pragmatic randomised controlled trial, which recruited women with a pre‐pregnancy body mass index ≥30 kg/m 2 giving birth by elective/semi‐urgent CS who received ci‐NPWT ( n = 1017) or standard dressings ( n = 1018). Resource use and health‐related quality of life (SF‐12v2) collected during admission and for four weeks post‐discharge were used to derive costs and quality‐adjusted life years (QALYs). ci‐NPWT was associated with AUD$162 (95%CI −$170 to $494) higher cost per person and an additional $12 849 (95%CI −$62 138 to $133 378) per SSI avoided. There was no detectable difference in QALYs between groups however, there are high levels of uncertainty around both cost and QALY estimates. There is a 20% likelihood that ci‐NPWT would be considered cost‐effective at a willingness‐to‐pay threshold of $50 000 per QALY. Per protocol and complete case analyses gave similar results, suggesting that findings are robust to protocol deviators and adjustments for missing data. ci‐NPWT for the prevention of SSI in obese women undergoing CS is unlikely to be cost‐effective in terms of health service resources and is currently unjustified for routine use for this purpose.
Publisher: Wiley
Date: 29-12-2015
DOI: 10.1111/JOG.12918
Abstract: The purpose of this study was to investigate neonatal outcome of dichorionic diamniotic twins born beyond 32 weeks' gestation according to mode of delivery at a major tertiary center in Australia. This was a retrospective cohort study of women with dichorionic diamniotic twins delivering at ≥32 weeks' gestation at a large tertiary maternity center in Australia using data from a maternity database. Primary and secondary outcomes included mode of delivery, birthweight, stillbirth, Apgar score, neonatal unit admission, neonatal resuscitation, death and respiratory distress. Of 1261 women, 82.9% (1045/1261 2090 babies) delivered at ≥32 weeks' gestation. The mode of delivery for these babies was as follows: normal vaginal delivery, 419 (20%) instrumental delivery, 179 (8.6%) emergency cesarean section, 658 (31.5%) and elective cesarean section, 834 (39.9%). Babies delivered by emergency cesarean section or instrumental vaginal delivery had worse outcome. In contrast, the lowest complications were seen in the uncomplicated vaginal delivery and elective cesarean section cohorts. Neonatal outcome was worse for those delivering via emergency cesarean section or instrumental vaginal delivery compared with elective cesarean section or uncomplicated vaginal delivery. The rate of uncomplicated vaginal delivery, however, was low, with only 14.8% of women delivering both babies vaginally without any form of intervention.
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-044463
Abstract: The perinatal–postnatal family environment is associated with childhood outcomes including impacts on physical and mental health and educational attainment. Family longitudinal cohort studies collect in-depth data that can capture the influence of an era on family lifestyle, mental health, chronic disease, education and financial stability to enable identification of gaps in society and provide the evidence for changes in government in policy and practice. The Queensland Family Cohort (QFC) is a prospective, observational, longitudinal study that will recruit 12 500 pregnant families across the state of Queensland (QLD), Australia and intends to follow-up families and children for three decades. To identify the immediate and future health requirements of the QLD population pregnant participants and their partners will be enrolled by 24 weeks of gestation and followed up at 24, 28 and 36 weeks of gestation, during delivery, on-ward, 6 weeks postpartum and then every 12 months where questionnaires, biological s les and physical measures will be collected from parents and children. To examine the impact of environmental exposures on families, data related to environmental pollution, household pollution and employment exposures will be linked to pregnancy and health outcomes. Where feasible, data linkage of state and federal government databases will be used to follow the participants long term. Biological s les will be stored long term for future discoveries of biomarkers of health and disease. Ethical approval has been obtained from the Mater Research Ethics (HREC/16/MHS/113). Findings will be reported to (1) QFC participating families (2) funding bodies, institutes and hospitals supporting the QFC (3) federal, state and local governments to inform policy (4) presented at local, national and international conferences and (5) disseminated by peer-review publications.
Publisher: Wiley
Date: 10-09-2022
DOI: 10.1111/AJO.13428
Abstract: Surgical site infection (SSI) after a caesarean section is of concern (CS) is of concern to both clinicians and women themselves. The aim of this study is to identify the cumulative incidence and predictors of SSI in women who are obese and give birth by elective CS. The method used was planned secondary analysis of data from women with a pre‐pregnancy body mass index (BMI) ≥30 kg/m 2 giving birth by elective CS in a multicentre randomised controlled trial of a prophylactic closed‐incision negative pressure wound therapy dressing. Data were collected from medical records, direct observations of the surgical site and self‐reported signs and symptoms from October 2015 to December 2019. The Centers for Disease Control and Prevention definition was used to identify SSI. Women were followed up once in hospital just before discharge and then weekly for four weeks after discharge. Blinded outcome assessors determined SSI. After the cumulative incidence of SSI was calculated, multiple variable logistic regression models were used to identify independent risk factors for SSI. SSI incidence in 1459 women was 8.4% (122/1459). Multiple variable‐adjusted odds ratios (OR) for SSI were BMI ≥40 kg/m 2 (OR 1.55, 95% confidence interval (CI) 1.30–1.86) as compared to BMI 30–34.9 0 kg/m 2 , ≥2 previous pregnancies (OR 1.38, 95% CI 1.00–1.80) as compared to no previous pregnancies and pre‐CS vaginal cleansing (OR 0.55, 95% CI 0.33–0.99). Our findings may inform preoperative counselling and shared decision‐making regarding planned elective CS for women with pre‐pregnancy BMI ≥30 kg/m 2 .
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2023-076130
Abstract: Antenatal maternal magnesium sulfate (MgSO 4 ) administration is a proven efficacious neuroprotective treatment reducing the risk of cerebral palsy (CP) among infants born preterm. Identification of the neuroprotective component with target plasma concentrations could lead to neonatal treatment with greater efficacy and accessibility. This is a prospective observational cohort study, in three tertiary Australian centres. Participants are preterm infants, irrespective of antenatal MgSO 4 exposure, born in 2013–2020 at 24 +0 to 31 +6 weeks gestation, and followed up to 2 years corrected age (CA) (to September 2023). 1595 participants are required (allowing for 17% deaths/loss to follow-up) to detect a clinically significant reduction (30% relative risk reduction) in CP when sulfate concentration at 7 days of age is 1 SD above the mean. A blood s le is collected on day 7 of age for plasma sulfate and magnesium measurement. In a subset of participants multiple blood and urine s les are collected for pharmacokinetic studies, between days 1–28, and in a further subset mother/infant blood is screened for genetic variants of sulfate transporter genes. The primary outcome is CP. Surviving infants are assessed for high risk of CP at 12–14 weeks CA according to Prechtl’s Method to assess General Movements. Follow-up at 2 years CA includes assessments for CP, cognitive, language and motor development, and social/behavioural difficulties. Multivariate analyses will examine the association between day 7 plasma sulfate/magnesium concentrations with adverse neurodevelopmental outcomes. A population pharmacokinetic model for sulfate in the preterm infant will be created using non-linear mixed-effects modelling. The study has been approved by Mater Misericordiae Ltd Human Research Ethics Committee (HREC/14/MHS/188). Results will be disseminated in peer-reviewed journal publications, and provided to the funding bodies. Using consumer input, a summary will be prepared for participants and consumer groups.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Javier García-Serrano.