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Aim: To estimate the relative risk of sudden unexpected death in infancy (SUDI) by district health board (DHB) in New Zealand after adjustment for socio‐economic deprivation, ethnicity and other demographic factors. Methods: We conducted a population‐based cohort study using data from the Integrated Data Infrastructure, a large research database containing linked data from a range of government agencies. The study population was all live births and their mothers in New Zealand from 2012 to 2018. The exposure of interest was DHB. The outcome was SUDI. Results: There were 418 068 live births in New Zealand from 2012 to 2018, and of these 415 401 (99.4%) had valid DHB data. There was considerable variation in the proportion of infants in each DHB living in the most deprived decile varying from 4.5% in Nelson, West Coast and Canterbury to 29.7% in Counties Manukau. There were 267 SUDI cases, giving an overall rate of 0.64/1000 live births during the study period (2012–2018). The SUDI rate varied from 1.11/1000 in Northland to 0.30/1000 in Waitemata and Auckland. Counties Manukau had the largest number of deaths (n = 54; rate = 1.08/1000). Five DHB regions had increased risk of SUDI compared to the reference group but, after adjustment, no DHB was significantly increased. Conclusions: This study found that there is marked variation in SUDI risk by DHB, but this is explained by socio‐economic and demographic variation within DHBs. This study emphasises the importance of the contribution of social determinants of health to SUDI. [ABSTRACT FROM AUTHOR]

Aim: Childhood obesity continues to be a major health issue for children world-wide, with well-recognised major health effects. This study evaluated the prevalence of obesity in children presenting to secondary care in Southern New Zealand, as well as their clinical management.Methods: Obesity prevalence was determined by a review of data contained in the electronic anthropometry database in the region for the period 19 July 2010-16 July 2015. All clinical records were further examined using a standard data extraction form for 333 obese children regarding their clinical management.Results: A total of 8551 individuals were identified in the database for review. The prevalence of overweight and obesity was higher than the average national rates but stable over the 5-year period. Children of Maori and Pacific Island ethnicity, those most deprived and males were over-represented in terms of obesity. Of the 333 obese children whose clinical management was examined, 45.0% received a diagnosis of obesity. Of those diagnosed, 24.7% had further investigations related to possible obesity complications, and 72.7% were given management plans. Older females were more likely to receive clinical intervention, while Maori and Pacific Island children were less likely.Conclusions: Of the children seen in this secondary care setting, 40% are overweight or obese, and yet the rate of clinical intervention left room for improvement, suggesting a need for further staff education and clear guidelines. Maori and Pacific Island children have higher obesity burden but were less likely to receive clinical intervention. This may highlight a need for specific education regarding cultural practices. [ABSTRACT FROM AUTHOR]

Aim: The introduction of an electronic system for recording and displaying growth measurements replaces multiple paper growth charts and theoretically improves the availability and consistency of information to support clinical decision-making. Introducing this in a single New Zealand District Health Board provided the opportunity to evaluate usage in hospital settings and determine the uptake of growth recording in a defined population.Methods: All records between 2010 and 2015 in the Southern District Health Board (SDHB) anthropometry database were downloaded and examined in a retrospective cohort analysis. Records were extracted after matching to demographic and clinical setting data from the hospital patient management system.Results: Analysis included 30 670 data entry points, representing 8551 children. Data entry increased over time to a maximum of 8407 observations in 2015. By the fifth year of use, up to 67% of available clinical encounters had anthropometry recorded in the outpatient department. Rates were lower in the inpatient setting, where only up to 18.4% had anthropometry recorded. The errors identified were low (0.2% of all data). Weight was the most commonly recorded measurement (98.2% of anthropometry entries, 35.1% of available clinical presentations). Height was available for 82.6% of entries and 29.5% of presentations. A body mass index z-score was available for 81.5% of entries and 29.1% of presentations. A head circumference was available for 50.2% of children <2 years age who had anthropometry recorded.Conclusions: The introduction of an electronic anthropometry database has been successful with increasing rates of use over time, especially in outpatient clinics. Further focus to improve inpatient recording of height and weight is needed. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify the potential risks and benefits of sleeping infants in a Pēpi-Pod distributed to families with high risk of sudden unexpected death in infancy compared to a bassinet.Methods: Forty-five mostly indigenous Māori mothers who were referred by local health providers to receive a Pēpi-Pod were surveyed at recruitment, 1 and 3 months. A sleep study at 1 month included infrared video, oximetry and temperature measures.Results: When compared with 89 historical bassinet controls, an intention-to-treat analysis of questionnaires showed no increase in direct bed sharing but demonstrated significantly less sharing of the maternal bedroom at both interviews, with the majority of those not sleeping in the maternal bedroom, actually sleeping in the living room. The 1 month 'as-used' analysis showed poorer maternal sleep quality. The 'as-used' analysis of video data (24 Pēpi-Pod and 113 bassinet infants) also showed no increase in direct bed sharing, head covering or prone/side sleep position. Differences in oxygen saturation were not significant, but heart rate was higher in the Pēpi-Pod infants by 8.37 bpm (95% confidence interval 4.40, 12.14). Time in the thermal comfort zone was not different between groups despite Pēpi-Pod infants being situated in significantly warmer rooms.Conclusions: Overall, we found that most differences in infant risk behaviours in a Pēpi-Pod compared to a bassinet were small, with confidence intervals excluding meaningful differences. We noted poorer maternal sleep quality at 1 month. Higher infant heart rates in the Pēpi-Pod group may be related to higher room temperatures. The Pēpi-Pod appears physiologically safe but is associated with lower reported maternal sleep quality. [ABSTRACT FROM AUTHOR]

Aim To determine whether a single session of motivational interviewing ( MI) for feedback of a child's overweight status promotes engagement in treatment following screening. Methods One thousand ninety-three children aged 4-8 years were recruited through primary and secondary care to attend health screening, including assessment of parenting practices and motivation (questionnaire). Families with normal-weight children were informed about their child's weight but had no further involvement. Parents of overweight (body mass index ≥85th percentile) children ( n = 271) were randomised to receive weight feedback via MI or best practice care ( BPC) using a traffic light concept to indicate degree of health risk. Follow-up interviews were held 2 weeks later to examine intervention uptake, changes to motivation and behaviour, and parental response to feedback. Results Recruitment into the intervention was high (76%) and not altered by feedback condition (percentage difference 6.6 (95% confidence interval −2.9, 16.0). High scores on the Health Care Climate Questionnaire (rating of the interviewer) indicated satisfaction with how the information was provided to parents. No differences were observed in multiple indicators of harm. However, self-determined motivation for healthy life-styles was significantly higher in the MI condition at follow-up (0.18: 0.00, 0.35), after only a single session of MI. Conclusions MI and BPC were both successful in encouraging parents to participate in a family-based intervention, with MI offering little significant benefit over BPC. A traffic light approach to weight feedback is a suitable way of providing sensitive information to parents not expecting such news. [ABSTRACT FROM AUTHOR]

Aim: To compare the performance of pulse oximeters during movement and brachial artery occlusion. Methods: Three machines (MasimoSET, using MasimoSET LNOP Pdt paediatric sensor, Mars 2001 using Novametrix paediatric sensor no. 6455 and Nellcor 595 using Nellcor 595 Oximax-P paediatric sensor and Nellcor 595 MAX-FAST adhesive forehead reflectance sensor) were used simultaneously on the left hand and forehead. The subjects were 18 healthy children aged 6–10 years. Interventions were 20 sequential 90° body turns from mimicking normal movements while asleep followed by step increases in brachial artery occlusion. Mean heart rate (HR) from the four machines was compared with ECG HR. Haemoglobin O2 saturation was compared with a baseline saturation and the proportion of epochs with false (low) saturation values. Results: The mean difference from ECG HR was not clinically significantly different for any machine but the limits of agreement were such that the Mars Model 2001 and Nellcor 595 (forehead) could have clinically important differences from ECG-derived HR (−20.04–15.00 and −14.95–14.04, respectively). Only the Nellcor 595 with finger probe had limits of agreement within the a priori set value of 4%. The prevalence of epochs with an haemoglobin O2 saturation of greater than 4% below baseline values was lowest for the Nellcor 595 finger probe (1.59%) and highest for the Nellcor forehead probe (20.45%). During brachial artery occlusion, all machines performed well up to within 20 mmHg of total occlusion. Conclusion: Current motion-resistant pulse oximeters performed well but only the Nellcor 595 with finger probe achieved our a priori set standards. [ABSTRACT FROM AUTHOR]

Objectives: To develop and provide initial data to validate a contemporary measure of maternal perceptions of infant vulnerability. Methods: Questions that address current concerns of mothers regarding their young children (such as the risk of sudden infant death syndrome) were added to an existing Vulnerable Child Questionnaire. Questions not relevant to either current concerns or to young infants were removed. The modified questionnaire, along with standard measures of maternal anxiety and depressive symptoms, were administered to mothers of 39 healthy full-term babies, 17 mothers of ‘medically fragile’ babies and 19 mothers of jaundiced babies. Babies were approximately 12 weeks of age at the time of completion of the questionnaire. Results: Three questions were removed from the questionnaire on the basis of poor item-total correlations, leaving the final version with 10 questions, scored on 1–5 rating scales. Cronbach alpha for the revised scale was 0.7. There was a significant difference ( P = 0.002) in mean vulnerable baby scores between the control group and the ‘medically fragile’ group. There was a moderately strong correlation between vulnerable baby score and maternal state anxiety ( r = 0.6) and a weaker correlation with maternal depressive symptoms ( r = 0.3). Conclusions: The modified questionnaire has good internal consistency. The difference in mean scores between the three groups, and correlations with maternal anxiety and depressive symptoms, lend construct validity to the scale. The Vulnerable Baby Scale appears to be suitable for assessing maternal perceptions of the vulnerability of their young babies in clinical and research settings although further research, with larger samples, may be necessary to fully establish the scale's psychometric properties. [ABSTRACT FROM AUTHOR]