Auckland Children Research Articles

The power of place in play: A Bourdieusian analysis of Auckland children's seasonal play practices. Christina R.Ergler. Transcript Independent Academic Publishing, 2020. 404 pp. ISBN: 978‐308376‐3671‐0

The power of place in play: A Bourdieusian analysis of Auckland children's seasonal play practices. Christina R.Ergler. Transcript Independent Academic Publishing, 2020. 404 pp. <scp>ISBN</scp>: 978‐308376‐3671‐0

Microbiology of septic arthritis in young Auckland children.

Kingella kingae is an important cause of septic arthritis in young children, with modern laboratory methods leading to increased detection. Prevalence of this pathogen in New Zealand, where there are high rates of childhood infections due to Staphylococcus aureus and Streptococcus pyogenes, is not known. We conducted a retrospective review of children <5 years with septic arthritis (without osteomyelitis) at a tertiary children's hospital in Auckland, over 10 years (2005-2014). Data were collected on demographics, microbiology, clinical presentation, investigations and management. Of the 68 cases of septic arthritis, 57 (83.8%) occurred in children aged <24 months. Among those <3 months, Streptococcus agalactiae (Group B streptococcus) was predominant (45.5% of 11 cases), followed by S. aureus (36.4%). The most common pathogen in those 3 to <12 months was Streptococcus pneumoniae (38.5% of 13 cases). In children aged 12 to <24 months, K. kingae was most common (30.3% of 33 cases). Of the 12 cases of K. kingae, 91.7% were identified from synovial fluid culture. All K. kingae isolates were susceptible to amoxicillin. K. kingae is the leading pathogen in septic arthritis in New Zealand children aged 12 to <24 months. Routine inoculation of synovial fluid into blood culture bottles at time of sample collection, in addition to use of polymerase chain reaction methods, should be encouraged to improve detection rates. For infants and preschool children presenting with single joint septic arthritis, empiric antibiotics should include cover for S. aureus and K. kingae.

Community-acquired invasive Staphylococcus aureus: Uncovering disparities and the burden of disease in Auckland children.

Staphylococcus aureus (SA) causes serious invasive disease in children. Large studies have measured the incidence of SA bacteraemia, but there is less information on the total burden of community-acquired invasive SA (iSA) in children. A retrospective, cross-sectional analysis of Auckland resident children aged 0-14 years who were hospitalised with iSA between 2011 and 2015 was performed. Laboratory databases and SA-related international classification of diseases 10 discharge codes were searched to identify community-onset cases with SA isolated from a normally sterile site. Clinical records and coroner's reports were reviewed to determine clinical syndromes and exclude nosocomial infections. A total of 295 children with iSA were identified. The average annual incidence of iSA was 18.6 per 100 000 - for Pacific populations 44.3 per 100 000, Māori 24.3 per 100 000 and New Zealand European and other 8.8 per 100 000; 68% had bacteraemia. The incidence of iSA for Pacific infants was 10 times greater than non-Māori/non-Pacific (113.4/100 000 population vs. 11.8/100 000). Multivariate analysis found a higher risk of admission in Pacific children, males and those living in areas of high deprivation. Thirty-two patients (10.8%) were admitted to the intensive care unit; risk was higher in infants, Pacific children and those with respiratory infection (Relative Risk (RR) 12.2, 95% confidence interval (CI) 5.7-26.4) and multifocal (RR 6.9, 95% CI 3.4-13.8) and endovascular disease (RR 8.9, 95% CI 3.9-20.6). All deaths (n = 7) had respiratory infections, and four were patients <1 year of age. Studies investigating SA bacteraemia alone significantly underestimate the total burden of iSA disease. There are marked ethnic and socio-economic disparities in iSA disease among Auckland children. Pacific infants are at the highest risk.

Scabies is strongly associated with acute rheumatic fever in a cohort study of Auckland children.

This study sought to determine whether scabies infection is associated with acute rheumatic fever (ARF) or chronic rheumatic heart disease (CRHD). A cohort study was undertaken using health records of children aged 3-12 years attending an oral health service for the first time. Subjects were then linked to hospital diagnoses of scabies and ARF or CRHD. A total of 213 957 children free of rheumatic heart disease at baseline were available for analysis. During a mean follow-up time of 5.1 years, 440 children were diagnosed with ARF or CRHD in hospital records. Children diagnosed with scabies during follow-up were 23 times more likely to develop ARF or CRHD, compared with children who had no scabies diagnosis. After adjustment for confounders in a Cox model, the association reduced but remained strong (adjusted hazard ratio: 8.98; 95% confidence interval: 6.33-20.2). In an analysis restricted to children hospitalised at least once during follow-up, the adjusted hazard ratio for the same comparison was 3.43 (95% confidence interval: 1.85-6.37). A recent diagnosis of scabies from hospital records is strongly associated with a subsequent diagnosis of ARF. Further investigation of the role that scabies infestation may play in the aetiology of ARF is warranted.

The Microbiology of Septic Arthritis in Young Auckland Children

The Microbiology of Septic Arthritis in Young Auckland Children

Emergency weight estimation lookup tables for New Zealand children aged 5-10years.

To derive novel emergency weight estimation tables for New Zealand children aged 5-10years using ethnicity and sex to increase accuracy and precision. Using an existing dataset (collected in five New Zealand primary schools during July 2013; n=376), body mass index and current emergency weight estimates were calculated. Stepwise regression with Akanke Information produced two best-fit models for predicting weight, one based on age and the other on height. Potential explanatory variables included ethnicity, sex and body habitus. The length-based model included height, ethnicity and body habitus. Accuracy (weight estimates within 10% of actual weight) for the length-based lookup table (74.8%) was similar to that for the Broselow-Luten tape (73.4%). The age-based model included age, sex, ethnicity and body habitus. Accuracy (51.3%) for the age-based lookup table was better than for existing formulae including Shann (45.7%), Advanced Paediatric Life Support (39.1%) and Theron (28.7%). The most accurate method for weight estimation in Auckland children aged 5-10years is either the novel length-based lookup table or the existing Broselow-Luten tape. When length-based methods are not possible, the age-based lookup tables incorporating age, sex, ethnicity and body habitus are more accurate than existing methods of weight estimation.

High unchanged incidence of diabetic ketoacidosis between 2000 and 2009 in Auckland children

Methods Data from Auckland children with newly diagnosed T1DM between 1 January 2000 and 31 December 2009 were collected from Starbase, the Starship Children’s Hospital diabetes database. T1DM was confirmed by the presence of glutamic acid decarboxylase and/or tyrosime phosphatise-like protein (IA2) antibodies. DKA was defined by international criteria as venous or capillary pH and bicarbonate as mild DKA with pH <7.30 and bicarbonate <15 mmol/l, moderate DKA pH <7.20 and bicarbonate <10 mmol/l and severe DKA ph <7.10 and bicarbonate <5 mmol/l.

Increasing Incidence and Sociodemographic Variation in Community-onset Staphylococcus Aureus Skin and Soft Tissue Infections in New Zealand Children

We analyzed all cases of community-onset Staphylococcus aureus skin and soft tissue infection in children presenting to our hospital between 2007 and 2010. A total of 1860 children were included. There was significant sociodemographic disparity, with the incidence disproportionately higher in Maori and Pacific Island children residing in deprived areas.

Changes in young children’s OHRQoL after dental treatment under general anaesthesia

To use the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and Family Impact Scale (FIS) to determine whether dental treatment of young Auckland children under general anaesthesia (GA) improved oral-health-related quality of life (OHRQoL) for them and their families. A pretest/post-test design, with a consecutive clinical sample of parents/caregivers of children (10 years or younger) treated under GA. More than half of the children were Māori or Pacific Islanders. Of the 157 children in the baseline sample, 144 (91.7%) were followed up. The overall P-CPQ score showed a large decrease following treatment, along with an increase in the number scoring 0 (no impact). Similar relative changes were observed in the oral symptoms and emotional well-being subscales, whereas the other two subscales showed moderate decreases. All post-treatment FIS scores were lower than pre-treatment ones; all showed moderate effect sizes. The greatest relative changes were seen in the parental/family activity and parental emotions subscales. The dental treatment of young children under GA is associated with considerable improvement in their OHRQoL. The P-CPQ and the FIS are valid and responsive to treatment-associated changes in young children with early childhood caries (ECC).

Vitamin D and tonsil disease – Preliminary observations

Objective To estimate the prevalence of 25(OH) vitamin D deficiency in children undergoing (adeno)tonsillectomy. Methods From 1st November 2008 to 20th December 2008, 33 children aged from 4 to 16 and resident in Auckland, New Zealand (latitude 36° 52′ S) undergoing (adeno)tonsillectomy for difficulty breathing/sleep apnoea and/or recurrent tonsillitis had 25(OH) vitamin D, iron and zinc levels measured. Results Of the 32 patients who had 25(OH) vitamin D levels measured, 15.6% were vitamin D deficient (25(OH) vitamin D < 50 nmol/L), and 78% had levels, <75 nmol/L. 25(OH) vitamin D level was inversely correlated with Fitzpatrick skin type (Spearman's rho = −0.713, p < 0.01), body mass index (BMI) (Spearman's rho = −0.434, p = 0.013) and tonsil size (Spearman's rho = −0.417, p = 0.017). However regression modeling demonstrated that only Fitzpatrick skin type ( β = −0.687, p = 0.001) and BMI ( β = −0.256, p = 0.044) were significant predictors of vitamin D levels ( R 2 = 0.572). Conclusions Seventy-eight percent of Auckland children undergoing (adeno)tonsillectomy had a 25(OH) vitamin D level < 75 nmol/L, a level which is associated with an increased incidence of upper respiratory tract infection. Low 25(OH) vitamin D levels were related to a darker skin, increased BMI and larger assessed tonsil size. The association of larger tonsil size with lower 25(OH) vitamin D status needs further evaluation but offers a potential explanation why black and Hispanic children are more likely than white children to have (adeno)tonsillectomy for snoring or obstructive sleep apnoea.

Effects of Weather on Pedometer-Determined Physical Activity in Children

The effects of weather conditions on children's physical activity have not been well described. To evaluate the effects of meteorological variables on the number of pedometer steps accumulated by children. Between August and December 2004 (winter to summer), 1115 Auckland children (536 boys, 579 girls; aged 5-12 yr) from 27 socioeconomically and ethnically diverse schools wore sealed multiday memory pedometers for five consecutive days (three weekdays and two weekend days). Values of daily (7 a.m. to 7 p.m.) mean ambient temperature, mean wind speed, precipitation, and duration of bright sunshine were obtained from local meteorological stations. The independent effects of each of these variables on step counts were estimated using composite mixed linear models. Effects were standardized for interpretation of magnitudes. Weekday and weekend-day step counts for boys were 16,100 +/- 5000 and 12,900+/- 5900 (mean +/- SD), whereas those for girls were 14,200 +/- 4200 and 11,300 +/- 4800. A 10 degrees C rise in mean ambient temperature was associated with a small increase in weekday steps [1700; 90% confidence intervals (CI) +/-1300] and a moderate increase in weekend-day steps (3400; 90% CI +/-1500) for boys, whereas for girls the effects were small (2300; 90% CI +/-1000) and unclear (-300; 90% CI +/-1200), respectively. There were substantial decreases in weekday and weekend-day steps during moderate rainfall (1.1-4.9 mm) for both sexes. Most effects of day length, wind speed, and hours of bright sunshine on step counts were trivial or unclear. Ambient temperature and rainfall have substantial effects on children's daily step counts and should therefore be considered when comparing physical activity across different locations or periods. Strategies to increase activity on cold or rainy days may also be appropriate.

Children at risk of giardiasis in Auckland: a case-control analysis.

The incidence rate of giardiasis in New Zealand is one of the highest among developed countries, peaking in the 1-4 year age group. A case-control study was undertaken to identify risk factors for giardiasis among Auckland children under 5 years of age. The exposure history of 69 cases and 98 controls were analysed. Ninety-five per cent cases and 86% controls used water from the Auckland Metropolitan mains (AMM) supply for domestic purpose, 44 cases and 42 controls swam and 59 cases and 54 controls wore nappies. Children wearing nappies were at significantly increased risk of the disease (OR = 30, 95% CI = 1.01-8.9), as were those from households which had more than one child wearing a nappy (6.5, 1.8-23.4). The Auckland metropolitan mains water supply was associated with a reduced risk compared to other drinking water sources. Significantly increased risks were also associated with drinking water consumed away from home (4.7, 2.2-10.1), swimming at least once a week (2.4, 1.1-5.3) and travelling domestically (2.5, 1.03-6.0). The study identified vulnerable groups and modifiable risk factors for diarrhoeal diseases, particularly Giardia infection. Nappy wearing was an independent risk factor for infection. Further study is advocated to ensure better protection of public health, especially for children.

Asthma and allergy: a worldwide problem of meanings and management?

Asthma and allergy: a worldwide problem of meanings and management?

Household crowding a major risk factor for epidemic meningococcal disease in Auckland children.

New Zealand is in its ninth year of a serogroup B meningococcal disease epidemic with annual rates of up to 16.9 cases per 100,000. The highest incidence is in Maori and Pacific Island children in the Auckland region. We conducted a case-control study to identify potentially modifiable risk factors for this disease. A case-control study of 202 cases of confirmed and probable meningococcal disease in Auckland children younger than 8 years of age recruited from May, 1997, to March, 1999, was undertaken. Controls (313) were recruited door-to-door by a cluster sampling method based on starting points randomly distributed in the Auckland region. They were frequency matched with the expected distribution of age and ethnicity in the meningococcal disease cases. With the use of a multivariate model and controlling for age, ethnicity, season and socioeconomic factors, risk of disease was strongly associated with overcrowding as measured by the number of adolescent and adult (10 years or older) household members per room [odds ratio (OR), 10.7; 95% confidence interval (CI), 3.9 to 29.5]. This would result in a doubling of risk with the addition of 2 adolescents or adults to a 6-room house. Risk of disease was also associated with analgesic use by the child, which was thought to be a marker of recent illness (OR 2.4, CI 1.5 to 4.0); number of days at substantial social gatherings (10 or more people for > 4 h; OR 1.8, CI 1.2 to 2.6); number of smokers in the household (OR 1.4, CI 1.0 to 1.8); sharing an item of food, drink or a pacifier (OR 1.6, CI 1.0 to 2.7); and preceding symptoms of a respiratory infection (cough, "cold or flu," runny nose, sneezing) in a household member (OR 1.5, CI 1.0 to 2.5). Some of these identified risk factors for meningococcal disease are modifiable. Measures to reduce overcrowding could have a marked effect on reducing the incidence of this disease in Auckland children.

Hospitalization for pneumonia in children in Auckland, New Zealand.

To describe the epidemiology of hospitalizations for pneumonia in children in Auckland, New Zealand. A consecutive sample of children hospitalised with pneumonia at the Starship Childrens Hospital from 1 July 1993 to 30 June 1996. Subjects were Pacific Island, Maori, and European/other children aged 0-14 years resident in north, west and central Auckland who were hospitalized with pneumonia. Comparisons were made of the number of hospitalisations by year, ethnicity, age and season; and of the hospitalisation rates by year, ethnicity and age. There were 681 children who were hospitalized with pneumonia during 1993-94, 731 during 1994-95 and 630 during 1995-96. The average annual hospitalization rate was 5.0 per 1000 children aged 0-14 years (95% CI 4.8-5.2). The average annual hospitalisation rate for Pacific Island children was 14.0 per 1000 (95% CI 13.0-14.9), for Maori children 6.7 per 1000 (95% CI 6.0-7.4) and for European/other children was 2.7 per 1000 (95% CI 2.6-2.9). Fifty-three per cent of the hospitalised children were less than 2 years of age. A larger percentage of Pacific Island (61%) and Maori (60%) children were aged less than 2 years compared to European/other (42%) children (P < 0.001). There was marked seasonal variability in the number of hospitalizations, with peaks in hospitalizations corresponding to peaks in positive respiratory viral isolates. Pneumonia was a consistent cause of hospitalisation for a large number of Auckland children during this 3-year period. Hospitalisation rates and age distribution varied with ethnicity. Hospitalization rates were highest for Pacific Island. intermediate for Maori and lowest for European/other children. Based on these hospitalisation data, pneumonia is a significant cause of morbidity for children in Auckland, New Zealand.

Are babies with gastroschisis small for gestational age?

A large proportion of babies with gastroschisis (GS) have low birth weights. It is not clear, however, whether only certain subgroups or the whole population of babies with GS have low birth weights. The aim of this study was to ascertain if the birth weights of babies with GS are significantly lower than those of the general population and to determine if the birth weights of babies with GS from two different populations were significantly different. From 1969 to 1995, 44 babies with GS were treated at Auckland Children's Hospital, New Zealand. From 1980 to 1993, 69 babies were treated at Birmingham Children's Hospital, England. For each group, the mean birth weight relative to the mean birth weight for gestation (WtStdev) was significantly different from zero (Auckland = -0.806, Birmingham = -0.762, P < 0.001, one-sample analysis). The mean WtStdev scores from each centre were not significantly different from each other. Our data demonstrate that the birth weights of babies with GS are significantly lower than those of the general population and are similar in different populations. These findings support the notion that a normally functioning intestinal tract is essential for normal fetal growth.

Sclerosing osteosarcoma of the great toe phalanx in an 11‐year‐old girl

HistopathologyVolume 26, Issue 3 p. 281-284 Sclerosing osteosarcoma of the great toe phalanx in an 11-year-old girl Y.F. CHAN, Corresponding Author Y.F. CHAN Histopathology Laboratory, Auckland Children's Hospital, Auckland, New ZealandAddress for correspondence: Dr Y.F. Chan, Histopathology Laboratory, Auckland Children's Hospital, Auckland, New Zealand.Search for more papers by this authorH. LLEWELLYN, H. LLEWELLYN Histopathology Laboratory, Auckland Children's Hospital, Auckland, New ZealandSearch for more papers by this author Y.F. CHAN, Corresponding Author Y.F. CHAN Histopathology Laboratory, Auckland Children's Hospital, Auckland, New ZealandAddress for correspondence: Dr Y.F. Chan, Histopathology Laboratory, Auckland Children's Hospital, Auckland, New Zealand.Search for more papers by this authorH. LLEWELLYN, H. LLEWELLYN Histopathology Laboratory, Auckland Children's Hospital, Auckland, New ZealandSearch for more papers by this author First published: March 1995 https://doi.org/10.1111/j.1365-2559.1995.tb01445.xCitations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume26, Issue3March 1995Pages 281-284 RelatedInformation

Acute rheumatic fever in Auckland, New Zealand

Annual specific rates for acute rheumatic fever (ARF) in Auckland children less than 15 years were 22/100,000 for the years 1980 to 1984. From 1984 to 1992 the rates remained relatively constant with an average of 45 (range, 30 to 70) children annually admitted with ARF to the Auckland Children's Hospital. This study examined retrospectively Group A streptococci identified from hospitalized pediatric patients during these 9 years. The total of 2410 isolates included 32 isolates from well-documented cases of ARF and an additional 6 from siblings of cases. Results of M typing indicated that streptococci associated with ARF are generally different from those described overseas and involved types which cause more skin than throat infections in the community.

Ethnic differences in prevalence of asthma symptoms and bronchial hyperresponsiveness in New Zealand schoolchildren.

Maoris and Pacific Islanders in New Zealand have a higher asthma mortality and hospital admission rates than Europeans. To determine whether difference in asthma prevalence is the major factor underlying these differences in mortality, 2053 Auckland children aged 7-10 years (European 1084, Maori 509, Pacific Islander 460) were randomly sampled from school classes in the Auckland Urban Area, and studied by questionnaire (completed by parents) and histamine inhalation challenge to assess the provocative dose of histamine causing a 20% fall in FEV1 (PD20). Maoris had the highest prevalence rates of respiratory symptoms, and Europeans had rates similar to Pacific Islanders. For "any current wheeze" for example, the prevalence in Maoris was 22.2% compared with 16.1% and 16.3% in the Europeans and Pacific Islanders. The prevalence of diagnosed asthma was similar in the three groups. When bronchial hyperresponsiveness (defined as a PD20 less than or equal to 7.8 mumol histamine) was considered, Europeans had the highest rates (20%), followed by Maoris (13%), and then Pacific Islanders (8.7%). These differences were not accounted for by differences in socioeconomic status, rates of smoking in the home, age, gender, or height. It is concluded that differences in asthma prevalence do not satisfactorily explain the mortality and admission rate differences, although the higher symptom prevalence in the Maoris could be relevant to the higher mortality rate. Maori and Pacific Island children with symptoms of asthma were less likely to be taking prophylactic medication than European children. It is proposed that differences in management are important factors relevant to the increased mortality and morbidity from asthma in Polynesians.

Evaluation of progress using the context input process and product model

Most evaluations of programme effectiveness are based on process data (the data generated by the programme) and used for internal monitoring and service development. Context (the ecology of therapeutic systems), input (the identification of what is in fact different between two therapeutic systems) and product (the consequence of different inputs, taking account of context) evaluations are rarely, if ever, produced. In this paper (using input and product evaluations) the progress of twelve Down's syndrome and twelve multiply-handicapped children attending, over a period of 18 months, two different therapeutic systems operated by the New Zealand Society for the Intellectually Handicapped (Auckland Branch/outside Auckland Branches) is assessed. The progress of the Auckland children is significantly better in a number of areas than for those outside Auckland. This improvement in progress can be attributed to input differences that reflect the Auckland Branch's policy of service development. The most important determinants of a successful programme are not staff/student ratios, time in class or specialist assistance, all of which favour the outside Auckland groups, but the degree of structure, detail of programmes and assessments, and quality of parent contact in which Auckland seems superior. The results for the Down's syndrome group compare favourably with those from other Down's syndrome programmes.