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Aims: Group B streptococcal (GBS) disease is the leading cause of early-onset neonatal sepsis in New Zealand. Disease follows vertical transmission of GBS from the mother, which can largely be prevented by intravenous intrapartum antibiotics. A 2004 New Zealand guideline recommended using clinical risk factors to identify mothers who would qualify for intrapartum antibiotics. An expert multidisciplinary group met to reconsider these guidelines in the light of a two year survey of the incidence of early onset GBS neonatal sepsis., Methods: Representatives from the New Zealand College of Midwives, the Fetus and Newborn Committee of the Paediatric Society of New Zealand, the Royal New Zealand College of General Practitioners, the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the New Zealand sub-Committee of the Australasian Society of Infectious Diseases, and the Canterbury Home Birth Association met to review the literature and the most recent New Zealand data., Results: The multidisciplinary group noted that the estimated incidence of early-onset GBS sepsis had halved over a 10-year period to be 0.26 per 1,000 live births in 2009-11 and that there were missed opportunities for preventing GBS infection. Consensus was reached that adoption of a national guideline on prevention and management of early onset GBS neonatal sepsis by all practitioners and District Health Boards would have the greatest potential to further reduce the incidence., Conclusion: A risk-based GBS prevention strategy continues to be recommended as being the most clinically and cost effective for the New Zealand context. Universal routine antenatal GBS screening is not recommended.

Aims: The incidence and prevalence of Type 1 diabetes is increasing internationally. There is, however, no current estimate of the prevalence of Type 1 diabetes in young New Zealanders. We therefore aimed to estimate prevalence in 0 to 24 year olds., Methods: The point prevalence of Type 1 diabetes was determined in a geographically defined area, namely the Canterbury District Health Board catchment area, by comparing data from multiple clinical and research sources. The New Zealand prevalence, stratified by age and ethnicity, was then estimated using 2001 population census data., Results: There were 353 people with diabetes aged 24 years and less, residing within the catchment area at the time of study. Of these 353 people, 330 had Type 1 diabetes, giving a prevalence of 227 per 100,000 children and young adults. The estimated number of New Zealanders with Type 1 diabetes in this defined age group, adjusted for ethnicity, was 2,540. An estimated 2,158 were of European descent., Conclusions: Although the prevalence of Type 1 diabetes is lower in non European New Zealanders compared to European New Zealanders, the changing demographics of children and youth in New Zealand means that there are increasing numbers of Maori, Asian, and Pacific peoples with Type 1 diabetes.

Aims: Early-onset neonatal group B streptococcus (GBS) is the leading infectious cause of disease in newborn babies. Since intrapartum antibiotics interrupt vertical GBS transmission, this is now a largely preventable public health problem. An important first step is to develop (then implement) nationally, agreed prevention policies., Methods: Representatives from the New Zealand College of Midwives, the Paediatric Society of New Zealand, the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal New Zealand College of General Practitioners, and the Homebirth Association met to review evidence that will assist in the formulation of GBS prevention policies that are most suitable for New Zealand., Results: The Technical Working Group noted that (i) no strategy will prevent all cases of early-onset GBS infection, (ii) intrapartum antibiotics are associated with rare, but serious, adverse effects, (iii) concerns remain over developing antibiotic resistance, (iv) an economic analysis is required to help inform policy, (iv) reliable bedside diagnostic tests for GBS in early labour are not yet available and (iv) the most important determinant of effectiveness will be compliance with a single national prevention policy., Conclusions: As an interim measure a GBS risk-based prevention strategy is recommended. This exposes the least numbers of women and their babies to antibiotics, while virtually preventing all deaths from GBS sepsis. Continuing education of health professionals and pregnant women, auditing protocol compliance, tracking adverse events amongst pregnant women, and national surveillance of neonatal sepsis and mortality rates and antibiotic resistance are necessary for the strategy's success.

Aim: To audit the identification and screening of graduates from a neonatal intensive care unit with risk factors for sensorineural hearing loss., Methods: Hospital medical records of newborn infants discharged from the neonatal intensive care unit, Christchurch Womens Hospital, between 1 July 1994 and 30 June 1995 (n=564), were examined to identify those at risk for sensorineural hearing loss according to the American Speech-Language Hearing Association risk criteria 1991. Auditory brainstem response test results were obtained from the Christchurch Hospital Audiology Department. Outcome measures were: presence of hearing loss risk factors, numbers tested with auditory brainstem response, age at test and presence and degree of hearing impairment., Results: Of 5,215 live births in Christchurch, 564 infants were discharged through the neonatal intensive care unit. Of these, 86 had risk factors for sensorineural hearing loss. There were 72 (84%) infants tested at audiology, with fifteen (17%) having abnormal test results. There were fourteen with risk factors who did not get audiology screening., Conclusion: A high proportion (84%) of high risk newborn infants had auditory brainstem response testing. Further improvement would require strict implementation of standard procedures. Auditory brainstem response screening is part of a wider population surveillance approach to identify hearing loss as early as possible.

Neonatal abstinence syndrome is seen commonly in infants born to women on methadone maintenance. Many of these infants are breast-fed but few data are available on the distribution of methadone in breast milk, particularly for women receiving doses greater than 60 mg daily. We report two infants who appeared to develop neonatal abstinence syndrome, after abrupt discontinuation of breast-feeding by women receiving 70 mg and 130 mg of methadone. Women on methadone maintenance on high doses should be counselled to wean breast-feeding gradually.

Aims: To audit the use of inhaled nitric oxide for the treatment of persistent pulmonary hypertension of the newborn in New Zealand neonatal intensive care units., Methods: Prospective data collection on all infants treated with inhaled nitric oxide in neonatal intensive care units in the 20-month period from first use to December 1995. Data included perinatal factors, principal diagnosis, echocardiogram results, ventilation details and response to nitric oxide, adverse reactions and outcome., Results: Twenty-eight infants received nitric oxide in three centres, all bar one being 36 weeks or more gestation. Overall survival was 68%. Thirteen infants (46%) responded to nitric oxide treatment, 12 (92%) surviving. Seven (47%) of non-responders survived. Infants with primary pulmonary hypertension or meconium aspiration syndrome had 90% survival and more often responded to nitric oxide than infants with congenital diaphragmatic hernia (40% survival) or pulmonary hypoplasia (no survivors). No serious complications of treatment were recorded., Conclusions: Inhalational nitric oxide was not universally successful treatment for pulmonary hypertension of the newborn but was likely to have been life-saving in a proportion of cases. Future studies may allow better case selection. Ongoing audit of this new treatment is warranted.

Aims: To determine the survival and disability rates at 7-8 years in infants of less than 28 weeks gestation born in New Zealand in 1986 and admitted to a neonatal unit., Methods: In 1986, all infants with birthweight less than 1500 g and admitted to neonatal units were enrolled in a prospective audit of retinopathy of prematurity. Surviving infants, including the subset born at less than 28 weeks gestation, have been assessed at a home visit. Parents completed a comprehensive questionnaire and children underwent a visual assessment and were tested on the Wechsler Intelligence Scale for Children., Results: Of 126 liveborn infants less than 28 weeks gestation, 80 (64%) survived to 7-8 years. Sixty eight children (97% survivors resident in New Zealand) were assessed: 72% had no, and 86% no or only mild disability, 77% had some visual problem, with close to one-third having myopia, strabismus or requiring spectacles and 32% received Ministry of Education funded special needs assistance., Conclusions: There have been few long-term follow-up studies of infants of less than 28 weeks gestation born in a defined geographical area. The outcome for New Zealand infants is comparable with that in other published data.

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.

Object: New Zealanders, because of a soil deficiency, have a low intake of selenium. To determine the impact of this on the infant population in Christchurch., Methods: we have measured red cell and plasma selenium and the selenoenzyme, glutathione peroxidase, in 70 infants less than 12 months old and related these to age and diet., Results: the infant population as a whole had mean plasma levels of selenium and glutathione peroxidase of 33 micrograms/L and 97 U/L compared with adult values of 74 micrograms/L and 150 U/L. Infant red cell levels of 0.30 mu g selenium and 9.0 U glutathione peroxidase per g haemoglobin were similar to those in adults. The selenium status of most breast fed infants after birth remained similar to that of cord blood. Mean plasma selenium and glutathione peroxidase levels in formula fed infants were about half those of breast fed infants, and their red cell selenium was also significantly lower. These did not increase until solids were introduced into the diet. The status of the infants reflected their diet, with the concentration of selenium in formulae being 3.9-5.2 micrograms/mL compared with a mean of 13.4 micrograms/mL in breast milk., Conclusions: since infants in more replete selenium areas show a gradual rise in blood selenium parameters after birth, this study suggests that formula fed and some breast fed infants in Christchurch receive an inadequate selenium intake. Consideration should be given to supplementing infant formulae and perhaps also the diet of pregnant and/or breast feeding mothers.

An eight-year-old girl with severe acquired aplastic anaemia received a bone marrow transplant from her 11-year-old brother. The bone marrow graft is firmly established, but the patient has mild chronic graft versus host disease affecting liver and skin. The indications for bone marrow transplantation in aplastic anaemia are discussed.

Following the Sheldon report (UK 1971) the proportion of newborn infants admitted to neonatal units in England and Wales rose to 20% of live births. Admission policies in Christchurch have followed Sheldon's recommendations and by 1981, 37% of all infants born in Christchurch Women's Hospital were admitted to the neonatal unit. Admission criteria were reviewed in 1982 with the result that most infants with a birth weight greater than 2.5 kg are no longer admitted to the unit. In addition an intermediate nursery was opened to admit healthy but low birth weight (1.8 to 2.5 kg) infants together with their mothers. In 1983 only 9.7% of inborn infants were admitted to the neonatal unit. Data relating to the operation of the intermediate nursery are presented.

Ten point three percent of infants of birthweight less than 2000 g developed an inguinal hernia within one to three years of birth. This figure rose to 18.9% in those who were under 1500 g at birth. The high requirement for surgical repair and the rising survival figures for very low birthweight infants stresses the increasing numbers at risk from postoperative apnoea and bradycardia. The need for respiratory and cardiac monitoring following anaesthesia in low birthweight infants is emphasised.

Details on transportation of all infants with a birthweight less than 1500 g born in 1986 have been recorded. Of 413 liveborn infants, 182 (42.3%) were involved in 256 transportations. Sixty-eight infants (16.5%) were transported from home or from a lesser to a more sophisticated neonatal unit within 48 hours of birth for neonatal intensive care. Twenty-five infants (6.1%), comprising 12 in utero (9 mothers) and 13 liveborn infants were transported out of their region because of a lack of intensive care spaces locally: 17 of these infants, including five born in National Women's Hospital, were Auckland and Northland infants (this representing 15% of regional very low birthweight infants). Hamilton received 12 infants from outside their region (14% of very low birthweight infants cared for). One hundred and fifty-three infants (45.1% of 339 surviving infants) were transported from one of the five regional neonatal intensive care centres to a smaller centre nearer home following recovery from intensive care. Most neonatal transportation is highly appropriate transfer within regions enabling scarce skills and resources to be concentrated in the regional centre and allowing infants to return nearer home when they are no longer sick. The number of very low birthweight infants coming to neonatal intensive care units increased dramatically in the decade prior to 1986 despite a fall in total New Zealand births. Now that the total births are increasing again the pressure on neonatal intensive care spaces is likely to increase further.

From January 1979 to December 1983, 178 infants with birthweight 501-1500 g were admitted to the neonatal unit at Christchurch Women's Hospital. One hundred and twenty-nine (72.5%) survived to discharge from the unit. Six infants died post discharge by 12 months of age. Fifty-six percent of surviving infants for whom records were available were admitted to hospital in the first year of life. Thirty infants could not be traced for follow-up. Ninety-three infants were assessed for functional abnormalities utilising medical records, neurological examination and developmental assessment. Thirteen infants (14%) had handicap: 7 (7.5%) with mild or moderate and 6 (6.5%) with major dysfunction. It is essential that neonatologists know the long term outcome for their neonatal intensive care practices and provision must be made for comprehensive follow-up of surviving very low birthweight infants.