New Zealand Children Research Articles

Harmonized Tubular Maximum Phosphate Reabsorption per Glomerular Filtration Rate (TmP/GFR) reporting in adults and children in Australia and New Zealand

Abstract Tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/GFR) is a key diagnostic test for renal phosphate wasting. However, there is a lack of international consensus regarding the reporting of age-related reference intervals. The TmP/GFR Harmonization Working Group, formed by The Australasian Association for Clinical Biochemistry and Laboratory Medicine and The Australian and New Zealand Bone and Mineral Society, aimed to evaluate analytical differences amongst commercial creatinine and phosphate assays, harmonize age-specific cut-offs and compare the ANZBMS TmP/GFR online calculator with existing products. A total of 11 360 results from The Royal College of Pathologists of Australasia Quality Assurance Programs were analyzed to assess creatinine and phosphate assay performance amongst five In Vitro Diagnostic (IVD) companies. Ortho-Clinical Diagnostics analyzers had a positive bias of up to 32% for serum phosphate and up to 29% for TmP/GFR. The other IVD companies produced comparable results and are suitable for harmonized reference intervals. To date, the AACB-ANZBMS TmP/GFR online calculator is the only validated Isotope Dilution Mass Spectrometry-creatinine aligned tool which caters for both pediatric and adult individuals, providing automatic interpretive comments to aid clinicians managing patients with hypophosphatemia.

Benchmarking nanopore sequencing and rapid genomics feasibility: validation at a quaternary hospital in New Zealand

Approximately 200 critically ill infants and children in New Zealand are in high-dependency care, many suspected of having genetic conditions, requiring scalable genomic testing. We adopted an acute care genomics protocol from an accredited laboratory and established a clinical pipeline using Oxford Nanopore Technologies PromethION 2 solo system and Fabric GEM™ software. Benchmarking of the pipeline was performed using Global Alliance for Genomics and Health benchmarking tools and Genome in a Bottle samples (HG002-HG007). Evaluation of single nucleotide variants resulted in a precision and recall of 0.997 and 0.992, respectively. Small indel identification approached a precision of 0.922 and recall of 0.838. Large genomic variations from Coriell Copy Number Variation Reference Panel 1 were reliably detected with ~2 M long reads. Finally, we present results obtained from fourteen trio samples, ten of which were processed in parallel with a clinically accredited short-read rapid genomic testing pipeline (Newborn Genomics Programme; NCT06081075; 2023-10-12).

Portable X-ray fluorescence of zinc and selenium with nail clippings-Mother and Infant Nutrition Investigation (MINI).

Zinc and selenium are essential minerals for human nutrition. Reliable biomarkers of zinc status and selenium status in humans are therefore important. This work investigates a novel portable X-ray fluorescence (XRF) method with the ability to rapidly assess zinc and selenium in nail clippings. This approach used a mono-energetic X-ray beam to excite characteristic X-rays from the clippings. Nail clippings were obtained from the Mother and Infant Nutrition Investigation (MINI), a study designed to assess nutrition in a population of women and their breastfed children in New Zealand. Twenty mother-infant pairings were selected to provide nail clippings at two time points (visit 1 at 3 months postpartum; visit 2 at 6 months postpartum). Nail clippings from each mother-infant pairing were divided into three groupings of clippings prior to analysis: those obtained from a big toe of the mother, those from the other toes of the mother, and those from the toes and fingers of the infant. Clippings were prepared and mounted prior to XRF measurement, providing four distinct fragments from each clipping grouping. These fragments were assessed by XRF using a measurement time of either 300 s (visit 1) or 180 s (visit 2). XRF results were determined through both an automated system output and an analysis of the X-ray energy spectrum. Following this assessment of zinc and selenium with the non-destructive XRF method, clippings were measured for zinc and selenium concentration using a "gold standard" technique of inductively coupled plasma mass spectrometry (ICP-MS). Mean ICP-MS concentrations ranged from 122 μg/g to 127 μg/g for zinc, and from 0.646 μg/g to 0.659 μg/g for selenium. Precision, assessed by a relative standard deviation of measurement, was superior for ICP-MS relative to XRF. For both zinc and selenium, XRF results were compared with ICP-MS concentrations. Linear equations of best fit were determined for each comparison between XRF and ICP-MS results. Coefficients of determination (r2) were stronger for zinc (from 0.74 to 0.95) than selenium (from 0.53 to 0.70). A decrease in XRF measurement time from 300 s to 180 s did not appear to adversely affect the correlation between XRF and ICP-MS results. Using the mono-energetic portable XRF method, the correlation of XRF zinc results with ICP-MS zinc concentrations was improved over previous findings, and selenium measurement was reported for the first time. The method may prove useful for future applications to trace element analysis using nail clippings as a biomarker.

HHI: How housing intervention programmes are improving health outcomes for children in New Zealand

ObjectivesIt is estimated that around 30,000 New Zealand (NZ) children are hospitalised each year for preventable conditions related to poor-quality housing. To combat the high levels of housing-related illness in NZ, the Healthy Homes Initiative (HHI) was established. The HHI is a government-funded, multicomponent housing intervention programme operating with the aim of reducing the incidence of housing-related illness in children. The objective of this study was to evaluate the impact of the HHI programme on health outcomes of participating families. ApproachThe Integrated Data Infrastructure (IDI) is a database of linked microdata maintained by Statistics NZ. Deidentified HHI referral data were linked to the IDI, and we used government administrative data to explore the impact of the HHI on health outcomes. ResultsThe HHI dataset linked to the IDI provided referral information for over 21,000 participants of the programme. Characteristics of the cohort included a higher proportion of participants who identified as Māori or Pacific Islander and lower socio-economic status than the general NZ population. Odds ratios were calculated for all variables in the model and showed lower odds of hospitalisation associated with participation in the HHI programme. ConclusionThis study demonstrates how housing-intervention programmes can improve health outcomes for those at risk of illness related to housing. These programmes are imperative for addressing the burden of disease and significant health inequities driven by exposure to substandard housing in NZ. This study shows how data linkage methods and administrative data can be used to evaluate large-scale government housing programmes.

Childhood eczema prevalence in New Zealand using topical corticosteroid dispensing data.

To determine the prevalence of eczema among children in New Zealand. Population-based retrospective observational study utilising national pharmaceutical dispensing records for topical corticosteroids and emollients for all New Zealand children aged 0-14 years from 1st January 2006 to 31st December 2019. Data are reported using descriptive statistics, with comparisons between ethnicities and socioeconomic quintiles undertaken with rate ratios. Based on dispensing data, the prevalence of eczema for New Zealand children aged 0-14 years in 2018 was 14.0% (95% CI 14.0%-14.1%), with prevalence decreasing in older age groups (children aged <1 year 26.0% (25.6%-26.4%); children aged 10-14 years 8.8% (8.7%-8.9%)). Prevalence was higher in Pacific children (23.6% (23.3%-24.0%)), but slightly lower in Māori children (13.2% (13.0%-13.3%)). Eczema is a common condition affecting a considerable proportion of children in New Zealand. This study provides nationwide paediatric prevalence data for New Zealand, and highlights the increased burden of eczema in Pacific children. Inequity in dispensing of topical corticosteroids is postulated to explain the reduced rates found for Māori children compared to previous studies. These results support the need for further research to determine factors contributing to differing eczema prevalence rates in New Zealand.

Facilitators of Success for Teacher Professional Development in Literacy Teaching Using a Micro-Credential Model of Delivery

Teachers play a critical role in supporting the early literacy development of students; however, keeping up with evidence-based practice while performing a busy teaching role can be challenging. Micro-credentials are one potential route for keeping teachers up to date with the best practices for literacy teaching due to their ability to provide targeted and flexible professional development opportunities. The current study used a mixed-methods design to evaluate two micro-credential courses being offered through the Better Start Literacy Approach. The Better Start Literacy Approach (BSLA) is an evidence-based, structured literacy approach, targeted at 5–7-year-old children in New Zealand. An online survey was used to collect qualitative and quantitative data from 263 teachers and literacy specialists regarding their experience of completing the BSLA micro-credential training. Overall, respondents reported positive experiences, describing how the micro-credential changed their teaching practice, built their knowledge of effective literacy instruction and led to measurable progress in students’ literacy skills. Several design features were highlighted as useful, including the ability to revisit videos and resources multiple times, the organization into modules and the ‘24/7’ nature of access. Findings from the current research demonstrate the importance of utilizing key course design decisions to ensure accessibility and the potential for the positive impact of micro-credentials in the education sector.

Manifold child, family and social variables are associated with injury among New Zealand preschool children

AimApproaches to understanding child injury tend to focus on short-term proximal influences. Previous analyses have found higher rates of injury among Māori and Pacific children in Aotearoa New Zealand (NZ)....

Ocular Chloramphenicol Exposure in Early Childhood in Aotearoa/New Zealand

Background: The paediatric use of ophthalmic chloramphenicol in New Zealand (NZ) is relatively high; however, little more is known about its utilisation, including whether this is equitable. This study aimed to describe chloramphenicol utilisation in NZ children aged five years and under, by patient ethnicity, socioeconomic deprivation, and urban/non-urban domicile. Methods: This analysis included every publicly subsidised chloramphenicol dispensing received from birth to five years of age, for every child born in NZ in 2013. Cumulative proportion of first exposure, dispensing rate per person-year, and seasonality of dispensing were quantified. These were calculated following stratification by ethnicity, socioeconomic deprivation quintile, and urban/non-urban health district. For cumulative proportion of first exposure, odds ratios (OR) were calculated and multivariate logistic regression was performed. For dispensing rate, incidence rate ratios (IRR) were calculated and zero-inflated Poisson regression was performed. Results: Almost one-quarter of NZ children received their first dispensing within the first year of life. By five years of age, 55.2% of children had received their first dispensing. By five years of age, children of Pacific ethnicity, those in the highest deprivation quintile, and in those non-urban health districts had lower odds of receiving chloramphenicol (adjusted OR 0.90, 0.79, and 0.81, respectively, all p &lt; 0.001). In contrast, children of Māori ethnicity had higher odds (adjusted OR 1.99, p &lt; 0.001). Māori and Pacific ethnicity, and residence in non-urban health districts, were associated with fewer dispensings (adjusted IRR 0.88, 0.75 and 0.87, all p &lt; 0.001). In contrast, deprivation quintile was not significantly associated with dispensing rate. Conclusion: Chloramphenicol utilisation is prevalent among NZ children, and utilisation may be lower among children of Pacific ethnicity and those in non-urban areas

Association between Paediatric Complementary and Alternative Medicine Use and Parental Health Literacy, Child Health, and Socio-Economic Variables: A Prospective Study.

Complementary and Alternative Medicines (CAMs) constitute products and practices not considered allopathic medicine. CAM use is high in children, but little is known about factors that may influence parents using CAM with their child. This study aimed to determine the variables associated with CAM use in children with a prospective study among children and their parents attending a tertiary care hospital in New Zealand (NZ). Outcomes included current CAM use, parental opinions on CAM, parental health literacy and child well-being. This study was completed by 130 parents (85% female), and the mean child age was 6.7 years. CAM use was reported for 59 (45%) children, the most common being oral supplements and body manipulation. Children were more likely to use CAM if their parent had higher health literacy (p = 0.001), and if they had previously attended the emergency department within 12 months (p = 0.03). There was no association between child well-being and CAM use. Parental opinion of using CAM only if a doctor recommended it was associated with CAM use for their child (p = 0.01). Only 40% of parents disclosed their child's CAM use to the medical team. This study highlights that parental health literacy influences the use of CAM for children in NZ, providing insight for translational research to improve CAM safety and disclosure rates in NZ.

Critical appraisal of Australian and New Zealand paediatric vision screening clinical practice guidelines using the AGREE II tool

ABSTRACT Clinical Relevance Vision disorders in children impact health-related quality of life, with early detection and intervention improving outcomes and educational performance. Eye health professionals should be aware of paediatric vision screening guidelines and their development to understand the components of local programmes and the differences in sensitivity and specificity between protocols. Background High-quality clinical practice guidelines (CPGs) for vision screening enable the early detection of common vision disorders; however, they require rigorous development to ensure optimal accuracy in detecting vision disorders, enabling timely interventions. This study evaluated the quality of available vision screening CPGs on vision screening of children in Australia and New Zealand. Methods A systematic search of academic databases, guideline databases, professional associations and Google search engines was conducted to identify relevant paediatric vision screening CPGs. Four independent reviewers used the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument to assess the quality of individual guidelines and scores were aggregated and reported as the percentage of the total possible score across the six AGREE II domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. Results Initial 2,999 items were evaluated, with seven guidelines included. AGREE-II quality score agreement ranged from 43.3% to 95.8%. All guidelines scored >60.0% in the scope and purpose, however, most had poor scores of <26.5% in the rigour of development and <3.3% in editorial independence domains. All guidelines recommended screening using measures of habitual distance vision. Conclusion Of the guidelines developed for use in Australia and New Zealand, most guidelines scored poorly when assessed against the AGREE II tool, because of lack of editorial independence and rigour of development. Paediatric vision screening guidelines should prioritise systematic review of literature to inform practice and include statements regarding competing interests.

Children's speech, language and communication skills and parental knowledge in the growing up in New Zealand cohort.

There is a substantial discrepancy between international and local prevalence rates for speech, language and communication needs (SLCN) amongst children in New Zealand. Reports of communication impairment are likely to be underestimates. Prevalence data can describe population characteristics and inform the scope and nature of services to adequately meet demand. Parents and other caregivers are central to the early identification of children with communication needs but they may not recognise their child's needs or act on their concerns. Cross-sectional data were available for the Growing Up in New Zealand (GUiNZ) longitudinal study cohort at 24, 54 and 72 months of age, with 76% of whānau (families; n = 5241) completing three data waves. Descriptive and chi-square analyses were used to address: (1) What are the communication abilities of children in the first 5 years of life? (2) What do New Zealand parents understand of their children's communication? (3) Do New Zealand parents have concerns? (4) What are the trajectories of parental concern for children's communication in the first 6 years of life? At 24 months old, 16% of children had communication skills that were of concern to their parents. At 54 months, there were concerns for 12.6% of children. Although most parents were able to describe their child's expressive abilities, many parents remained unconcerned when their child demonstrated communication skills that did not met developmental expectations. Parents can offer valuable insights about their children, but in many cases their level of concern about SLCN did not align with a professional view which reflects a more nuanced understanding of children's speech and language and the impact on future communication skills and needs. Increased awareness through public health messaging specifically regarding lifelong influences of communication challenges will aid in prevention, early detection and intervention. What is already known on this subject Parent's expectations of child speech and language development will inform how responsive they are to difficulties in their child. Appropriate parental concern is key to recognition of children with speech, language and communication needs that warrant referral to a professional. What this paper adds to existing knowledge Parents are aware of expressive language skills that children acquire and can accurately identify their children's skills but have less knowledge of the ages of acquisition. Some parents are not concerned, do not seek support despite recognisable difficulties, and demonstrate limited understanding of the future consequences for children with communication needs that are unmet. What are the potential or actual clinical implications of this work? Public health messaging should include both skills and age ranges for speech and language acquisition. Additionally, educating the public of the impact of speech, language and communication skills on children's futures is needed.

A better start to literacy for bilingual children in New Zealand: findings from an exploratory case study in te reo Māori and English

ABSTRACT This article details findings from an exploratory case study that examined the efficacy of a phonological awareness and vocabulary programme with children educated in a bilingual immersion context of English and te reo Māori (Māori language) in Aotearoa New Zealand. The current paper discusses changes in the development of early literacy skills in English and te reo Māori in two groups of children aged from 5 years 0 months to 7 years 5 months. Twenty-six children from two bilingual classrooms in a rural school participated in a programme implemented by teachers over 15 weeks. The programme included explicit instruction in phonological awareness and vocabulary. One classroom was from Level 1 te reo Māori immersion, and one was from Level 3 te reo Māori/English. Results were analysed at cohort and class levels. Analyses indicated that both groups of children significantly improved in phonological awareness skills, non-word reading, and expressive vocabulary. Correlational analyses indicated that growth in te reo Māori skills was positively associated with growth in English skills. These findings suggest that further investigation into how the explicit teaching of te reo Māori can benefit the development of phonological awareness and print-related skills in English.

Household food insecurity and associations with energy, nutrient intake, and sociodemographic characteristics in young New Zealand children

Although food insecurity affects a significant proportion of young children in New Zealand (NZ)(1), evidence of its association with dietary intake and sociodemographic characteristics in this population is lacking. This study aims to assess the household food security status of young NZ children and its association with energy and nutrient intake and sociodemographic factors. This study included 289 caregiver and child (1-3 years old) dyads from the same household in either Auckland, Wellington, or Dunedin, NZ. Household food security status was determined using a validated and NZ-specific eight-item questionnaire(2). Usual dietary intake was determined from two 24-hour food recalls, using the multiple source method(3). The prevalence of inadequate nutrient intake was assessed using the Estimated Average Requirement (EAR) cut-point method and full probability approach. Sociodemographic factors (i.e., socioeconomic status, ethnicity, caregiver education, employment status, household size and structure) were collected from questionnaires. Linear regression models were used to estimate associations with statistical significance set at p &lt;0.05. Over 30% of participants had experienced food insecurity in the past 12 months. Of all eight indicator statements, “the variety of foods we are able to eat is limited by a lack of money,” had the highest proportion of participants responding “often” or “sometimes” (35.8%). Moderately food insecure children exhibited higher fat and saturated fat intakes, consuming 3.0 (0.2, 5.8) g/day more fat, and 2.0 (0.6, 3.5) g/day more saturated fat compared to food secure children (p&lt;0.05). Severely food insecure children had lower g/kg/day protein intake compared to food secure children (p&lt;0.05). In comparison to food secure children, moderately and severely food insecure children had lower fibre intake, consuming 1.6 (2.8, 0.3) g/day and 2.6 (4.0, 1.2) g/day less fibre, respectively. Severely food insecure children had the highest prevalence of inadequate calcium (7.0%) and vitamin C (9.3%) intakes, compared with food secure children [prevalence of inadequate intakes: calcium (2.3%) and vitamin C (2.8%)]. Household food insecurity was more common in those of Māori or Pacific ethnicity; living in areas of high deprivation; having a caregiver who was younger, not in paid employment, or had low educational attainment; living with ≥2 other children in the household; and living in a sole-parent household. Food insecure young NZ children consume a diet that exhibits lower nutritional quality in certain measures compared to their food-secure counterparts. Food insecurity was associated with various sociodemographic factors that are closely linked with poverty or low income. As such, there is an urgent need for poverty mitigation initiatives to safeguard vulnerable young children from the adverse consequences of food insecurity.

Assessing vocabulary and grammar development in New Zealand Mandarin- and Cantonese-speaking children: a validation study

ABSTRACT New Zealand has a growing population of Mandarin and Cantonese speakers, including children with speech, language, and communication disorders. However, the absence of language development profiles poses challenges in effectively identifying and addressing these concerns. This study aimed to capture the current state of monolingual, bilingual, and multilingual Mandarin- and Cantonese-speaking children living in New Zealand. Over 200 mothers in the Growing Up in New Zealand longitudinal cohort study identified their children as understanding Mandarin and/or Cantonese. Mothers completed newly adapted vocabulary and grammar checklists for New Zealand Mandarin and Cantonese speakers at the Age 2 data wave. Both of the adapted New Zealand Mandarin and Cantonese versions showed high reliabilities and validities. Unique demographic predictors of children’s vocabulary and grammar were mothers’ education, household deprivation level, and children’s birth order. Language status and maternal concerns were also unique predictors of children’s vocabulary development in Mandarin and Cantonese, with monolingual children whose mothers reported no concerns having higher Mandarin and Cantonese vocabularies. These results have rich implications for researchers, clinicians, and practitioners working with Mandarin- and Cantonese-speaking children in New Zealand and worldwide.

Retraction of: Adverse childhood experiences (including violence and abuse) and obesity and obesogenic behaviors: result from a population-based sample of children in New Zealand

Retraction of: Adverse childhood experiences (including violence and abuse) and obesity and obesogenic behaviors: result from a population-based sample of children in New Zealand

Parent-Teacher Partnership for Gifted Early Readers in New Zealand

The experiences of gifted preschool readers and their parents are discussed in this paper, with data obtained through extended parent interviews of 11 four-year-old children in New Zealand (Margrain, 2005). In addition to sharing the experiences of these parents, common misconceptions are reported, and the positive role that parents play in supporting their children highlighted. Findings indicate that the parents were able to identify their children’s strengths and talents, acted as advocates to support their children, were responsive, and provided the key resource of time. These findings negate commonly held assumptions that the parents of gifted children are overtly ‘pushy’ or ‘hothousing’. Instead, this paper argues that teachers can learn a lot from parents and they need to work together to plan for positive outcomes for young gifted children.

Retracted: Adverse childhood experiences (including violence and abuse) and obesity and obesogenic behaviors: result from a population-based sample of children in New Zealand

This abstract has been retracted and withdrawn as the authors were not in a position to release the results. This is being done at the request of the authors, and with the agreement of the editors. Please see https://doi.org/10.1093/ckad205

Influenza: Searching for Pandemic Origins.

From a farming family of 13 children in New Zealand, I graduated with a Master of Science degree in microbiology from the University of Otago (Dunedin, Otago, New Zealand). I established the first veterinary virology laboratory at Wallaceville Animal Research Station. I subsequently completed my PhD degree at Australian National University (Canberra, Australia) and a postdoctoral fellowship at the University of Michigan (Ann Arbor, Michigan). While in New South Wales, Australia, a walk on a beach littered with dead mutton birds (shearwaters) with Dr. Graeme Laver led to the surveillance of influenza in seabirds on the Great Barrier Reef Islands and my lifelong search for the origin of pandemic influenza viruses. Subsequent studies established that (a) aquatic birds are a natural reservoir of influenza A viruses, (b) these viruses replicate primarily in cells lining the intestinal tract, (c) reassortment in nature can lead to novel pandemic influenza viruses, and (d) live bird markets are one place where transmission of influenza virus from animals to humans occurs.

An Insight into Principals' Implementation of Exclusionary Discipline Measures in Aotearoa New Zealand

All children in New Zealand have a legal right to an education. Yet, over the last five years over 20,000 decisions have been made annually to temporarily or permanently deny students of this right by removing them from school on disciplinary grounds. Surprisingly, little is known in Aotearoa New Zealand about the way in which the relevant law is interpreted and applied by those who make these decisions: principals. Responding to concerns over variation across schools in their rates of removals, this article presents findings from a socio-legal research study that explored secondary school principals' implementation of exclusionary discipline measures. The findings highlight significant variation in principals' interpretation and application of the statutory grounds for removing students from school. The implications of the study results are discussed with a particular focus on children's rights. Recommendations are made for law and policy reform, along with professional development.

Epidemiology and Outcomes of Children with Kidney Failure Receiving Kidney Replacement Therapy in Australia and New Zealand

The incidence and outcomes of kidney replacement therapy (KRT) have been well-studied in adults, but much less so in children. This study aimed to investigate the epidemiology and outcomes of KRT in children in Australia and New Zealand from 2000 to2020. Children aged<18 years initiating KRT in Australia and New Zealand between January 1, 2000 and December 31, 2020 and reported to the Australia and New Zealand Dialysis and Transplant Registry were included. Patient survival, technique-survival, and graft survival were analyzed by Cox regression analyses. Overall, 1058 children (median [interquartile range (IQR)] age 11 [5-15] years, 41% female, 66% White) were followed-up with for a median period of 12.3 years. First KRT modalities were peritoneal dialysis (PD; 48%), hemodialysis (HD; 34%), and kidney transplantation (KT; 18%). Pre-emptive KT incidence was highest in Caucasian children (80.4%) and lowest in the Indigenous population (3.2%). There was no difference in 5-year patient survival rates between 2011 and 2020 (96.9%, 95% confidence interval [CI] 93.8-98.4) and the preceding decade, 2000-2010 (94.5%, 95% CI 90.4-96.8) (P= 0.79). There was no difference in 5-year death-censored technique survival between 2011 and 2020 (51.2%, 95% CI 39.1-62) and 2000-2010 (48.8%, 95% CI 40.5-56.6) (P= 0.27). However, 5-year derath-censored graft survival was significantly higher in 2011-2020 (88.4%, 95% CI 84.6-91.4) than in 2000-2010 (84.3%, 95% CI 80.4-87.5) (P< 0.001). PD is the most commonly prescribed KRT modality for children in Australia and New Zealand. Patient-survival, technique-survival, and graft survival rates are excellent and graft survival has improved over the last 2 decades.