Maria Makrides

South Australian Health and Medical Research Institute, Adelaide Hills, South Australia, Australia

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Publications (147)644.34 Total impact

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    ABSTRACT: To assess vitamin D status and its predictors in a representative population sample of pre-school children in Adelaide (latitude of 35°S).
    Journal of Paediatrics and Child Health 11/2014; · 1.19 Impact Factor
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    ABSTRACT: Multiple births are an important subgroup to consider in trials aimed at reducing preterm birth or its consequences. Including multiples results in a unique mixture of independent and clustered data, which has implications for the design, analysis and reporting of the trial. We aimed to determine how multiple births were taken into account in the design and analysis of recent trials involving preterm infants, and whether key information relevant to multiple births was reported.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 11/2014; · 3.86 Impact Factor
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    ABSTRACT: This paper aimed to identify the dietary and non-dietary determinants of docosahexaenoic acid (DHA) levels in umbilical cord blood at delivery. DHA was measured in cord blood plasma phospholipids of 1571 participants from the DOMInO (DHA to Optimize Mother Infant Outcome) randomized controlled trial. Socioeconomic, lifestyle and clinical data relating to the mother and current pregnancy were obtained from all women and their relationships with cord blood DHA assessed. DHA concentrations in the cord plasma phospholipids at delivery covered a 3–4 fold range in both control and DHA groups. The total number of DHA-rich intervention supplement capsules consumed over the course of pregnancy and gestational age at delivery individually explained 21% and 16% respectively of the variation in DHA abundance in the cord blood plasma phospholipids at delivery, but no other clinical or life-style factors explored in this study could account for >2% of the variation. Indeed, more than 65% of the variation remained unaccounted for even when all factors were included in the analysis. These data suggest that factors other than maternal DHA intake have an important role in determining cord blood DHA concentrations at delivery, and may at least partially explain the variation in the response of infants to maternal DHA supplementation reported in published trials.
    Prostaglandins Leukotrienes and Essential Fatty Acids 10/2014; · 1.98 Impact Factor
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    Maria Makrides, Ricardo Uauy
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    ABSTRACT: Preterm infants are denied the rapid accumulation of docosahexaenoic acid (DHA) occurring during the third trimester in utero. The potential benefit of long-chain polyunsaturated fatty acids (LCPUFAs) has generated interest over the last 3 decades. Early intervention trials assessed the effects of supplementing infant formulas lacking DHA with concentrations equivalent to LCPUFA in milk of women from Westernized societies, leading to the inclusion of LCPUFA by the year 2000. Recently attention has been on determining the optimal dose of DHA and on whether there is in advantage in matching the higher doses of late pregnancy.
    Clinics in Perinatology 06/2014; · 2.13 Impact Factor
  • JAMA The Journal of the American Medical Association 05/2014; 311(17):1802-4. · 29.98 Impact Factor
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    ABSTRACT: Background: There is limited large-scale longitudinal data evaluating the role of antenatal support on postnatal depressive symptomatology. This aim of the present study was to evaluate if antenatal support is an independent association of postnatal depression. Methods: 2200 pregnant women completed the Maternal Social Support Index at their booking visit. An Edinburgh Postnatal Depression Screen was completed at six weeks and six months postpartum. Univariate and multivariate analysis were undertaken to determine the influence of poor support on depressive symptomatology. Results: 600 women met the criteria for poor support and were compared to 1200 women with normal support levels. Women with poor support were significantly older, more likely to have a past history of depression, a history of having ever smoked, smoked immediately prior to index pregnancy, continuing to smoke during pregnancy and of drinking alcohol prior to index pregnancy (all p<0.001). Women with poor support had higher gravidity (p<0.0001) but not parity. There were no significant differences in gestational age, birthweight or gender. The incidence of maternal depressed mood was significantly higher in women with low support at six weeks (low 21%, normal 9%, p<0.0001) and six months (low 21%, normal1%, p<0.0001). In multivariate analysis, poor social support, past history of depression and continuing to smoke in pregnancy remained significant associations of depressive symptomatology at six weeks and six months (all p<0.0001). Conclusion: Improving antenatal support may modify postnatal depressive symptomatology.
    Perinatal Society of Australia and New Zealand Annual Scientific Conference; 04/2014
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    ABSTRACT: Magnesium is an essential mineral required for regulation of body temperature, nucleic acid and protein synthesis and in maintaining nerve and muscle cell electrical potentials. Many women, especially those from disadvantaged backgrounds, have low intakes of magnesium. Magnesium supplementation during pregnancy may be able to reduce fetal growth restriction and pre-eclampsia, and increase birthweight. To assess the effects of magnesium supplementation during pregnancy on maternal, neonatal/infant and paediatric outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013). Randomised and quasi-randomised trials assessing the effects of dietary magnesium supplementation during pregnancy were included. The primary outcomes were perinatal mortality (including stillbirth and neonatal death prior to hospital discharge), small-for-gestational age, maternal mortality and pre-eclampsia. Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Ten trials involving 9090 women and their babies were included; one trial had a cluster design (with randomisation by study centre). All 10 trials randomly allocated women to either an oral magnesium supplement or a control group; in eight trials a placebo was used, and in two trials no treatment was given to the control group. In the 10 included trials, the compositions of the magnesium supplements, gestational ages at commencement, and doses administered varied, including: magnesium oxide, 1000 mg daily from ≤ four months post-conception (one trial); magnesium citrate, 365 mg daily from ≤ 18 weeks until hospitalisation after 38 weeks (one trial), and 340 mg daily from nine to 27 weeks' gestation (one trial); magnesium gluconate, 2 to 3 g from 28 weeks' gestation until birth (one trial), and 4 g daily from 23 weeks' gestation (one trial); magnesium aspartate, 15 mmol daily (three trials, commencing from either six to 21 weeks' gestation until birth, ≤ 16 weeks' gestation until birth, or < 12 weeks until birth), or 365 mg daily from 13 to 24 weeks until birth (one trial); and magnesium stearate, 128 mg elemental magnesium from 10 to 35 weeks until birth (one trial).In the analysis of all trials, oral magnesium supplementation compared to no magnesium was associated with no significant difference in perinatal mortality (stillbirth and neonatal death prior to discharge) (risk ratio (RR) 1.10; 95% confidence interval (CI) 0.72 to 1.67; five trials, 5903 infants), small-for-gestational age (RR 0.76; 95% CI 0.54 to 1.07; three trials, 1291 infants), or pre-eclampsia (RR 0.87; 95% CI 0.58 to 1.32; three trials, 1042 women). None of the included trials reported on maternal mortality.Considering secondary outcomes, while no increased risk of stillbirth was observed, a possible increased risk of neonatal death prior to hospital discharge was shown for infants born to mothers who had received magnesium (RR 2.21; 95% CI 1.02 to 4.75; four trials, 5373 infants). One trial contributed over 70% of the participants to the analysis for this outcome; the trial authors suggested that the large number of severe congenital anomalies in the supplemented group (unlikely attributable to magnesium) and the deaths of two sets of twins (with birthweights < 750 g) in the supplemented group likely accounted for the increased risk of death observed, and thus this result should be interpreted with caution. Furthermore, when the deaths due to severe congenital abnormalities in this trial were excluded from the meta-analysis, no increased risk of neonatal death was seen for the magnesium supplemented group. Magnesium supplementation was associated with significantly fewer babies with an Apgar score less than seven at five minutes (RR 0.34; 95% CI 0.15 to 0.80; four trials, 1083 infants), with meconium-stained liquor (RR 0.79; 95% CI 0.63 to 0.99; one trial, 4082 infants), late fetal heart decelerations (RR 0.68; 95% CI 0.53 to 0.88; one trial, 4082 infants), and mild hypoxic-ischaemic encephalopathy (RR 0.38; 95% CI 0.15 to 0.98; one trial, 4082 infants). Women receiving magnesium were significantly less likely to require hospitalisation during pregnancy (RR 0.65, 95% CI 0.48 to 0.86; three trials, 1158 women).Of the 10 trials included in the review, only two were judged to be of high quality overall. When an analysis was restricted to these two trials none of the review's primary outcomes (perinatal mortality, small-for-gestational age, pre-eclampsia) were significantly different between the magnesium supplemented and control groups. There is not enough high-quality evidence to show that dietary magnesium supplementation during pregnancy is beneficial.
    Cochrane database of systematic reviews (Online) 04/2014; 4:CD000937. · 5.94 Impact Factor
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    ABSTRACT: Background: Whilst the majority of Australian babies are initially breastfed (92%), by six months rates of partial or total breastfeeding have dropped to 50%. The aim of this study was to determine the associations of continued breastfeeding at six months. Methods: Multi-institutional ethics committee approval and informed consent were obtained. Women were enrolled in the antenatal period and antenatal, delivery and six month postnatal questionnaires were completed. Univariate and multivariate analysis was undertaken to determine the factors associated with feeding type at six months postpartum. Results: Of 2399 women enrolled, outcome data were available for 2148 women, of whom 877 continued to breastfed either partially (N=262) or fully (N=615) until six months post partum and 1271 did not. In multivariate analysis, factors that remained significantly associated with maternal breastfeeding at six months postpartum were completion of secondary education (p<0.0001), completion of further education (p<0.0001), being a non-smoker pre-pregnancy (p<0.0001) or during the pregnancy (p<0.0001), an absence of preterm birth (P=0.01) or lower birthweight (p<0.0004). Conclusion: Higher maternal education, non-smoking status, term birth and higher birthweight were significant associations of breast feeding at six months.
    Perinatal Society of Australia and New Zealand Annual Scientific Meeting, Perth, Australia; 04/2014
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    ABSTRACT: Docosahexaenoic acid (DHA) accumulates in the hippocampus and frontal lobes of the fetal brain during the last trimester of pregnancy. These areas of the brain contribute to attention and working memory and inhibitory control (WMIC). We evaluated the effect of maternal omega-3 (n-3) long-chain polyunsaturated fatty acid supplementation in pregnancy on child attention and WMIC. A total of 185 term-born children of mothers who were randomly allocated to consume 800 mg DHA/d (treatment) or a placebo (control) from ∼20 wk of gestation until birth were assessed with multiple measures of attention and WMIC at a mean (±SD) of 27 ± 2 mo. Primary outcomes were the average time it took to be distracted when playing with a toy (distractibility) and the accuracy of remembering a new hiding location while inhibiting a learned response to search in the previous location (WMIC). Assessments were completed by 81 children in the treatment group (mean ± SD age: 835± 50.4 d) and 77 children in the control group (mean ± SD age: 839 ± 65.6 d). There was no effect of supplementation on primary outcomes [distractibility mean difference: -0.2 s (95% CI: -0.7, 0.4 s); WMIC mean difference: 8.9 mm (95% CI: -10.6, 28.3 mm)]. There was no difference between DHA-supplemented and control groups except that treatment-group children looked away from the toys fewer times than controls when presented with multiple toys competing for attention but less accurately remembered a repeated hiding location. These secondary effects were not consistent with any other outcomes and may have been a result of chance. Cord plasma DHA was not consistently associated with attention and WMIC. Maternal DHA supplementation during pregnancy does not enhance attention or WMIC in term-born preschoolers. The DHA for Maternal and Infant Outcomes trial was registered at as ACTRN1260500056906.
    American Journal of Clinical Nutrition 04/2014; 99(4):851-859. · 6.50 Impact Factor
  • Q U Lee, D J Palmer, T Sullivan, M Makrides
    Allergy 03/2014; 69(3):411-2. · 6.00 Impact Factor
  • Article: Reply.
    D J Palmer, T Sullivan, M Makrides
    Allergy 03/2014; 69(3):411-2. · 6.00 Impact Factor
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    ABSTRACT: The safety and nutritional adequacy of goat milk infant formulas have been questioned. The primary aim of the present study was to compare the growth and nutritional status of infants fed a goat milk infant formula with those of infants fed a typical whey-based cow milk infant formula. The secondary aim was to examine a range of health- and allergy-related outcomes. A double-blind, randomised controlled trial with 200 formula-fed term infants randomly assigned to receive either goat or cow milk formula from 2 weeks to at least 4 months of age was conducted. A cohort of 101 breast-fed infants was included for comparison. Weight, length and head circumference were measured at 2 weeks and 1, 2, 3, 4, 6 and 12 months of age. Nutritional status was assessed from serum albumin, urea, creatinine, Hb, ferritin, and folate and plasma amino acid concentrations at 4 months. Z-scores for weight, length, head circumference and weight for length were not different between the two formula-fed groups. There were differences in the values of some amino acids and blood biomarkers between the formula-fed groups, but the mean values for biomarkers were within the normal reference range. There were no differences in the occurrence of serious adverse events, general health, and incidence of dermatitis or medically diagnosed food allergy. The incidence of parentally reported blood-stained stools was higher in the goat milk formula-fed group, although this was a secondary outcome and its importance is unclear. Goat milk formula provided growth and nutritional outcomes in infants that did not differ from those provided by a standard whey-based cow milk formula.
    The British journal of nutrition 02/2014; · 3.45 Impact Factor
  • Article: Reply.
    The Journal of allergy and clinical immunology 02/2014; 133(2):601-2. · 12.05 Impact Factor
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    ABSTRACT: Diets high in n-3 long chain polyunsaturated fatty acids (LCPUFA) may modulate the development of IgE-mediated allergic disease and have been proposed as a possible allergy prevention strategy. The aim of this study was to determine whether n-3 LCPUFA supplementation of pregnant women reduces IgE-mediated allergic disease in their children. Follow-up of children (n = 706) at hereditary risk of allergic disease in the Docosahexaenoic Acid to Optimise Mother Infant Outcome randomized controlled trial. The intervention group (n = 368) was randomly allocated to receive fish oil capsules (providing 900 mg of n-3 LCPUFA daily) from 21 weeks' gestation until birth; the control group (n = 338) received matched vegetable oil capsules without n-3 LCPUFA. The diagnosis of allergic disease was made during medical assessments at 1 and 3 years of age. No differences were seen in the overall percentage of children with IgE-mediated allergic disease in the first 3 years of life between the n-3 LCPUFA and control groups (64/368 (17.3%) vs 76/338 (22.6%); adjusted relative risk 0.78; 95% CI 0.58-1.06; P = 0.11). Eczema was the most common allergic disease; 13.8% of children in the n-3 LCPUFA group had eczema with sensitization compared with 19.0% in the control group (adjusted relative risk 0.75; 95% CI 0.53-1.05; P = 0.10). Overall, n-3 LCPUFA supplementation during pregnancy did not significantly reduce IgE-associated allergic disease in the first 3 years of life. Further studies should examine whether the nonsignificant reductions in IgE-associated allergies are of clinical and public health significance.
    Allergy 09/2013; · 6.00 Impact Factor
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    ABSTRACT: Routine iodine supplementation during pregnancy is recommended by leading health authorities worldwide, even in countries where the iodine status of the population is sufficient. We evaluated the efficacy and safety of iodine supplementation during pregnancy or the periconceptional period on the development and growth of children. Secondary outcomes included pregnancy outcome and thyroid function. A systematic review of randomized controlled trials (RCTs) was conducted. PUBMED, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases were searched to identify relevant RCTs. Fourteen publications that involved 8 trials met the inclusion criteria. Only 2 included trials reported the growth and development of children and clinical outcomes. Iodine supplementation during pregnancy or the periconceptional period in regions of severe iodine deficiency reduced risk of cretinism, but there were no improvements in childhood intelligence, gross development, growth, or pregnancy outcomes, although there was an improvement in some motor functions. None of the remaining 6 RCTs conducted in regions of mild to moderate iodine deficiency reported childhood development or growth or pregnancy outcomes. Effects of iodine supplementation on the thyroid function of mothers and their children were inconsistent. In this review, we highlight a lack of quality evidence of the effect of prenatal or periconceptional iodine supplementation on growth and cognitive function of children. Although contemporary RCTs of iodine supplementation with outcomes addressing childhood development are indicated, conduct of such RCTs may not be feasible in populations where iodine supplementation in pregnancy is widely practiced.
    American Journal of Clinical Nutrition 09/2013; 98(5). · 6.50 Impact Factor
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    M Netting, P Middleton, M Makrides
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    ABSTRACT: Objectives To investigate the relationship between maternal diet during pregnancy and lactation and development of atopic disorders in childhood. Methods We included studies published up to August 2011 which either assessed food-based maternal dietary interventions or examined associations between maternal dietary intake during pregnancy and/or lactation and allergic outcomes (eczema, asthma, hay fever and sensitization) in their children. Results We included 43 studies (over 40 000 children): 11 intervention studies (including seven RCTs), 27 prospective cohort studies, four retrospective cohort studies and one case-control study. In the RCTs, no significant difference was noted overall in the prevalence of eczema and asthma in the offspring of women on diets free from common food allergens during pregnancy. The prospective cohorts investigated a large number of potential associations, but reported few significant associations between maternal dietary intake and development of allergy. Maternal diets rich in fruits and vegetables, fish and foods containing vitamin D and ‘Mediterranean’ dietary patterns were among the few consistent associations with lower risk of allergic disease in their children. Foods associated with higher risk included vegetable oils and margarine, nuts and fast food. Conclusion This review did not find widespread or consistent links between mother’s dietary intake and atopic outcomes in their children. However, maternal consumption of ‘Mediterranean’ dietary patterns, diets rich in fruits and vegetables, fish and vitamin D containing foods were suggestive of benefit, requiring further evaluation.
    Clinical and Translational Allergy. 07/2013; 3(3).
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    ABSTRACT: Observational studies suggest that early regular ingestion of allergenic foods might reduce the risk of food allergy. We sought to determine whether early regular oral egg exposure will reduce subsequent IgE-mediated egg allergy in infants with moderate-to-severe eczema. In a double-blind, randomized controlled trial infants were allocated to 1 teaspoon of pasteurized raw whole egg powder (n = 49) or rice powder (n = 37) daily from 4 to 8 months of age. Cooked egg was introduced to both groups after an observed feed at 8 months. The primary outcome was IgE-mediated egg allergy at 12 months, as defined based on the results of an observed pasteurized raw egg challenge and skin prick tests. A high proportion (31% [15/49]) of infants randomized to receive egg had an allergic reaction to the egg powder and did not continue powder ingestion. At 4 months of age, before any known egg ingestion, 36% (24/67) of infants already had egg-specific IgE levels of greater than 0.35 kilounits of antibody (kUA)/L. At 12 months, a lower (but not significant) proportion of infants in the egg group (33%) were given a diagnosis of IgE-mediated egg allergy compared with the control group (51%; relative risk, 0.65; 95% CI, 0.38-1.11; P = .11). Egg-specific IgG4 levels were significantly (P < .001) greater in the egg group at both 8 and 12 months. Induction of immune tolerance pathways and reduction in egg allergy incidence can be achieved by early regular oral egg exposure in infants with eczema. Caution needs to be taken when these high-risk infants are first exposed to egg because many have sensitization already by 4 months of age.
    The Journal of allergy and clinical immunology 06/2013; · 12.05 Impact Factor
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    ABSTRACT: AIM: The composition of faecal microbiota of babies is known to be influenced by diet. Faecal calprotectin and α1-antitrypsin concentrations may be associated with mucosal permeability and inflammation. We aimed to assess whether there was any difference after consumption of a probiotic/prebiotic formula on faecal microbiota composition, calprotectin and α1-antitrypsin levels, and diarrhoea in comparison with breast milk-fed Indonesian infants. METHODS: One hundred sixty infants, 2 to 6 weeks old, were recruited to the study. They were either breastfed or formula fed (80 per group). Faecal samples were collected at recruitment and 3 months later. Bacterial groups characteristic of the human faecal microbiota were quantified in faeces by quantitative polymerase chain reaction. Calprotectin and α1-antitrypsin concentrations were measured using commercial kits. Details of diarrhoeal morbidity were documented and rated for severity. RESULTS: The compositions of the faecal microbiota of formula-fed compared with breast milk-fed children were similar except that the probiotic strain Bifidobacterium animalis subsp. lactis DR10 was more abundant after 3 months consumption of the formula. Alpha1-antitrypsin levels were higher in breastfed compared with formula-fed infants. The occurrence of diarrhoea did not differ between the groups of babies. CONCLUSION: Feeding Indonesian babies with a probiotic/prebiotic formula did not produce marked differences in the composition of the faecal microbiota in comparison with breast milk. Detrimental effects of formula feeding on biomarkers of mucosal health were not observed.
    Journal of Paediatrics and Child Health 06/2013; · 1.19 Impact Factor
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    ABSTRACT: Food allergies are one of the first manifestations of allergic disease and have been shown to significantly impact on general health perception, parental emotional distress and family activities. It is estimated that in the Western world, almost one in ten children have an IgE-mediated allergy. Cow's milk and egg allergy are common childhood allergies. Until recently, children with food allergy were advised to avoid all dietary exposure to the allergen to which they were sensitive, in the thought that consumption would exacerbate their allergy. However, recent publications indicate that up to 70% of children with egg allergy can tolerate egg baked in a cake or muffin without apparent reaction. Likewise, up to 75% of children can tolerate baked goods containing cow's milk, and these children demonstrate IgE and IgG4 profiles indicative of tolerance development. This article will review the current literature regarding the use of heated food allergens as immunotherapy for children with cow's milk and egg allergy.
    Nutrients 06/2013; 5(6):2028-46. · 3.15 Impact Factor
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    ABSTRACT: The aim of the study was to compare the composition of the fecal microbiotas of infants fed goat milk formula to those fed cow milk formula, or breast milk as the 'gold standard'. Pyrosequencing of 16S rRNA gene sequences was used in the analysis of the microbiotas in stool samples collected from 90 Australian babies (30 in each group) at two months of age. Beta-diversity analysis of total microbiota sequences and Lachnospiraceae sequences revealed that they were more similar in breast milk/goat milk comparisons compared to breast milk/cow milk. The Lachnospiraceae were mostly restricted to a single species (Ruminococcus gnavus) in breast milk-fed and goat milk-fed babies compared to a more diverse collection in cow milk-fed babies. Bifidobacteriaceae were abundant in the microbiotas of infants in all three groups. Bifidobacterium longum, Bifidobacterium breve, and Bifidobacterium bifidum were the most commonly detected bifidobacterial species. A semi-quantitative PCR method was devised to differentiate between B. longum subsp. longum and B. longum subsp. infantis and was used to test stool samples. Subspecies infantis was seldom present in stools, even of breast milk-fed babies. The presence of B. bifidum in the stools of breast milk-fed infants at abundances greater than 10% of the total microbiota was associated with the highest total abundances of Bifidobacteriaceae. When Bifidobacteriaceae abundance was low, Lachnospiraceae abundances were greater. New information about the composition of the fecal microbiota when goat milk formula is used in infant nutrition was thus obtained.
    Applied and Environmental Microbiology 03/2013; · 3.95 Impact Factor

Publication Stats

3k Citations
644.34 Total Impact Points


  • 2014
    • South Australian Health and Medical Research Institute
      Adelaide Hills, South Australia, Australia
  • 2007–2013
    • Women's and Children's Health Network
      Tarndarnya, South Australia, Australia
  • 1998–2013
    • University of Adelaide
      • • Discipline of Public Health
      • • School of Paediatrics and Reproductive Health
      • • Discipline of Paediatrics
      • • Women's & Children's Health Research Institute (WCHRI)
      • • Discipline of Obstetrics and Gynaecology
      Adelaide, South Australia, Australia
  • 2012
    • University of Western Australia
      • School of Paediatrics and Child Health
      Perth, Western Australia, Australia
  • 2011
    • Boston Children's Hospital
      • Division of Newborn Medicine
      Boston, MA, United States
    • Medical University of Warsaw
      • Department of Paediatrics
      Warszawa, Masovian Voivodeship, Poland
  • 2008
    • Queensland University of Technology
      • Institute of Health and Biomedical Innovation
      Brisbane, Queensland, Australia
  • 2001–2007
    • Women`s and Children`s Hospital
      Tarndarnya, South Australia, Australia
    • Flinders Medical Centre
      Tarndarnya, South Australia, Australia
  • 1998–2003
    • Flinders University
      • Department of Paediatrics and Child Health
      Adelaide, South Australia, Australia