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Introduction: Necrotizing enterocolitis (NEC) affects mainly preterm infants, has a multifactorial etiology and is associated with intestinal dysbiosis and disordered immunity. Use of probiotics for prophylaxis is beneficial with studies indicating reduction in NEC ≥ stage 2, late onset sepsis (LOS) and mortality. However, not all studies have shown a reduction, there are questions regarding which probiotic to use, whether infants <1,000 g benefit and the risk of probiotic sepsis. All neonatal intensive care units in New Zealand (NZ) use probiotics and contribute to an international database (Australian and New Zealand Neonatal Network or ANZNN). Objective: To use ANZNN data to investigate the experience of NZ neonatal units with probiotics for NEC prevention in a setting where the baseline incidence of severe NEC was low, to compare results of 2 commonly used probiotic regimes and report on the extremely low birth weight subgroup. Method: Outcomes before (Pre group 2007-2010) and after (Probiotic group 2013-2015) starting routine probiotics for preterm infants <1,500 g or <32 weeks were compared. Clinicians reviewed cases to ensure they met database criteria. Five units used Infloran ( Bifidobacterium bifidum and Lactobacillus acidophilus) and 1 unit used Lactobacillus GG (LGG) and bovine lactoferrin (bLF). Results: Four thousand five hundred and twenty nine infants were included and Pre and Probiotic groups were well-balanced with regard to gestation, birth weight and gender. The incidence of NEC in the Probiotic group was 1.6 and 2.7% in the pre group (corrected OR 0.62 CI 0.41-0.94). There was one case of probiotic sepsis. There was no significant difference between the Infloran and LGG/bLF combinations in regard to observed NEC rates. Late onset sepsis rates were significantly lower in the Probiotic group ( p < 0.01). Conclusions: Introduction of probiotics for preterm infants in NZ has been associated with significant reductions in NEC and late onset sepsis., (Copyright © 2020 Meyer, Chow, Alsweiler, Bourchier, Broadbent, Knight, Lynn and Patel.)

Unlabelled: Extremely immature newborns develop a self-limiting normal anion gap metabolic acidosis in early life. This study examined the natural history of this acidosis in a population of infants of gestation less than 26 weeks in the first 14 days of life. The acidosis was maximal on day 4 with a mean base deficit of 10.6 mmol/l and had resolved in 90 % of infants by day 11. Dopamine usage was the only independent predictor of the acidosis. Its use was associated with a greater degree of acidosis., Conclusion: Extremely preterm infants experience a self-limiting normal anion gap metabolic acidosis in the first 2 weeks of life which is consistent with renal tubular immaturity.

Unlabelled: Plasma aldosterone levels were measured in 50 infants of less than 30 weeks gestation at 24 h (D1) and 7 days (D7). The relationship between the plasma aldosterone level and a number of clinical and biochemical variables was explored. Plasma aldosterone levels ranged from 1000 to 30000 pmol/l and were inversely correlated with the severity of illness (D1 or D7), serum sodium (D7) and 24 h sodium intake (D1). No correlation with the serum potassium level was noted., Conclusion: Plasma aldosterone levels in this extremely premature cohort were significantly greater than those reported in more mature infants. Important determinants were severity of illness and sodium homeostasis.

Two cases of hyponatraemic hypertensive syndrome occurring in extremely low birthweight infants are presented. Both infants experienced unilateral renal ischaemia resulting in hyponatraemia and hypertension. A proposed pathophysiological mechanism, namely unilateral renal ischaemia leading to a pressure-natriuresis in the contralateral kidney, is presented. This is associated with an increase in plasma renin and aldosterone, with a paradoxical increase in urinary sodium loss. Immature renal tubular function and relative aldosterone resistance could place the extremely low birthweight infant at increased risk for the condition. The paucity of reports suggests that the condition might be under-recognized.

Aim: To compare the efficacy of hydrocortisone with dopamine for the treatment of hypotensive, very low birthweight (VLBW) infants., Methods: Forty infants were randomly allocated to receive either hydrocortisone (n = 21) or dopamine (n = 19)., Results: All 19 infants randomised to dopamine responded; 17 of 21 (81%) did so in the hydrocortisone group. Three of the four non-responders in the hydrocortisone group had clinically significant left to right ductal shunting. The incidence of bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular haemorrhage, necrotising enterocolitis, symptomatic patent ductus arteriosus, hyperglycaemia, sepsis (bacterial or fungal) or survival did not differ between groups. The adrenocorticotrophic hormone (ACTH) stimulated plasma cortisol activity, either before or after treatment, did not differ between the two groups of infants. Although a significant difference in efficacy between dopamine and hydrocortisone was not noted (P = 0.108), there were four treatment failures in the hydrocortisone group, compared with none in the dopamine group., Conclusion: Both hydrocortisone and dopamine are effective treatments for hypotension in very low birthweight infants.

Infants of very low birthweight (VLBW) who underwent thoracotomy were given 2.0 mg.kg-1 of bupivacaine by the intrapleural route, and serial blood levels were taken to determine the pharmacokinetic profile in this group of babies. It was apparent that the half life was longer, clearance lower, and volume of distribution greater than in term infants. Although the drug did not reach toxic levels at this dose, caution should be observed when redosing as the accumulation of the drug may be unpredictable.

Aims: To determine the neurodevelopmental outcome of infants with birthweight < 1000 g at 2 years., Methods: Prospective, regional case-control cohort., Results: Of 141 liveborn infants with birthweight between 500-999 g born to mothers of central North Island domicile, 83 (58.9%) were alive at 2 years. Sixty nine of the survivors completed a neurodevelopmental assessment at a corrected age of 2 years along with 29 control infants. Neurological disability was present in 27.5% of survivors, and 20.7% of controls, with severe disability being more prevalent amongst survivors (10.1% vs 3.4%). The mean developmental index, expressive and receptive language scores were not significantly different between the groups., Conclusion: Infants with birthweight < 1000 g are at increased risk of major neurodevelopmental disability at age 2 years compared with a control cohort.

Aims: To assess the impact, mortality, morbidity and economic costs, of respiratory distress syndrome severe enough to warrant ventilation in one year in New Zealand., Methods: Review of data from all five New Zealand regional neonatal intensive care units' participation in the international OSIRIS trial of exogenous surfactant (Exosurf) treatment for respiratory distress syndrome (involving 6700 infants in 21 countries), and extrapolation of these data to a full year., Results: There were 265 New Zealand infants entered in the OSIRIS trial; the mean birthweight was 1335 g and mean gestation 29 weeks; 61% of infants were less than 30 weeks gestation. Forty-seven infants (17.7%) died prior to discharge from hospital, 40 deaths being attributed to prematurity or respiratory distress syndrome. One hundred and two infants (38.5% of the cohort; 45% of surviving infants) were oxygen dependent and 36 infants (13.6%) were dead at 28 days of age. Thirty-four infants (12.8% of the cohort; 15% of surviving infants) were oxygen dependent and 40 infants (15%) were dead at the expected date of delivery. Infants were intubated for a mean 12.5 days, with surviving infants of less than 27 weeks gestation intubated for a disproportionately long period of time. Seventy-two infants (29% of the 246 infants examined) had an abnormality detected by cranial ultrasound scan at 1 or 6 weeks of age and in 23 (9%) this was a major abnormality. Of surviving infants 16 (7.5% of 213 examined) had a major abnormality on cranial ultrasound scan. Amongst infants at high risk for respiratory distress syndrome (gestation less than 30 weeks) 53% received antenatal steroids, compared with 22% in the OSIRIS trial overall. In a full year the cost of caring for infants with respiratory distress syndrome sufficiently severe enough to warrant ventilation is estimated to be NZ$12.5 million. The average cost of caring for a surviving infant was roughly NZ$52,500 and a nonsurviving infant was NZ$24,500., Conclusions: In a full year (total births 60,000) approximately 350 New Zealand infants may require ventilation for respiratory distress syndrome. Increasing the percentage of infants who receive antenatal steroids is likely to be extremely cost effective. In the era of antenatal steroids and exogenous surfactant, 85% of infants with respiratory distress syndrome requiring ventilation survive to discharge home and over 90% of survivors are likely to be healthy normal adults.

The incidence, aetiologic organism and mortality associated with neonatal septicaemia were retrospectively reviewed over a seven year period (June 1983 to July 1990). Trends with time were evaluated by dividing the study period in half. Although there was no significant change in the incidence of septicaemia during the study period (3.59 vs 3.40 per 1000 livebirths), there was a marked increase in the numbers of very low birthweight infants developing early onset group B streptococcal sepsis and an associated increase in mortality.

The relationship between the degree of oliguria following severe birth asphyxia and outcome at 12 months was examined in 31 infants. All 31 infants developed encephalopathy following severe birth asphyxia and 25 had oliguria for 24 h or more following delivery. Eighteen had persistent oliguria (i.e. greater than 48 h) and the remaining seven had transient oliguria (between 24 and 48 h). Poor outcome (death or neurological abnormality at 12 months) was significantly associated with the degree of oliguria. Encephalopathy, however, was found to be more closely correlated with poor outcome rather than duration of oliguria and a stepwise regression model confirmed that encephalopathy was the more powerful predictor of poor outcome. In those situations where an infant's degree of encephalopathy can not be assessed accurately (e.g. muscle relaxant use) the duration of oliguria may prove a useful prognostic indicator.

Sixty-five infants with seizures in the neonatal period were followed to the age of one year. There were 27 nonsurvivors, with 14 neonatal deaths from causes directly related to the initial neurologic insult, and 13 postneonatal deaths, eight related to neurologic sequelae and five to unrelated causes. Twenty-four (63.2%) of the survivors were neurologically normal, while five (13.2%) had seizures at age one year. Multivariate stepwise analysis identified low birthweight (p less than 0.01) and the number of anticonvulsants used to control the initial seizure(s) (p less than 0.05) as being significantly associated with nonsurvival and neurodevelopmental sequelae amongst the survivors was significantly associated with the duration of initial seizure (p less than 0.05).

The effect of a 21-day (reducing dose) course of dexamethasone upon platelet numbers, neutrophil numbers and neutrophil morphology in ventilator-dependent preterm infants with chronic lung disease is reported. Forty-one infants, who were sepsis-free throughout the treatment period, received 46 courses of dexamethasone. In these infants the circulating platelet count increased significantly from 235 +/- 157 to 476 +/- 208 X 10(9)/L. Both total neutrophil numbers (7.94 +/- 7.16 to 19.56 +/- 12.40 X 10(9)/L) and immature neutrophil numbers (1.19 +/- 1.22 to 2.68 +/- 2.58 X 10(9)/L) also showed a significant increase reaching a peak on day 7 of treatment and decreasing thereafter. The immature:total (I:T) neutrophil ratio remained essentially unchanged. Eight other infants who developed serious sepsis during the treatment period showed a fall in both platelets (293 +/- 236 to 140 +/- 170 X 10(9)/L) and total neutrophil numbers (18.61 +/- 10.83 to 15.76 +/- 10.53 X 10(9)/L), together with an increase in immature neutrophils (2.30 +/- 2.80 to 8.22 +/- 13.91 X 10(9)/L) and consequent increase in I:T ratio.

A cohort of very low birthweight (VLBW) infants (ie, less than 1500 g) who were admitted to the newborn unit, Waikato Hospital between 1984 and 1988 were followed to the age of 12 months. Four hundred and twenty-five infants were admitted with 385 surviving the neonatal period. A further 29 infants died in the postneonatal period (68.2 per 1000 livebirths). Sixteen of the infants died during their initial hospitalisation - primarily from complications of prematurity, while the remaining 13 died following discharge from hospital (9 from sudden infant death syndrome). The postneonatal mortality rate was 3-5 fold greater than that described in similar studies, reflecting the generally increased rate in New Zealand and a lower neonatal mortality rate. The duration of mechanical ventilation was associated with an increased risk of postneonatal death, but no risk factors for posthospital discharge death could be identified.

A two and a half year old child presented with "bleeding" ears which proved to be factitious in origin. A previous episode of haematuria, haematemesis and melaena at age 9 months was probably also factitious. A brief discussion of Munchausen syndrome by proxy is presented.

Arterial blood oxygen tensions (Pao2) were compared with simultaneously obtained transcutaneous oxygen measurements (TcO2) in 15 children during an acute asthma attack and in 18 children with an illness other than asthma. A close correlation between TcO2 and PaO2 was obtained in the non-asthmatic group but not in the asthmatics. It is suggested that impaired cutaneous blood flow may explain this poor correlation.

Fifteen preterm babies (mean gestation: 26.7 weeks; mean birthweight 860 g) with significant glucose intolerance were treated with insulin infusions. During the insulin infusions there was a significant increase in both the mean energy intake (60.8 +/- 25.1 cal/kg per day to 79.9 +/- 24.5 cal/kg per day; P less than 0.001) and the mean amount of intravenous dextrose tolerated (7.0 +/- 2.7 mg/kg per min to 9.2 +/- 2.6 mg/kg per min; P less than 0.01). The infusions were initiated at a mean postnatal age of 5.3 days (range: 2-12 days) and were continued for 1.5-17.5 days. Of the 998 blood glucose estimations performed during the insulin infusions, 28 (2.8%) were less than 2 mmol/l and 216 (21.6%) greater than 8 mmol/l. We conclude that continuous insulin infusion is a safe and effective way of managing glucose intolerance in very low birthweight infants, provided adequate means for continuous monitoring of blood glucose are available.

A ten year (1 January 1978 to 31 December 1987) review of neonatal surgery at Waikato Hospital is reported. There were 367 operations performed on 296 infants aged 0-28 days, with 144 of the operations being classified as a major. Of the 31 deaths, three occurred preoperatively and 28 postoperatively, with diaphragmatic hernia (n = 8) and necrotising enterocolitis (n = 7) being the commonest causes. A significant increase in the number of operations (% major operations), infants with birthweights less than 1500 g, preoperative ventilation and the proportion of operations performed by paediatric surgeons and anaesthetists was seen in the five year period 1983-7, when compared with 1978-82. It is recommended that neonatal surgery only be undertaken at hospitals with level III neonatal intensive care facilities and only by paediatric surgeons and anaesthetists.

Haemorrhagic disease of the newborn is preventable by the routine administration of vitamin K to newborn babies. Despite this, prophylactic administration of Vitamin K1 remains controversial and haemorrhagic disease of the newborn continues to cause significant morbidity and mortality. We present two cases of this disease occurring recently in this region of New Zealand; one resulting in an infant's death, the other baby suffering from an intraventricular haemorrhage and secondary hydrocephalus. These cases prompted us to survey major New Zealand hospitals to assess their policy as regards routine vitamin K administration to newborn infants. The results of this survey suggest that there is now a uniform policy in New Zealand hospitals of giving intramuscular vitamin K. However, intramuscular vitamin K administration may still be objected to by some parents and lead to further cases of this preventable disease. Evidence now available shows that vitamin K1 given orally in a dose of 1 mg is effective in preventing haemorrhagic disease of the newborn.

Whooping cough continues to be a major health problem in New Zealand. In a twelve month period, 64 cases were admitted to the paediatric wards of Christchurch Hospital. Of these 64 patients, 24 (37.5%) were fully immunised. The possible explanations for the large number of children contracting whooping cough, who have been immunised according to the schedule used in New Zealand, is discussed.

Seven ventilator-dependent infants with severe bronchopulmonary dysplasia were treated with dexamethasone. Six of the seven infants were extubated within 12 days of commencing the dexamethasone, whilst the remaining infant continued to need respiratory support for apnoea, despite significant improvement in the pulmonary disease. All infants survived; although only two were neurologically intact. Of the other five survivors, two had mild developmental delay, two were blind (secondary to retinopathy of prematurity) and the other had a spastic quadriplegia (secondary to bilateral periventricular leukomalacia).

Twenty-two months experience with a transcutaneous bilirubinometer (TCB) at Waikato Hospital is reported. During this period 2787 paired TCB and serum bilirubin samples were collected. Correlation coefficients for TCB (forehead and sternum) versus serum bilirubin in both Maori and caucasian infants ranged from 0.57 to 0.67.

Sixteen children (mean age 1.9 years) admitted to hospital with viral croup were assigned randomly to either a high humidity atmosphere or room air. No other treatment was given. During the initial 12 h both groups of patients showed a similar rate of recovery as measured by pulse rate, respiration rate, transcutaneous oxygen (TcO2), transcutaneous carbon dioxide (TcCO2) and a clinical rating. No therapeutic benefit was demonstrated from the provision of a high humidity atmosphere. The widespread use of humidification in the management of croup requires reappraisal.

An intravenous urogram and micturating cystourethrogram were carried out in 100 infants presenting with documented urinary tract infections. Ninety three cases were identified by suprapubic aspiration and 7 by culture of two voided urine samples containing greater than 100 X 10(6) organisms per litre. The urinary tract abnormalities were analysed in respect of their clinical importance, patient's age, sex, and prematurity (in the 10 preterm infants). Radiological abnormalities were found in 47% of the infants (40% of boys; 63% of girls). Twenty nine per cent of the infants had a urinary tract abnormality regarded as clinically important--namely grade 3 or 4 vesicoureteric reflux, reflux nephropathy, or obstructive lesions requiring surgery. Six of the 10 preterm infants had radiological abnormalities. Spontaneous resolution or improvement occurred within 6 months of birth in three of the four preterm infants with severe vesicoureteric reflux.

Six infants with hypertrophic pyloric stenosis and 20 control infants were studied ultrasonically on four occasions during the first year of life. At each examination the total diameter and muscle wall thickness of the pylorus were measured. Initially the pylorus was significantly (P less than 0.05) larger in the hypertrophic pyloric stenosis group but returned to normal values by 6 months postoperation. The control group showed a small increase in size of the pylorus over the 12 month period.