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Aim: To establish how clinicians in New Zealand (NZ) approach screening for and management of coeliac disease (CD) in type 1 diabetes mellitus (T1DM) in their paediatric patients., Methods: All clinicians caring for children under 15 years with T1DM in NZ in 2010 were asked to complete an online survey detailing their personal and departmental approach to diagnosing and managing patients with CD and T1DM., Results: Thirty-four from 37 clinicians responded to the survey. Most clinicians in NZ have a protocol for screening for CD in T1DM, and 25/34 respondents will screen for CD at diagnosis of T1DM. Those who do not screen will use symptoms, growth and hypoglycaemia as indicators to test. All use anti-tissue transglutaminase to screen for CD, and 32/34 use biopsy-proven CD as a criterion for commencing gluten-free diet (GFD). Nearly all consultants will still advise a GFD in symptom-free CD and will try to encourage the patients to adopt a GFD if they initially decline., Conclusions: Most clinicians in NZ screen for CD, but there is a wide variation in practice., (© 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Background: Knemometry has been used to accurately measure linear growth in both neonates and children over the last 20 years. It has been used principally as a research tool., Aim: To investigate whether serial measurement of lower leg length (LLL) by knemometry is a useful addition to other measures of growth in the neonatal unit., Methods: A 1-year prospective hospital-based cohort study from 2004 to 2005. Knemometry was performed every 3-4 days from the time of consent to time of discharge. Infants were grouped by gestation at birth for analysis (<28 weeks, 28-31 weeks, 32-36 weeks and >36 weeks gestation). The main outcome assessed was longitudinal growth. Subgroup analyses were performed on infants <10th percentile for weight, surgical infants and infants who had received antenatal steroids., Results: LLL measured by knemometry correlated well with postmenstrual age (r = 0.93) and weight (r = 0.93). The mean (SD) increase in LLL was 0.45 (0.7) mm/day., Conclusion: Change in LLL correlates well with change in weight and postmenstrual age in the neonatal period but adds little extra information to routine practice in the neonatal unit.

Objective: To determine in New Zealand infants the attack rates, risk factors, preventive policies, strain serotype and antibiotic susceptibilities of early-onset neonatal group B streptococcus (GBS) infection., Method: A 2-year prospective active surveillance study was conducted in New Zealand's 19 neonatal units. Cases had to present within 48 h of delivery, be unwell, possess abnormal haematological indices and have GBS isolated from sterile sites., Results: Of the 112 402 infants born in New Zealand during 1998-1999, 56 had early-onset GBS infection, an attack rate of 0.5 per 1000 live births (95% confidence interval [CI] 0.38, 0.65). Seven had meningitis and there was one death (case fatality rate of 1.8%; upper 95% CI 9.5%). Univariate analysis identified young maternal age, parity, preterm labour, prolonged membrane rupture, maternal fever and assisted delivery as risk factors. Preventive policies for GBS were reported by 14 (74%) obstetric centres associated with neonatal units. Of the 56 cases, five (9%) were born to mothers receiving intrapartum antibiotics, 32 (57%) had mothers with risk factors but were not treated with antibiotics, and 19 (34%) were born to mothers without identifiable risk factors for GBS prevention. Serotypes Ia and III predominated, while two isolates were resistant to erythromycin and/or clindamycin., Conclusions: Rates of early-onset GBS infection are similar to other countries following the introduction of prevention policies. Further reductions are possible with full implementation of these guidelines. Meanwhile, emergence of antibiotic resistance complicates the management of women with penicillin allergy. Vaccine development therefore remains a priority.

Objective: To determine whether regional differences in early neonatal morbidity in a national cohort of very low-birthweight (VLBW) infants persisted at 7-8 years of age., Methods: Perinatal data collected prospectively from birth on all VLBW infants born in New Zealand in 1986 and admitted to a neonatal unit included the hospital principally caring for the infant: hospitals A-D being level III hospitals and 'Other' including the smallest level III and all level II hospitals. At 7-8 years of age, 298 surviving children (96% survivors living in New Zealand) were assessed at a home visit. Parents were given a comprehensive questionnaire to complete, the children underwent a visual examination and were tested with the Revised Wechsler Intelligence Scale for Children and the child's teacher was sent a questionnaire to complete., Results: Neonatal survival was significantly greater in the two largest hospitals (A and B) and this difference in survival remained at 7-8 years of age after adjustment for perinatal factors (P < 0.05). There were no differences between hospitals in risks of long-term sensorineural disability and behavioural or educational outcomes. There were interhospital differences in rates of visual problems and, after adjustment for confounding factors, there remained a marginally significant (P = 0.06) increased risk of myopia in hospital D., Conclusions: Despite differences in early morbidity favouring larger hospitals, there were no substantive differences in long-term (7-8 years) outcomes across a range of measures in this national cohort of VLBW infants.

Objective: To determine the survival and sensorineural outcome at 7-8 years in very low birthweight (VLBW) infants born in New Zealand in 1986., Methodology: In 1986 all VLBW New Zealand infants admitted to neonatal units were enrolled in a prospective study of acute retinopathy of prematurity. Surviving infants were traced and were assessed at a home visit. Parents were asked a comprehensive questionnaire, and children underwent a visual assessment including photorefraction and were tested with the Revised Wechsler Intelligence Scale for Children (WISC-R)., Results: Four hundred and thirteen VLBW infants were admitted to neonatal units in 1986, 338 (81.8%) surviving to discharge, 12 children died after discharge, 17 were traced to overseas, seven declined to participate and four were untraced, leaving 298 (96% survivors resident in New Zealand) who were assessed at a mean age of 7.6 (+/- 0.4 years, 15 children (5.0%) had severe disability, 14 (4.7%) moderate disability, and 46 (15.4%) mild disability. Blindness (vision worse than 6/60) occurred in eight children (2.7%), deafness requiring aids in four (1.3%), any form of cerebral palsy in 17 (5.7%), and an JQ score on the WISC-R > 1 SD below the mean in 62 (20.8%). There was no significant difference in outcome for children with birthweight < 1000 g and 1000-1499 g., Conclusions: Long-term (7-8 year) survival and disability rates in this national cohort of VLBW infants is comparable with that reported from other populations. Although a majority of children have no disability a sizeable proportion do perform poorly on the WISC-R. This may relate in part to problems such as a short attention span and poor visual-motor integration.

Objective: New Zealand soils are deficient in the essential micronutrient, selenium. New Zealand infants have low selenium levels at birth and experience a further decline if fed cows milk based formula. This study examined the selenium status of infants fed with a new commercially available selenium supplemented formula., Methodology: Forty-four newborn infants, whose mothers wished to formula feed, were randomized in an open controlled trial to be fed a commercially available selenium supplemented cows milk formula (containing 17 micrograms Se/L) or an unsupplemented formula (containing 4.6 micrograms Se/L). Cord, 1 and 3 month blood samples were obtained for selenium status (plasma and red cell selenium and glutathione peroxidase) and thyroid function., Results: Mean plasma selenium and glutathione peroxidase values were significantly higher in supplemented than unsupplemented infants at 1 month (unpaired t-tests; P < 0.0001 and P = 0.001 respectively) and 3 months (P < 0.0001 and P = 0.0005). Analysis within treatment groups between time points (paired t-tests) showed that selenium supplementation prevented the fall in plasma selenium from birth to 1 month seen in unsupplemented infants and was associated with a rise in levels between 1 and 3 months (P = 0.002)., Conclusions: Supplementing cows milk formula with selenium to replicate the levels found in breast milk is nutritionally sound. Feeding from a few days of age with a formula containing 17 micrograms Se/L in infants with low selenium status at birth is sufficient to cause a rise to 80% of adult levels at 3 months of age.