Australian Infants Research Articles

Microcephaly in Australian infants: A retrospective audit.

To describe clinical characteristics, outcomes and causes of microcephaly in children whose condition was identified within the first year of life. Retrospective review of medical records of microcephalic children born between 2008 and 2018 and admitted for any reason during the same period to a tertiary paediatric hospital. Microcephaly was defined as occipitofrontal circumference (OFC) more than two standard deviations below the mean (>-2 SD). Between January 2008 and September 2018, 1083 medical records were retrieved. Of the children, 886 were ineligible and 197 were confirmed cases of microcephaly. Of cases, 73 (37%) had primary microcephaly (at birth) and 72 (37%) had severe microcephaly (OFC > -3 SD). Of microcephalic children, 192 (98%) had congenital anomalies, of whom 93% had major anomalies, mostly cardiovascular or musculoskeletal. Neurological signs or symptoms were reported in 148 (75%), seizures being the most common. Of the 139 children with abnormal central nervous system (CNS) imaging, one or more structural brain abnormalities were identified in 124 (89%). Failure to reach developmental milestones was observed in 69%, visual impairment in 41% and cerebral palsy in 13%. Microcephaly was idiopathic in 51% and 24% had diagnosed genetic disorders. There was no association between developmental outcomes or structural brain anomalies and severity of microcephaly or timing of diagnosis. Our results suggest the need for a systematic investigative approach to diagnosis, including a careful history, examination, genetic testing and neuroimaging, to determine the underlying cause of microcephaly, identify co-morbidities, predict prognosis and guide genetic counselling and therapy.

A better start to life: Risk factors for, and prevention of, preterm birth in Australian First Nations women - A narrative review.

The unacceptable discrepancies in health outcomes between First Nations and non-Indigenous Australians begin at birth. Preterm birth (birth before 37 completed weeks of gestation) is a major contributor to adverse short- and long-term health outcomes and mortality. Australian First Nations infants are more commonly born too early. No tangible reductions in preterm births have been made in First Nations communities. Factors contributing to high preterm birth rates in Australian First Nations infants are reviewed and interventions to reduce preterm birth in Australian First Nations women are discussed. More must be done to ensure Australian First Nations infants get a better start to life. This can only be achieved with ongoing and improved research in partnership with Australian First Nations peoples.

Dietary intake of Indigenous Australian infants and young children in the Gomeroi gaaynggal cohort.

AimThe nutritional quality of foods consumed by infants and young children to complement breastfeeding or formula feeding influences growth and development. The aim of this study was to identify the dietary intake of Indigenous infants and young children in the Gomeroi gaaynggal cohort, and evaluate the nutritional adequacy of their intake compared with Australian recommendations.MethodsDietary intake was assessed using diet recalls at approximately 9‐, 12‐ and 24‐month visits. Nutrient values of foods were obtained from AUSNUT 2011‐13 and nutrient intake compared to the Australian Nutrient Reference Values. Foods were categorised into food groups and intakes compared to the Australian Guide to Healthy Eating.ResultsA total of 206 infants and young children were included in the study. Of these, 95 individual children had dietary data collected between 7.6 and 24.7 months. Infant formula and breastfeeding rates were highest among infants (70% and 20%, respectively). Cow's milk intake was highest among young children (75%).Infants and young children in the cohort met most macro‐ and micronutrient intake recommendations. Few young children met recommendation for iron (42%), no infant met recommendation for omega‐3 fatty acids and almost all exceeded recommendation for sodium. Most young children met daily dairy and fruit recommendations although intake of discretionary foods was high.ConclusionsThis study found that diets of Indigenous infants and young children met most key nutrient reference targets. Potential target areas that require dietary optimisation have been identified and will be the focus of community‐led strategies in adequate infant nutrition promotion.

Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial.

BackgroundDespite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding.ObjectiveThe objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes.MethodsThe study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support.ResultsA total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers.ConclusionsThis study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695International Registered Report Identifier (IRRID)RR2-10.1186/s12884-015-0601-5

Maternal and Cord Blood 25-Hydroxyvitamin D3 Are Associated with Increased Cord Blood and Naive and Activated Regulatory T Cells: The Barwon Infant Study.

Vitamin D has shown immune-modulatory effects but mostly in in vitro and animal studies. Regulatory T cells (Treg) are important for a balanced immune system. The relationship between vitamin D on the number of circulating neonatal Treg is unclear. We sought to investigate the association between maternal and neonatal vitamin D metabolites and cord blood (CB) Treg subsets. In a cohort of Australian infants (n = 1074), recruited using an unselected antenatal sampling frame, 158 mother-infant pairs had data on the following: 1) 25-hydroxyvitamin D3 (25(OH)D3) measures in both maternal peripheral blood (28- to 32-wk gestation) and infant CB; 2) proportions (percentage of CD4+ T cells) of CB Treg subsets (CD4+CD45RA+ FOXP3low naive Treg, and CD4+CD45RA- FOXP3high activated Treg [aTreg]); and 3) possible confounders, including maternal personal UV radiation. Multiple regression analyses were used. The median 25(OH)D3 was 85.4 and 50.7 nmol/l for maternal and CB samples, respectively. Higher maternal 25(OH)D3 levels were associated with increased CB naive Treg (relative adjusted mean difference [AMD] per 25 nmol/l increase: 5%; 95% confidence interval [CI]: 1-9%), and aTreg (AMD per 25 nmol/l increase: 17%; 95% CI: 6-28%). Furthermore, a positive association between CB 25(OH)D3 levels and CB aTreg (AMD per 25 nmol/l increase: 29%; 95% CI: 13-48%) was also evident. These results persisted after adjustment for other factors such as maternal personal UV radiation and season of birth. 25(OH)D3, may play a role in the adaptive neonatal immune system via induction of FOXP3+ Tregs. Further studies of immune priming actions of antenatal 25(OH)D3 are warranted.

Mycobacterium ulcerans-specific immune response after immunisation with bacillus Calmette-Guérin (BCG) vaccine

BackgroundBacillus Calmette–Guérin (BCG) vaccine provides partial protection against Buruli ulcer caused by Mycobacterium ulcerans in epidemiological studies. This study aimed to quantify M. ulcerans-specific immune responses induced by BCG immunisation. MethodsIntracellular cytokine analysis of in-vitro experiments done 10 weeks after BCG immunisation in 130 Australian infants randomised to one of three BCG vaccine strains given either at birth (BCG-Denmark, BCG-Japan, or BCG-Russia) or at two months of age (BCG-Denmark). ResultsProportions of polyfunctional CD4+ T-cells were higher in M. ulcerans-stimulated compared to unstimulated control samples. These proportions were not influenced by the vaccine strain or timing of the immunisation. The M. ulcerans-specific immune responses showed similar patterns to those observed in M. tuberculosis-stimulated samples, although they were of lower magnitude. ConclusionsOur data show that BCG immunisation induces M. ulcerans-specific immune responses in infants, likely explaining the cross-protective effect observed in epidemiological studies. (ACTRN12608000227392)

Longitudinal egg-specific regulatory T- and B-cell development: Insights from primary prevention clinical trials examining the timing of egg introduction.

Egg allergy affects almost 1 in 10 Australian infants. Early egg introduction has been associated with a reduced risk in developing egg allergy; however, the immune mechanisms underlying this protection remain unclear. To examine the role of regulatory immune cells in tolerance induction during early egg introduction. Cryopreserved peripheral blood mononuclear cells (PBMC) were obtained from infants from 2 randomized controlled trials of early introduction of egg for the primary prevention of egg allergy; BEAT (at 12months, n=42) and STEP (at 5months n=82; 12months n=82) study cohorts. In vitro ovalbumin-stimulated PBMC were analyzed by flow cytometry for presence of ovalbumin-specific regulatory T cells, using activation markers, FoxP3, and IL-10 expression. Ovalbumin-specific regulatory B cells were identified by co-expression of fluorescence-conjugated ovalbumin and IL-10. Specific, age-dependent expansion of ovalbumin-specific regulatory T cells was only observed in infants who (a) had early egg introduction and (b) did not have egg allergy at 12months. This expansion was blunted or impaired in children who did not undergo early egg introduction and in those with clinical egg allergy at 12months. Infants with egg allergy at 12months of age also had reduced frequency of ovalbumin-specific regulatory B cells compared to egg-tolerant infants. Early egg introduction and clinical tolerance to egg were associated with expansion of ovalbumin-specific T and B regulatory cells, which may be an important developmental process for tolerance acquisition to food allergens.

"How about We Give It a Go?": A Case Study on Supporting Breastfeeding Families in an Australian Child Care Centre.

The World Health Organization (WHO) recommends exclusive breastfeeding for six months and continuation of breastfeeding for up to two years. Formal child care has an important role in supporting breastfeeding, as many Australian infants commence care before two years of age. Currently, little is known about support or barriers in child care contexts. The present qualitative instrumental case study explores practices which protect, promote and support breastfeeding at a child care centre located in the Australian Capital Territory’s outer suburbs. Extending from a previously published collective case study, a cultural-institutional focus of analysis was used to explore the roles of proximity, flexibility and communication in supporting breastfeeding within a child care centre located close to an infant’s home. Interviews with centre staff and mothers, triangulated with observations of the centre environment and policy documents provide insight into the environment. Affirming the roles of flexibility in routine and staff rostering and two-way communication, findings suggest longer-term benefits may be derived from selecting a child care centre close to an infant’s home, provided mothers can overcome barriers to breastmilk expression in the workplace. The study recognises the role of non-lactating caregivers in the transition to formal child care, and of the support culture for educators who breastfeed. This study extends the knowledge base of breastfeeding support interventions in the child care setting to inform future research and policy.

Anthropometry-based prediction of body fat in infants from birth to 6 months: the Baby-bod study.

Prediction equations generated from anthropometric measures are frequently used to quantify paediatric body composition. We tested the agreeability and predictive power of select (Lingwood and Aris) fat mass prediction equations against body fat measured via ADP; and generated and evaluated new anthropometry-based models for use in the first 6 months of life. Data were obtained from 278 white European Australian infants at birth, 3 and 6 months. Prediction models (i.e. Baby-bod models) were generated for each time point via stepwise linear regression and compared for agreeability with ADP via limits of agreement, mean difference and total bias in Bland-Altman analyses. Predictive power of all equations in comparison to ADP were assessed using linear regression analysis. Overall, there was poor agreeability between percent body fat predicted via published equations and ADP. Proportional bias was detected for both methods (i.e. published equations and Baby-bod models) of body fat prediction. At birth, both Lingwood and BB0 equations overestimated percent body fat at the lower end of the FM spectrum. This trend was repeated at 3 months with all equations displaying a propensity to overestimate body fat at lower FM levels and underestimate at higher FM levels. The results indicate that anthropometry, although less costly and relatively easier to implement, does not always produce comparable results with objective measures such as ADP. Given the importance of the accurate assessment of physical growth, including body composition in early life, it is timely to recommend the increased utilisation of techniques such as ADP.

Hearing loss among Australian Aboriginal infants and toddlers: A systematic review

AimAustralian Aboriginal and Torres Strait Islander children have among the highest rates of otitis media (OM) and associated conductive hearing loss in the world. OM begins early in life and is well-documented in the research literature. In contrast, audiology data for the infant and toddler age-groups are limited. This review aimed to summarise the recent literature on hearing loss among Aboriginal and Torres Strait Islander infants and toddlers. MethodsSystematic literature review. PubMed and ScienceDirect databases were searched for relevant journal articles. Key search terms were “Aboriginal”, “children”, “hearing loss”, “otitis media”, and their relevant synonyms. Journal articles published before 2000 were excluded. ResultsOnly two journal articles met review inclusion criteria. Ear disease and associated conductive hearing loss was significantly higher among Aboriginal and Torres Strait Islander than non-Aboriginal and Torres Strait Islander children. No intervention studies were found. ConclusionsMore research is needed to evaluate hearing health outcomes of medical (including surgical) and audiological interventions in this high-risk population.

Burden of infection in Australian infants.

To determine the incidence, risk factors and health service utilisation for infection in the first 12 months of life in a population-derived Australian pre-birth cohort. The Barwon Infant Study is a population-derived pre-birth cohort with antenatal recruitment (n = 1074) based in Geelong, Victoria, Australia. Infection data were collected by parent report, and general practitioner and hospital records at 1, 3, 6, 9 and 12 months of age. We calculated the incidence of infection, attendance at a health service with infection and used multiple negative binomial regression to investigate the effects of a range of exposures on incidence of infection. In the first 12 months of life, infections of the upper and lower respiratory tract (henceforth 'respiratory infections'), conjunctivitis and gastroenteritis occurred at a rate of 0.35, 0.04 and 0.04 episodes per child-month, respectively. A total of 482 (72.4%) infants attended a general practitioner with an infection and 69 (10.4%) infants attended the emergency department. Maternal antibiotic exposure in pregnancy and having older siblings were associated with respiratory infection. Childcare attendance by 12 months of age was associated with respiratory infections and gastroenteritis. Breastfeeding, even if less than 4 weeks in total, was associated with reduced respiratory infection. Infection, especially of the respiratory tract, is a common cause of morbidity in Australian infants. Several potentially modifiable risk factors were identified, particularly for respiratory infections. Most infections were managed by general practitioners and 1 in 10 infants attended an emergency department with infection in the first year of life.

Latent class analysis to identify clinical profiles among indigenous infants with bronchiolitis.

Better phenotyping of the heterogenous bronchiolitis syndrome may lead to targeted future interventions. This study aims to identify severe bronchiolitis profiles among hospitalized Australian Indigenous infants, a population at risk of bronchiectasis, using latent class analysis (LCA). We included prospectively collected clinical, viral, and nasopharyngeal bacteria data from 164 Indigenous infants hospitalized with bronchiolitis from our previous studies. We undertook multiple correspondence analysis (MCA) followed by LCA. The best-fitting model for LCA was based on adjusted Bayesian information criteria and entropy R2 . We identified five clinical profiles. Profile-A's (23.8% of cohort) phenotype was previous preterm (90.7%), low birth-weight (89.2%) and weight-for-length z-score <-1 (82.7% from combining those with z-score between -1 and -2 and those in the z-score of <-2 group) previous respiratory hospitalization (39.6%) and bronchiectasis on chest high-resolution computed tomography scan (35.4%). Profile-B (25.3%) was characterized by the oxygen requirement (100%) and marked accessory muscle use (45.5%). Infants in profile-C (7.0%) had the most severe disease, with oxygen requirement and bronchiectasis in 100%, moderate accessory muscle use (85% vs 0%-51.4%) and bacteria detected (93.1% vs 56.7%-72.0%). Profile-D (11.6%) was dominated by rhinovirus (49.4%), mild accessory muscle use (73.8%), and weight-for-length z-score <-2 (36.0%). Profile-E (32.2%) included bronchiectasis (13.8%), RSV (44.0%), rhinovirus (26.3%) and any bacteria (72%). Using LCA in Indigenous infants with severe bronchiolitis, we identified five clinical profiles with one distinct profile for bronchiectasis. LCA can characterize distinct phenotypes for severe bronchiolitis and infants at risk for future bronchiectasis, which may inform future targeted interventions.

The ORVAC trial: a phase IV, double-blind, randomised, placebo-controlled clinical trial of a third scheduled dose of Rotarix rotavirus vaccine in Australian Indigenous infants to improve protection against gastroenteritis: a statistical analysis plan

ObjectiveThe purpose of this double-blind, randomised, placebo-controlled, adaptive design trial with frequent interim analyses is to determine if Australian Indigenous children, who receive an additional (third) dose of human rotavirus vaccine (Rotarix, GlaxoSmithKline) for children aged 6 to < 12 months, would improve protection against clinically significant all-cause gastroenteritis.ParticipantsUp to 1000 Australian Aboriginal and Torres Strait Islander (hereafter Indigenous) infants aged 6 to < 12 months will be recruited from all regions of the Northern Territory.InterventionsThe intervention is the addition of a third scheduled dose of human monovalent rotavirus vaccine.Co-primary and secondary outcome measuresORVAC has two co-primary outcomes: (1) anti-rotavirus IgA seroconversion, defined as serum anti-rotavirus IgA ≥ 20 U/ml 28 to 55 days post Rotarix/placebo, and (2) time from randomisation to medical attendance for which the primary reason for presentation is acute gastroenteritis or acute diarrhoea illness before age 36 months. Secondary outcomes include (1) change in anti-rotavirus IgA log titre, (2) time from randomisation to hospitalisation with primary admission code presumed or confirmed acute diarrhoea illness before age 36 months, (3) time from randomisation to hospitalisation for which the admission is rotavirus confirmed diarrhoea illness before age 36 months and (4) time from randomisation to rotavirus infection (not necessarily requiring hospitalisation) meeting the jurisdictional definition before age 36 months.DiscussionA detailed, prospective statistical analysis plan is presented for this Bayesian adaptive design. The plan was written by the trial statistician and details the study design, pre-specified adaptative elements, decision thresholds, statistical methods and the simulations used to evaluate the operating characteristics of the trial. As at August 2020, four interim analyses have been run, but no stopping rules have been triggered. Application of this SAP will minimise bias and supports transparent and reproducible research.Trial registrationClinicaltrials.gov NCT02941107. Registered on 21 October 2016Original protocol for the studyhttps://doi.org/10.1136/bmjopen-2019-032549

Low allergen content of commercial baby foods.

Introduction of allergenic solid foods, especially peanut and hen's egg reduces the risk of food allergy development in early childhood. Ideally, parents will offer their infants home-prepared foods; however, many rely on the availability of convenient ready to purchase infant foods. This audit aimed to assess the major food allergen content of commercial infant foods. Infant foods available for sale in 2019 in Australia were the focus of this audit. The major food allergens investigated were peanut, tree nuts, hen's egg, cows milk, wheat, fish, shellfish, soy, sesame and lupin. Websites of infant food manufacturers and major supermarkets were used to identify ingredient lists of infant foods available for purchase. Where ingredients listings were unavailable this information was sourced directly from the product labels in the supermarket. Fourteen companies were identified, manufacturing over 251 foods specifically for the infants aged less than 1 year of age. Although there were many choices available containing wheat (27 products) and cows milk proteins (73 products), none contained peanut, tree nuts, sesame, shellfish or lupin. Despite infant feeding advice encouraging early introduction to food allergens, of 251 commercial baby foods surveyed only 1% contained egg and none contained peanut, the most common food allergies in young Australian infants. This low food allergen content may be disadvantageous for infants fed mostly commercial infant foods as they are unlikely to be exposed to sufficient amounts of the major food allergens on a regular basis during infancy.

Respiratory, birth and health economic measures for use with Indigenous Australian infants in a research trial: a modified Delphi with an Indigenous panel

BackgroundThere is significant disparity between the respiratory health of Indigenous and non-Indigenous Australian infants. There is no culturally accepted measure to collect respiratory health outcomes in Indigenous infants. The aim of this study was to gain end user and expert consensus on the most relevant and acceptable respiratory and birth measures for Indigenous infants at birth, between birth and 6 months, and at 6 months of age follow-up for use in a research trial.MethodsA three round modified Delphi process was conducted from February 2018 to April 2019. Eight Indigenous panel members, and 18 Indigenous women participated. Items reached consensus if 7/8 (≥80%) panel members indicated the item was ‘very essential’. Qualitative responses by Indigenous women and the panel were used to modify the 6 months of age surveys.ResultsIn total, 15 items for birth, 48 items from 1 to 6 months, and five potential questionnaires for use at 6 months of age were considered. Of those, 15 measures for birth were accepted, i.e., gestational age, birth weight, Neonatal Intensive Care Unit (NICU) admissions, length, head circumference, sex, Apgar score, substance use, cord blood gas values, labour, birth type, health of the mother, number people living in the home, education of mother and place of residence. Seventeen measures from 1-to 6 months of age were accepted, i.e., acute respiratory symptoms (7), general health items (2), health care utilisation (6), exposure to tobacco smoke (1), and breastfeeding status (1). Three questionnaires for use at 6 months of age were accepted, i.e., a shortened 33-item respiratory questionnaire, a clinical history survey and a developmental questionnaire.ConclusionsIn a modified Delphi process with an Indigenous panel, measures and items were proposed for use to assess respiratory, birth and health economic outcomes in Indigenous Australian infants between birth and 6 months of age. This initial step can be used to develop a set of relevant and acceptable measures to report respiratory illness and birth outcomes in community based Indigenous infants.

Parainfluenza Virus Infection in an Australian Community-based Birth Cohort.

In a community-based birth cohort of 158 Australian infants followed to age 2 years, the incidence rate of human parainfluenza virus (HPIV) was 0.42 (95% CI = 0.33, 0.54) episodes per child-year with episodes occurring year-round, peaking in the spring season. HPIV-3 was the dominant subtype. Overall, 41% of detections were asymptomatic; only 32% of HPIV episodes led to healthcare contact with 1 hospitalization.

10-Valent pneumococcal non-typeable H. influenzae protein D conjugate vaccine (PHiD-CV10) versus 13-valent pneumococcal conjugate vaccine (PCV13) as a booster dose to broaden and strengthen protection from otitis media (PREVIX_BOOST) in Australian Aboriginal children: study protocol for a randomised controlled trial

IntroductionStreptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are major otitis media pathogens that densely co-colonise the nasopharynx and infect the middle ear of Australian Aboriginal infants from very early in...

Temporal mapping of the closure of the anterior fontanelle and contiguous sutures using computed tomography, in silico models of modern infants.

The aim of this study is to quantify and statistically model the age-related decline in the fibrous connective tissue interface of the anterior fontanelle in modern Australian infants, using three-dimensional, semi-automated computed-assisted design protocols. Non-linear regression with variance models, using power functions, combined with quantile regression of the 5th and 95th population percentiles, were utilised to assess absolute anterior fontanelle surface area (AFSA) as a function of age, using multi-slice cranial computed tomography scans obtained from 256 infants aged <30months (males: n=126, females: n=109) from Brisbane children's hospitals. Normalised AFSA (NFSA), standardised for variation in cephalic size, followed a progressive decline from birth, the greatest velocity change occurring between the 3-6 and 6-9 month cohorts. Growth of the neurocranium is the most significant within the first 8months postpartum, with a mean increase of 19.03mm in maximum cranial length and 10.04mm in breadth. Directionality of fontanelle closure, quantified using spline curves refutes fundamental assumptions that the anterior fontanelle is consistent with a quadrilateral, and contiguous sutures exhibit constant velocity of closure. The present study provides normative values for fontanelle size and diameters as well as new predictive non-linear models for age substantiation, screening of developmental abnormalities and indicators of suspected child maltreatment in modern infants aged birth to 30months.

A randomised controlled trial of SMS messaging and calendar reminders to improve vaccination timeliness in infants

BackgroundThe effectiveness of SMS reminders in improving vaccination coverage has been assessed previously, with effectiveness varying between settings. However, there are very few studies on their effect on the timeliness of vaccination. DesignUnblinded, randomised controlled trial with blocked sampling. Methods1594 Australian infants and young children were recruited to assess the impact of (1) SMS reminders only, (2) a personalised calendar, (3) SMS reminder and personalised calendar and (4) no intervention, on receipt of vaccine within 30 days of the due date. Outcomes were measured for receipt of vaccines due at 2, 4, 6, 12 and 18 months of age. A post-hoc assessment was also conducted of the impact of a new national “No jab No Pay” policy introduced during the trial, which removed philosophical objections as an exemption for financial penalties for non-vaccination. ResultsThere was a statistically significant improvement in on-time vaccination only at the 12 month schedule point amongst infants who received SMS reminders alone (RR 1.09, 95% CI 1.01–1.18) or in combination with a personalised calendar (1.11, CI 1.03–1.20) compared to controls. This impact was limited to participants who had received one or more previous doses late. No statistically significant impacts of calendar interventions alone were seen. There was a high rate of on-time compliance amongst control participants − 95%, 86%, 80%, 74% at the 4, 6, 12 and 18 month schedule points respectively, which increased more than 10 percentage points after implementation of the “No Jab, No Pay” policy. ConclusionsSMS reminders are more effective in improving timeliness where pre-existing compliance is lower, but the 18 month schedule point appeared to be less amenable to intervention. Australia and New Zealand Clinical Trial Registration No. ACTRN12614000970640.

Determinants for early introduction of complementary foods in Australian infants: findings from the HSHK birth cohort study

ObjectiveThe purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids.MethodsMother-infant dyads (n = 1035) were recruited into the “Healthy Smiles Healthy Kids” study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks.ResultsThe median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14–0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33–4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child’s first birthday (OR = 0.54, CI95 0.30–0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21–0.84 and OR = 0.30, CI95 0.12–0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49–3.66).ConclusionsWomen who are younger, single mothers, those not working by the time of child’s first birthday, those born in Australia, and those who exclusively formula-feed their babies at 4 weeks postpartum should be targeted for health promotion programs that aim to delay the introduction of solids in infants to the recommended time.