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THE SCIENCE OF HEALINGTHE ART OF MEDICINE

Wednesday 16 to Friday 18 November 2016The Performing Arts Centre, Bethlehem College, Tauranga

PAEDIATRIC SOCIETY OF NEW ZEALAND68TH ANNUAL SCIENTIFIC MEETING 2016

CONFERENCE HANDBOOK

www.psnz2016.co.nz

2 PAEDIATRIC SOCIETY OF NEW ZEALAND 68TH ANNUAL SCIENTIFIC MEETING

CONTENTSWelcome 3Health and Safety 4General Information 5Transport Schedule 7Social Programme 8Keynote Speakers 9Contributing Speakers 10Programme Wednesday 11 Thursday 13 Friday 15Poster Listing 18Abstracts Oral 20 Poster 81Exhibition Floor Plan 102Exhibitor Directory 103Exhibitor Information 103Exhibitor Quiz 119Venue Floor Plan Back inside page

CONFERENCE ORGANISERSForumPoint2 Conference PartnersPO Box 1008WMCHamilton 3240Contact: Paula ArmstrongT: +64 7 838 1098E: [email protected]

ACKNOWLEDGEMENTS

The Organising Committee would like to acknowledge and thank all the sponsors and exhibitors for their support of this Meeting. Please take the time to visit all the exhibition stands to say hello, see what’s new, and complete the quiz competition to win an Apple product.

In particular we acknowledge the following sponsors:

Meeting Supporter

– Professor Phil Fischer

Award Sponsors

3PAEDIATRIC SOCIETY OF NEW ZEALAND 68TH ANNUAL SCIENTIFIC MEETING

WELCOMEIt is our great pleasure to welcome you to the 2016 Paediatric Society of New Zealand Annual Scientific Meeting.

The theme of the conference is The Science of Healing, The Art of Medicine. Working in today’s world is exciting but challenging, with the world of medicine rapidly becoming more complex. Patients and their families increasingly expect the best evidence based medicine delivered with a patient/whanau centred approach. This year’s conference will explore these dual themes.

We welcome our keynote and invited speakers to Tauranga and look forward to them contributing to our meeting.

The programme is designed to be challenging and thought provoking.

Where better to spend 3 days meeting friends and colleagues, than in Tauranga, with our amazing sunshine, beaches and wine!

ORGANISING COMMITTEECo-ConvenorsDr Kendall Crosson, Paediatrician, Bay of Plenty DHBDr Vivienne Hobbs, Paediatrician, Bay of Plenty DHB

1. Pharmaceutical Management Agency New Zealand. Changes to the National Immunisation Schedule, PHARMAC NZ; August 2016. Available at http://www.pharmac.govt.nz/news/notification-2016-07-28-immunisation-schedule/ Accessed 3 August 2016.

Varilrix® (live attenuated varicella vaccine) is available as an injection, 0.5mL per dose. Varilrix is a private-purchase prescription medicine for immunisation and prophylaxis against varicella (chickenpox) in adults and children older than 9 months. A prescription charge will apply. Children aged 13 years and older need two doses with an interval between doses of at least 6 weeks. Two doses at least 6 weeks apart are also recommended for children aged between 9 months and 12 years, to provide optimal immune responses against varicella virus. Contraindications: acute severe febrile illness, lack of cellular immunity (e.g. leukaemia, lymphoma, HIV infection, or immunosuppressive therapy), known systemic hypersensitivity to neomycin, or pregnancy. Pregnancy should also be avoided for 3 months after vaccination. Precautions: do not administer intradermally or intravenously. Ensure medical treatment is readily available in case of fainting or rare anaphylactic reaction following administration. Use caution in patients with serious chronic diseases (such as chronic renal failure, autoimmune diseases, collagen diseases, or severe bronchial asthma). Avoid salicylates for 6 weeks after vaccination. Vaccination should be delayed for at least 3 months after a patient has received immunoglobulins or a blood transfusion. If a measles vaccine is not given at the same time as Varilrix, it should be delayed by at least 1 month. Common side effects include mild rash; pain, redness and swelling at the injection site; and small numbers of papulo-vesicular eruptions. Uncommon side effects include fever, headache, cough, vomiting, lymphadenopathy, and arthralgia. Before prescribing Varilrix, please review the full Data Sheet at www.medsafe.govt.nz. Varilrix is a registered trade mark of the GlaxoSmithKline group of companies. Marketed by GlaxoSmithKline NZ Limited, Auckland. Adverse events involving GlaxoSmithKline products should be reported to GSK Medical Information on 0800 808 500. TAPS DA1637IG/16OC/VAR/0010/16. GSK00391

From 1 July 2017 chickenpox vaccination will be fully funded for 15 month olds on the

National Immunisation Schedule.1

Visit the GSK stand to discuss the

paediatricians role in controlling this serious disease.

GSK00391 Varilrix PSNZ Half Page Handbook Ad v4.indd 1 19/10/16 11:52 am


HEALTH AND SAFETYThe Conference Managers, ForumPoint2 Limited, in conjunction with the Paediatric Society of New Zealand 2016 Organising Committee and venues are morally and legally responsible to provide a safe and healthy environment for all attendees at the conference. This commitment extends to ensuring the Paediatric Society of New Zealand ASM 2016 Conference operations do not place the local community at risk of any injury, illness or property damage.

All measures within our ability will be undertaken to ensure that attendees are as informed as possible about any potential risks or hazards they may face whilst attending conference.

All attendees will need to:• listen to the health and safety briefing onsite and/or read the health and safety document available at the registration

desk• ensure that all health and safety concerns; and all accidents or near misses are immediately reported to the

Registration Desk.

All attendees are encouraged to be responsible at all times, and to promote a safe and healthy working environment for the entire conference duration.

First aid kits and defibrillator are located at the Registration Desk.

In the event of an medical emergency please call 111.

The nearest medical centres to the Performing Arts Centre at Bethlehem College are:Bethlehem Medical Centre16 Bethlehem Rd, TaurangaT: 07 576 29318.00am – 6.00pm Monday to Friday

Tauranga Hospital829 Cameron Rd, Tauranga South, Tauranga 3112T: 07 579 8000

Bethlehem PharmacyState highway 2, BethlehemT: 07 576 9770

Fire and emergency:In the event of fire: • On the discovery of fire, immediately activate an alarm and notify the ForumPoint2 team. • Upon hearing alarms, evacuate immediately. Further instructions may be given from the venue – please follow all

directions. • Proceed immediately to your nearest exit. • Use the stairs, not the lift. • Fire hoses and fire alarm switches must remain visible and accessible to the public at all times.

Earthquake Evacuation• Remain in the building. • Move away from any equipment, windows and furniture.• Take immediate shelter under solid furniture such as tables or desks.• If an evacuation order is given, follow the fire evacuation procedures.• Keep calm and assist those who panic.

Accident Reporting• All accidents and incidents must be reported immediately to the Registration Desk or Paula Armstrong, ForumPoint2,

027 649 2081.

Toilets • Toilets are located in various locations on both levels of the building. Please follow signage in corridors.

Smoking • Bethlehem College venue and grounds are smoking-free areas.


GENERAL INFORMATIONREGISTRATION AND INFORMATION DESKThe registration desk is staffed by Paula and Melanie who welcome your enquiries on any conference detail or local information. The desk will be open from Wednesday from 8.30am.

Useful Telephone NumbersRegistration Desk Staff:Paula Armstrong Tel: 027 649 2081Melanie Robinson Tel: 021 113 0289

Performing Arts Centre, Bethlehem College Tel: (07) 579 1748

Trinity Wharf Hotel Tel: (07) 577 8700Hotel on Devonport Tel: (07) 578 2668Quest Tauranga Tel: (07) 571 1455

Tauranga Mount Taxis Tel: 0800 829 477 Super Shuttle Tel: 0800 748 885 or (09) 522 5100 from a mobile

ATTENDEE LISTThere will be an attendee list available at the Registration Desk.

CERTIFICATE OF ATTENDANCE A certificate of attendance is located in your registration envelope.

CONTINUING PROFESSIONAL DEVELOPMENT (RACP)The Royal Australasian College of Physicians (RACP) does not currently accredit CPD activities or providers however Fellows of the RACP may apply for CPD credits in MyCPD under Category 2: Group Learning Activities (at one credit per hour). Participants will need to retain evidence of the CPD activities in the event of being selected for the annual random review process. Please contact the RACP CPD team on (04) 460 8122 for further information.

EVALUATION An online evaluation survey will be emailed to attendees after the conference. We welcome your feedback and would be grateful for a few minutes of your time to complete this.

FOOD AND BEVERAGES IN THE PERFORMING ARTS CENTRE AUDITORIUMPlease note that there is to be strictly NO food or beverages to be taken into the Auditorium.

INSURANCERegistration fees do not include personal, travel or health insurance of any kind. Neither the Paediatric Society of New Zealand nor ForumPoint2 Limited take responsibility for delegates failing to take out adequate insurance cover.

INTERNET ACCESSThe Performing Arts Centre has very limited Wifi available to conference delegates. If you are currently on a data plan we would ask you kindly to refrain from using the venue Wifi. Please visit the Registration Desk for the Wifi code.

If you have difficulty logging on, please see the ForumPoint2 team at the conference registration desk.

MESSAGESFor anyone wishing to leave you a message during conference hours, please ask them to use the following number for the registration desk. Registration desk: 027 649 2081

MOBILE PHONESDuring conference sessions mobile phones must be set to silent or vibrate. We ask that mobile phones are not used while sessions are in progress.

NAME BADGESAll conference attendees and industry representatives are asked to wear their name badges at all times during the conference and social functions. It is your official entrance pass to the sessions, catering and exhibition.

PARKINGThere is limited car parking available at the Performing Arts Centre, Bethlehem College. Coach transport is available from the Host Hotels i.e. Trinity Wharf, Hotel on Devonport and Quest Tauranga. Refer to schedule on page 7.


PRESENTERS INFORMATIONOral presentationsPresentations are being loaded by the audio visual technician at the back of the Auditorium in the Performing Arts Centre, Bethlehem College, during the catering breaks. Please ensure your presentation is loaded no later than the break prior to your session.

If you plan to present using your own laptop please report to the speakers’ room area speak to the technician on your arrival at the meeting.

Please be in the conference room where you are presenting ten minutes before the start of the session to check your presentation, familiarise yourself with the AV set-up and meet the session chair.

POSTER AND RAPID FIRE POSTER PRESENTERSPlease report to the registration desk for allocation of a poster number and location of your poster board. Posters will be displayed in M109, Primary Hall. Posters must be displayed by Wednesday 19 November at 11.00am and removed on Friday 18 November by 2.15pm.

Posters are to be manned on Friday 18 November in the lunch break from 1.45pm until 2.15pm.

The rapid fire poster round will be held on Friday 18 November from 8.35am until 9.35am. Presentations will be made in the M109, Primary Hall.

POWERPOINT PRESENTATIONSWhere presenters have approved, PowerPoint presentations will be saved and posted to the members’ section of the Paediatric Society website following the conference www.paediatrics.org.nz

SESSIONS CHAIRSTen minutes prior to your session commencing, please be in the conference room to meet the presenters. Please ensure each session starts and finished at the advertised time.

SPECIAL DIETSIf you have advised us of any special dietary requirements on your registration form these have been notified to the chef.

Vegetarian options are located on the main buffets. There will be a “pre-ordered special dietary requirement” table located in the catering area for other special diets. Please make yourself known to the catering staff at the social functions. If you have difficultly locating your appropriate meal options please contact the ForumPoint2 team at the conference registration desk.

WATER STATIONSWater stations are available in the Performing Arts Centre foyer, we encourage you to fill your water bottles at these stations.

DISCLAIMER OF LIABILITY Whilst we have endeavoured to ensure that information on the conference website and printed material is accurate, details may be subject to change without notice. Any corrections or amendments will be notified as soon as possible. In the event of industrial disruptions, or service provider failures, the Paediatric Society of New Zealand nor ForumPoint2 Limited will accept any responsibility for losses incurred by attendees or their partners.

Acceptance of oral or poster free papers does not indicate endorsement by the conference committee of any product or activity that the session may promote.

Although care has been taken to ensure accuracy, the conference committee does not accept liability for any errors in published abstracts.


TRANSPORT SCHEDULE

TRANSPORT SCHEDULETrinity Hotel

Hotel on Devonport

Quest Tauranga

Bethlehem College

Tauranga Art Gallery

Bluebiyou Restaurant

Wednesday 16 November 2016Daily ProgrammeCoach will pick up from the hotels

8.15am 8.15am 8.20am

Welcome FunctionCoach will depart Bethlehem College to Tauranga Art Gallery

5.45pm

Thursday 17 November 2016Daily ProgrammeCoach will pick up from the host hotels

7.30am 7.30am 7.35am

Depart Bethlehem College to host hotels 6.15pm

Paediatric Society of New Zealand Conference Dinner Coach will pick up from the hotels

7.15pm 7.15pm 7.20pm

Depart Bluebiyou Restaurant for host hotels: Coach will depart as close as possible to these times

10.30pm, 11.15pm

and midnight

Friday 18 November 2016Daily ProgrammeCoach will pick up from the host hotels

7.15am 7.15am 7.20am

Depart Bethlehem College to TaurangaCBD

4.35pm


SOCIAL PROGRAMMEWelcome FunctionWednesday 16 November 20166.00pm – 7.30pmVenue: Tauranga Art Gallery, Corner Wharf and Willow Streets, 108 Willow Street, Tauranga Transport: Coach transport will depart from Bethlehem College to the Tauranga Art Gallery at 5.45pm.

The Welcome Function is an occasion for you to catch up with friends and colleagues and chat with the exhibitors in a Gallery which delivers exhibitions of historical, and contemporary art.

Paediatric Society of New Zealand Conference Dinner and Awards PresentationThursday 17 November 20167.15pm to midnight Venue: Bluebiyou Restaurant, 559 Papamoa Beach Road, PapamoaDress: Smart / Resort StyleTransport: Coach transport from the host hotels to Bluebiyou will depart at 7.15pm. Return transport will depart Bluebiyou Restaurant at 10.30pm, 11.15pm and last coach at midnight.

Your ticket includes your meal, limited beverages and entertainment. A cash bar will be operating.

Entertainment:Get ready to dance the evening away to the fabulous sounds of the Shy N Retiring Band.

ImportantPlease take your ticket with you to the dinner (inside your name badge pocket), these will be collected. If you have a ticket for the dinner, but will no longer be attending, please advise the ForumPoint2 team at the conference registration desk.


KEYNOTE SPEAKERS

Associate Professor Jane Burns Jane Burns is Professor of Innovation and Industry at the University of Sydney. In 2010 she raised 35M as the founder and CEO of Young and Well Cooperative Research Centre an organisation that over its five years drove industry focused research and development to explore the role of new and emerging technology in improving wellbeing.

Jane was a winner in the category of Social Enterprise and Not-for-profit for 2015’s Australian Financial Review and Westpac Group 100 Women of Influence, and was a Victorian Finalist in the 2012 Telstra Business Women’s Awards.

Jane is a Graduate of the Australian Institute of Company Directors. She is Chair of the National Advisory Council for the Veterans and Veterans Families Counselling Service. She provides strategic

advice to the government, university and social enterprise sector and is a member of 10 advisory boards and government working group, including as a member of the Vision for Australia Advisory Council, the Department of Communications Online Safety Working Group and the Department of Veteran Affairs Clinical Reference Group. Previous Directorships include the Cooperative Research Centres Association, the Bounceback and Thomas Kelly Foundations.

Jane was Deputy Executive Officer and led the youth and public health agenda for beyondblue in its initial start up, was a Commonwealth Fund Harkness Fellow at the University of California, San Francisco, and was Director of International Partnerships at Inspire Foundation driving growth in the United States. Jane held a VicHealth fellowship from 2006-2013, an NHMRC fellowship from 1997-2000 and an NHMRC scholarship from 1994-1996. She has a PhD in Medicine from the Faculty of Medicine (Public Health and Epidemiology) University of Adelaide.

Professor Mike South Mike South is a Paediatrician/Intensivist and Chief Medical Information Officer at the Royal Children’s Hospital in Melbourne. He is Professor of Paediatric Medicine at the University of Melbourne and Fellow at the Murdoch Childrens Research Institute.

Mike has a long term interest in using technology to support clinical care and in driving standardised evidence-based care. His research interests are broad and focussed on the care of acutely unwell children.

Mike is currently leading the implementation of a fully electronic medical record and patient/family portal at The Royal Children’s Hospital.

Dr Robin Youngson Robin Youngson is an anaesthetic specialist in New Zealand, internationally renowned for his work on compassion in healthcare. He’s the Co-Founder of Hearts in Healthcare, a global movement for human-centred healthcare. He’s helped lead change in many countries including Australia, New Zealand, the UK, Ireland, the USA, Canada, Hong Kong, Saudi Arabia, the Netherlands, and Norway.

Robin is an Honorary Senior Lecturer at Auckland University, is on the Editorial Board of the Journal of Compassionate Healthcare, and is a member of the Global Compassion Council of the international Charter for Compassion. He’s the author of the acclaimed book “TIME TO CARE – How to love your patients and your job”.

For further information see: heartsinhealthcare.com

Mayo Clinic Visiting Speaker

Professor Phil FischerPhil Fischer is a Professor of Pediatrics at the Mayo Clinic in Rochester, Minnesota, USA. Following pediatric training in the US and tropical medicine training in the UK, he practiced pediatrics in the Democratic Republic of Congo (then Zaire) from 1985 to 1991 before returning to the US. He has studied deficiencies of calcium, vitamin D, and thiamine in developing countries. Currently, he deals with lots of adolescents with chronic pain and fatigue – and is pleased to see most all of them recovering nicely. He is co-editor of the American Academy of Pediatrics’ Textbook of Global Child Health.


MONTGOMERY SPENCER ORATIONDr John Newman John completed his MB, ChB at Otago in 1972 and his FRACP (paediatrics) in 1980.John has been involved in many aspects of general paediatrics, including clinical management,programme development and policy. He was heavily involved in the transition from a generalchildren’s’ facility at Princess Mary Hospital for Children to a sub-specialty oriented children’s hospitalat Starship.

Over the last two decades, John focussed increasingly on youth health, through the public sectorand more recently in the NGO sector. His recent work has focussed on practice with Maori andtransgender youth.

CONTRIBUTING SPEAKERSGrant Rix, Leader, Mindful LivingCameron Grant, Paediatrician, The University of Auckland - School of MedicineGemma Aburn, Nurse Specialist, Starship Children’s HospitalSandra Ball, Clinical Lead, Eastern Bay Primary Health AllianceEmily Chang, Paediatrician, Startship Palliative Care ServiceLucy Gibberd, Medical Advisor, Medical Protection SocietyLizzie Farrell, Clinical Manager, Kidz First Public Health Nursing ServiceJohn Fitzgerald, Senior Lecturer, Massey UniversityKarma Galyer, Clinical Psychologist, WaikatoMike Gudex, Psychiatrist, Bay of Plenty DHBHelen Holmberg, Clinical and Business Psychologist, TaurangaJess Jamieson, Social Worker, Starship Palliative Care ServiceRachel Johnson, Adolescent Health Physician, Counties Manukau DHBKarin Laska, Pyschiatrist, Bay of Plenty DHBAlison Leversha, Community Paediatrician, Starship Child HealthDiana Lennon, Professor of Population, Child and Youth Health, University of Auckland Chris McAlpine, Clinical Psychologist, Te Whanau Kotahi, TaurangaJohn Malcolm, Paediatrician, Bay of Plenty DHB Kiran More, Neonatal Paediatrician, Christchurch Women’s HospitalNeil Poskitt, General Practitioner, RotoruaBelinda Paku, Community Nurse, Auckland DHBAnna Rolleston, Director, The Cardiac ClinicMatthew Valentine, Medical Lead, Whakatane HospitalJustine Wilde, Paediatrician, Bay of Plenty DHB


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PAED

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IC S

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OF

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LAN

D 6

8th A

NN

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SCI

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TIN

G -

THU

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hairp

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8.15

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8.45

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9.45

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9.45

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10.0

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Mat

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Lunc

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PAED

IATR

IC S

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OF

NEW

ZEA

LAN

D 6

8th A

NN

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SCI

ENTI

FIC

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G -

THU

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1.15

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2.20

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Ae

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PAED

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IC S

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OF

NEW

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LAN

D 6

8th A

NN

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Berr

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Moh

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Ros

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The

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PAED

IATR

IC S

OCI

ETY

OF

NEW

ZEA

LAN

D 6

8th A

NN

UAL

SCI

ENTI

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TIN

G -

FRID

AY

9.40

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Step

hen

Brad

ley,

J Eg

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Hen

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12.1

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1.15

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Lunc

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Ve

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PAED

IATR

IC S

OCI

ETY

OF

NEW

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LAN

D 6

8th A

NN

UAL

SCI

ENTI

FIC

MEE

TIN

G -

FRID

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2.15

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posu

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sk o

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4.20

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4.25

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Conf

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lose


PostersPoster 1 – 12 Rapid Fire Poster PresentationsPoster number Paper Title

1 A review of the transition pathway for young people with bronchiectasis from paediatric to adult respiratory services in the greater Auckland regionAlana Ainsworth, B Farrant, N Pillarisetti, C Byrnes

2 Psychological and physical health during pregnancy: Associations with adverse birth outcomesAmy Bird, C Grant, S Morton

4 Antenatal smoke exposure and respiratory outcome to 12 months of ageJenny Chung, A De Beer, P Weston, A Wallace

5 Childhood obesity – e-growth chart monitoring in secondary careGloria Dainty, D Reith, B Taylor

6 Audit of hip surveillance in children with cerebral palsyPratima Giri

7 How do adolescents, parents, and healthcare professionals view confidentiality?Rebecca Kerry, K Crossen

8 Invasive pneumococcal disease in children in TongaFlora Lutui, C Grant, E Best, S Howie, G Aho

9 Engagement with Oral Health Services: An audit of preschool-aged paediatric inpatientsOlive Ngan, P Atatoa-Carr, T Jackson, A Wallace

10 Adolescent and whanau perceptions of their hospital experienceMelanie Steedman, N Calder

11 What’s for dinner? Relative and absolute differences in food pricesMavis Duncanson, G Boston, W Parnell, J Simpson

12 App development 101: Hackathon, NZHIH, MVP, sprints and scrumsAlison Leversha, F Mahony, A Hudgell, N Meredith, A Ko, D Marsh, A Scroggins, M Sinnock

14 Did our actions to improve immunisation practice at Starship have the intended outcome?E Ng, C Ingham, N Desmond, L Alley, E Wilson, A Leversha

15 Constipation: A common costly complex conditionMavis Duncanson, G Oben, A Wicken, S Morris, J Adams, S Gallagher, J Simpson

16 Being open: Timely access NZCYES publicationsSarah Gallagher, M Duncanson

17 Monitoring for children’s wellbeing: Looking to the futureJean Simpson, M Duncanson, G Oben, A Wicken

18 A case of GHB (gamma hydroxybutyrate) toxicity in a 2 year oldCarolyn Aird, J Goldsmith, T De Almeida

19 Life after ECMO: Outcomes and complications following prolonged ECMO therapy in an 11 month old childMorven Dockery

20 Complications arising from tongue-tie (ankyloglossia) treatmentMatt Hale, R Broadbent, L Edmonds, D Barker, N Dickson, N Mills, P Dawes, B Drummond, B Wheeler

21 Epidemiology and risk factors for Gastroschisis – a 20-year experience in a regional neonatal surgical centreGopakumar Hariharan,T Walwyn, PA Dargaville, M Ee, AG De Paoli

22 Review of late diagnoses of cystic fibrosis in a paediatric clinicMirjana Jaksic, J Tate, C Byrnes

23 Measuring the height/length of children with cerebral palsy in New ZealandJustine McCallum, P Clark, P Reed, R McLean, C Wheeler

24 Assessment of implementation of the guideline for supplementation of at risk infants with vitamin D in New ZealandJudith Nitert, P Tuohy

25 New Zealand Paediatric Surveillance Unit: Pleural Empyema in New Zealand children aged <15 yearsE Best, J Twiss, L Voss, C Byrnes, J Hamil, S Evans, R Matas, Katherine Rix-Trott, D Williamson, T Walls

26 The 1000 Days Trust Pilot – early findings from an ambitious early intervention residential program for ‘at risk’ whanau in SouthlandViliame Sotutu, R Stevenson


27 Evaluation of Puawaitahi, New Zealand’s first multiagency centre for child protectionRachel Stevenson, P Kelly, F Seymour

28 Community onset invasive staphylococcus aureus disease in Auckland children: Investigating ethnic disparitiesAnnie Borland, A Vogel, A Morales, A Vara, J Freeman, S Taylor, P Anderson, M Horsfall, D Drinković, D Lennon

29 Chickenpox complications at Wellington Regional Children’s Hospital: A six-year retrospective reviewIsaac Tranter-Entwistle, B Bowkett

30 Acute Rheumatic Fever BOPDHB Demographics 2000-15: More Maori boys get ARF, even with less deprivationLiam Walsh, R Michniewicz, M Tozer, J Humby, J Malcolm

31 Super-giant coronary aneurysm secondary to atypical Kawasaki disease, S/P quadruple coronary bypass and grafting in an 11-year oldMariko Yamanaka


ABSTRACTS1. Wednesday 16 November 2016 10.00am – 11.00am Plenary 1 – Opening Ceremony and Plenary

RECLAIMING OUR ROLE AS HEALERS: ADDING THE SCIENCE OF THE HEART TO THE SCIENCE OF THE HEADRobin YoungsonAnesthetic Specialist, Co-Founder of Hearts in Healthcare

Our materialistic science, reductive thinking, focus on disease, and use of technology have steered us towards treating the pathology rather than the patient. Furthermore, the emphasis on efficiency and productivity has made care so hurried that we miss the human connection. But every one of our patients has an extraordinary capacity for healing, which is greatly enhanced by our compassion and caring. Robin presents the surprising evidence that compassionate, whole-person care improves outcomes as much as our drug therapies and then explores the personal qualities, skills and practices that can supplement and enhance our technical skills.


2. Wednesday 16 November 2016 11.30am – 12.30pm Concurrent Session 1A

MEDICATION AT THE INTERFACE OF PAEDIATRICS AND CHILD AND ADOLESCENT PSYCHIATRY; “SCIENCE OF MEDICINE, ART OF HEALING”Mike Gudex, Colin Watt, Karin Laska

An interactive hour with child and adolescent psychiatrists regarding State of the Art Pharmacotherapy for mental healthissues at the interface of Paediatrics and Child Adolescent Psychiatry to upgrade your clinical knowledge.


3. Wednesday 16 November 2016 11.30am – 12.30pm Concurrent Session 1B

PRIVACY, PITFALLS AND MEDICO-LEGAL PREDICAMENTS IN PAEDIATRIC PRACTICELucy Gibberd

The presentation will cover a variety of the medico-legal aspects of Paediatric practice including• What medico-legal risks are you facing?• Privacy issues when dealing with children and families• Competency and consent to treatment issues• Cases/ Dealing with the HDC


4. Wednesday 16 November 2016 1.15pm – 2.15pm Mayo Clinic Speaker: Phil Fischer

THE ART AND SCIENCE OF MANAGING PAEDIATRIC PATIENTS (AND THEIR FAMILIES) WITH FUNCTIONAL DISORDERSPhil FischerMayo Clinic

Significant and even debilitating symptoms can result from either structural (anatomic, organic, pathophysiologic, “hardware”) or functional (no identifiable “organic” pathology but with clear limitations in normal physical activity, “software”) conditions. Several specific principles help ensure success in helping children/adolescents and their families overcome functional problems. First, the symptoms must be acknowledged and validated – they are real. Second, the patient and family must be affirmed and reassured – their problems are not their fault. Third, the situation must be understood – the problems relate to poor regulation of the interactions of various physical systems. Fourth, the family needs a plan – specific steps to take to overcome the problems. Fifth, they must not feel alone – they have a care team to help them. Finally, the patient and family need hope – with glimpses of other similar but successful patients and with a vision of their own recovery.


5. Wednesday 16 November 2016 2.15pm – 2.30pm Concurrent Session 2A – Free Papers

MANAGEMENT OF SEPTIC ARTHRITIS AND OSTEOMYELITIS AT WAIKATO HOSPITALJohn Mak1, Tobias Barker1, Ngaio Garcia1, Eleanor Carmichael2, Alexandra Wallace1,2

1 Waikato Clinical School, University of Auckland2 Department of Paediatrics, Waikato Hospital

BackgroundManagement of paediatric osteomyelitis and septic arthritis can be complex and often requires a multidisciplinary approach. At Waikato Hospital there is no clear delineation of responsibilities or defined protocol to guide management of these patients. This audit was undertaken to assess current practice and identify the roles of various specialties in the management of paediatric osteomyelitis and septic arthritis at our hospital.

MethodsA retrospective audit was undertaken of patients ≤15 years presenting to Waikato Hospital with osteomyelitis or septic arthritis from 2011 to 2015. Data collected included demographics, microbiological profile, antibiotics used, dosing, duration of treatment, and specialties involved in care.

Results54 patients (mean age 6.93(±4.14) years) were identified; 33 (61%) had septic arthritis. 26 (48%) were Maori, 23 (42%) European, and 4 (7%) Pacific. Flucloxacillin was the first choice antibiotic for 42 (78%). Antibiotic therapy was continued for 32.6(±12.8) days, with conversion to oral therapy after 10.0(±6.6) days. 19 (35%) patients were discharged on intravenous antibiotics. Blood and/or tissue cultures were performed and positive in 52 (96%) and 38 (70%) patients respectively. Staphylococcus aureus was cultured in 26 (69%), other organisms identified included Group A Streptococcus, Kingella kingae and MRSA. Subsequent sensitivities resulted in a change of antibiotics in 13 (37%). All patients were primarily under orthopaedic care. Paediatrics was consulted for 28 (52%) patients, mostly for unrelated medical issues, and antibiotic advice was sought from Infectious Diseases for 28 (52%) patients.

ConclusionMaori children were over-represented in this cohort of patients with osteomyelitis and septic arthritis, consistent with previous reports.1 Staphylococcus aureus was the predominant causative organism identified, and flucloxacillin remains the appropriate empiric treatment choice. As a result of this audit, a more collaborative multidisciplinary approach to the management of these patients has been adopted at Waikato Hospital.

References1. Street M et al. J Pediatr Orthop, 2015.



APPROPRIATE PRESCRIBING OF THIRD AND FOURTH GENERATION CEPHALOSPORINS IN STARSHIP CHILDREN’S HOSPITALSophie-Ann Chin1, Rachel Webb 1, Eamon Duffy1, Lesley Voss1

1 Auckland District Health Board

BackgroundThe goal of antimicrobial stewardship is to improve clinical outcomes, prevent unwanted toxicity and minimise antimicrobial resistance. Third and 4th generation cephalosporins are considered to be critically important by the World Health Organisation [1]. This audit aimed to evaluate the appropriateness of 3rd and 4th generation cephalosporin prescribing in the general paediatric and subspecialty patients in Starship Children’s Hospital (SCH).

MethodsPatients were identified from automatically generated lists of all patients admitted to SCH under general paediatric or selected subspecialty medical teams from 20/6/16 – 3/7/16 inclusive.

Inpatient charts were reviewed to look for prescription of 3rd or 4th generation cephalosporins. Clinical records were reviewed, the child’s diagnosis and prescription details were recorded. Records were then audited against Starship Clinical Guidelines [2] and the Restricted Anti-Infective List [3].

Criteria evaluated1. All 3rd and 4th generation cephalosporins are prescribed for indications stated in institutional guidelines or on the

recommendation of Infectious Diseases (ID)2. All patients prescribed a 3rd or 4th generation cephalosporin are charted an appropriate dose, frequency, route and

duration for the given indication3. All patients prescribed a 3rd or 4th generation cephalosporin have the medication chart “clearly annotated with the

indication and duration of the antimicrobial prescribed AND the name of the approver, exempted SMO or special authority number” as appropriate. [3]

ResultsDuring the two week audit period, 251 clinical records were reviewed. There were 19 prescriptions for 3rd generation cephalosporins. No 4th generation cephalosporins were prescribed. 17/19 (89.4%) prescriptions were made in accordance with guidelines, or were ID-approved. 12/17 (70.5%) were of appropriate dose, frequency, route, and duration for the given indication. No prescriptions had the medication chart clearly annotated with indication or duration.

ConclusionThere is scope for improvement of 3rd generation cephalosporin prescribing in SCH, although overall prescription rates of 3rd generation cephalosporins remain relatively low compared to other centres [4]. A specific target for improvement is documentation, particularly of indication and duration.

References1. WHO. 2012. Critically Important Antimicrobials for Human Medicine 3rd Revision 2011. Available from: http://apps.

who.int/iris/bitstream/10665/77376/1/9789241504485_eng.pdf. Accessed on 30/07/20162. Starship Children’s Health. Starship Clinical Guidelines. Available from: https://www.starship.org.nz/for-health-

professionals/starship-clinical-guidelines/ Accessed on 19/06/20163. DHB Paediatric anti-infectives for preapproval file:///N:/Groups/INTRANET/Pharmacy/AMS/AMSC%20Paed%20

Restricted.pdf. Accessed on 1/06/164. Osowicki J, Gwee A, Noronha J, Palasanthiran P, McMullan B, Britton PN, Isaacs D, Lai T, Nourse C, Avent M, et al.

Australia-wide point prevalence survey of the use and appropriateness of antimicrobial prescribing for children in hospital. Med J Aust. 2014 Dec 11; 201(11):657-62.



THE FOLLOW UP AND OUTCOME OF CHILDREN REQUIRING RENAL REPLACEMENT THERAPY FOR ACUTE KIDNEY INJURY FOLLOWING CARDIAC SURGERY IN NEW ZEALANDCarol Chan1, Tonya Kara1

1 Starship Children’s Hospital, Auckland District Health Board, Auckland

BackgroundTo examine the characteristics, follow-up and availability of long term outcome data in a cohort of New Zealand children with acute kidney injury (AKI) requiring renal replacement therapy (RRT) following cardiac surgery at Starship Hospital over a six-year period.

MethodsThe cohort used was identified in the previously published “Epidemiology and outcome of acute kidney injury in New Zealand children”. A retrospective review of medical records of all the children requiring RRT for AKI following cardiac surgery from January 2001 to December 2006 was repeated to add further data regarding their cardiac history. Patient characteristics were summarised. Primary outcome was rates of renal surveillance. Evidence of renal dysfunction and possible contributing factors were also studied.

Results130 children required RRT following 131 cardiosurgical procedures during the study period. Monitoring of renal status in these children is not consistent, and often performed for indications other than specific renal surveillance. 86.4% of surviving children have some measures of renal status at one year after discharge, falling to 79.6% at 5 years. 20 children (16.4% of survivors) were identified as having renal dysfunction or hypertension at discharge from hospital. At one year, 18 (16.4%) of surviving children had suggestions of ongoing kidney dysfunction including hypertension or abnormal urinalysis. At 5 years, 13 (12%) have ongoing dysfunction. The survival rate was 93.8% (122 children) at discharge, 84.6% (110 children) at one year and 83.1% (108 children) at 5 years following surgery for this cohort.

ConclusionThis study suggests that a proportion of children who have had cardiac surgery have ongoing renal dysfunction at 5 years. The care of this group of children, and identification of others at risk, could be improved by increasing awareness. A standardised monitoring guideline could provide surveillance over time and enable collection of further data.


8. Wednesday 16 November 2016 3.00pm - 3.15pm Concurrent Session 2A – Free Papers

SPIROMETRIC CONTROLLED CHEST CT SCAN IMPROVES INTERPRETATION AND ALLOWS REDUCTION IN RADIATION DOSE Rochelle Moss1, Nicole Westrupp 2 Nancy Kennelly2 Nikki Hamilton2 David McNamara2, Russell Metcalfe2, Cass Byrnes1,2

1 Department of Paediatrics and Child Health, University of Auckland 2 Starship Children’s Health, Auckland District Health Board

BackgroundAdolescence can be a critical time for progression of lung disease in Cystic Fibrosis (CF). Chest CTscans are more sensitive in determining parenchymal changes than lung function which often remains stable until significant scarring has occurred. For chest CTscans to be used as an outcome measure technical aspects and radiation exposure need to be addressed.

MethodsIn the ‘FAB’ study we are looking at a clinical annual review, lung function and volumetric chest CT scan in adolescents with CF 10-15 years of age two years apart looking for risk or resilience factors to explain disease trajectory. We have developed a new protocol where each individual controls their full inspiration and complete expiration by using spirometry during the scan.

ResultsIn NZ we have completed 18 first (mean 11.6 years, 11 boys) and 6 second CTscans using this technique. Compared to usual verbal instruction, the spirometric controlled CTscans have consistently been done at full inspiration as determined by rib spacing and chest dimensions, and at true residual volume as determined by tracheal shape. This means less areas of temporary atelectasis and less over-interpretation of air trapping because of poor exhalation. With this standardisation, given we are only interested in air trapping and bronchiectasis, the CTscan radiation dose is less than half that used for the normal chest CTscans. Under their individual control, the full inspiratory capacity and residual volume during the procedure has been recorded within 5% variability to same day clinic lung function testing.

ConclusionSpirometry controlled chest CTscan has been successful in standardising timing and technique of inspiratory and expiratory volumetric scans. This gives accurate determination of true findings rather than artefact from poor technique. This may be a helpful technique to use for all chest CTscans for children able to do lung function in future.

AcknowledgementsNHMRC grant: APP1044829. HDEC: 13/NTB/102FAB: Follow-up After BAL Collaboration Australia and New Zealand.


9. Wednesday 16 November 2016 2.15pm - 3.15pm Concurrent Session 2B

A PAEDIATRICIAN’S GUIDE TO PSYCHOMETRIC TESTING: EVERYTHING YOU WANTED TO KNOW BUT WERE AFRAID TO ASKChris McAlpine1, Karma Galyer2

1 Clinical Psychologist, Department of Paediatrics, Tauranga and Whakatane Hospitals, Bay of Plenty District Health Board. Clinical Psychologist, Te Whanau Kotahi, Child Development Service, Tauranga2 Clinical Psychologist, Department of Paediatrics, Tauranga Hospital, Bay of Plenty District Health Board

This presentation will explain the dark arts of psychometric testing to non-psychologists. Chris and Karma are senior Clinical Psychologists within the Paediatrics Department at Tauranga Hospital. Together, they will demystify the common psychological tools used to assess cognitive and adaptive functioning, ASD and ADHD. This will assist you in understanding and interpreting psychometric results for children and young people in your care.


10. Wednesday 16 November 2016 3.40pm - 3.55pm Concurrent Session 3A – Free Papers

TIME TO RETHINK MULTI-DISCIPLINARY OBESITY INTERVENTIONS FOR CHILDREN AND ADOLESCENTS? THE RESULTS OF WHANAU PAKARI RANDOMISED CONTROLLED TRIALYvonne C Anderson1, 2, Lisa E Wynter,1 Cameron C Grant,3,4,5 Joanna M Stewart,6 Tami L Cave,2 José G B Derraik,2 Wayne S Cutfield,2,4 Paul L Hofman2,4

1 Department of Paediatrics, Taranaki District Health Board, New Plymouth2 Liggins Institute, University of Auckland3 Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland4 Starship Children’s Hospital, Auckland District Health Board, Auckland5 Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Auckland6 Department of Epidemiology and Biostatistics, University of Auckland, Auckland

BackgroundImproving access to nutrition and physical activity is one of the targeted initiatives of the child obesity implementation plan. Maori and those from most deprived households are over-represented in child obesity statistics. We report the post-treatment outcomes of “Whanau Pakari”, a randomised controlled clinical trial of a multi-disciplinary obesity intervention programme targeting high-risk groups.

MethodsParticipants were recruited between January 2012 and August 2014, aged 5 to 16 -years, resident in Taranaki, with a body mass index (BMI) ≥98th centile or BMI >91st centile and weight-related co-morbidities. Assessments of health parameters including medical, dietary, physical and psychological wellbeing were undertaken in a “demedicalised” home visit. Participants were randomised either to the intervention, involving a 12-month multi-disciplinary programme with weekly group sessions from a physical activity co-ordinator, dietitian, and psychologist, or a less intensive control.

ResultsA total of 203 children were assessed (47% Maori, 43% New Zealand European [NZE]), age 10.7 years, 53% female, average BMI standard deviation score (SDS was 3.12 (1.52–5.34). 28% of the participants were from the most deprived quintile of household deprivation. Change in BMI SDS at 12 months compared with baseline was -0.11 in the intervention group (p<0.05), and -0.12 in the control group (p<0.05). Compared with baseline, participants showed improvements in cardiovascular fitness (p<0.0001), and improvements in paediatric quality of life (p<0.001). For those attending ≥70% of the sessions, change in BMI SDS was -0.22 compared with -0.05 for those attending <70% (p=0.036). However, 73% of those attending ≥70% of the sessions were NZE compared with 26% attending <70% of the sessions (p<0.0001).

ConclusionA home based obesity intervention improved Maori recruitment and reduced obesity irrespective of whether a more or less intensive intervention was used. Improving retention markedly improved obesity outcomes suggesting this needs to be a focus for future interventions.



BREASTFEEDING DURATION AMONG A NATIONALLY REPRESENTATIVE MULTI-ETHNIC SAMPLE OF NEW ZEALAND CHILDRENTeresa Castro1, Cameron Grant1, Clare Wall1, Michaela Welch2, Emma Marks1, CJ Fleming3, Catherine Gilchrist1, Juliana Teixeira4, Dinusha Bandara1, Sarah Berry1, Susan Morton1

1 University of Auckland, Auckland2 Boston University, Boston, United States of America3 Auckland District Health Board, Auckland 4 University of Sao Paulo, Sao Paulo, Brazil

BackgroundTo describe breastfeeding duration indicators within a representative sample of New Zealand (NZ) infants, and investigate relationships between maternal demographics and duration of any and exclusive breastfeeding.

MethodsGrowing Up in NZ (GUiNZ) cohort study enrolled 6685 singletons. Breastfeeding initiation, and duration of any and exclusive breastfeeding were described for 96.3%, 91.1% and 90.3% of the singletons enrolled in GUiNZ. Multivariate Poisson regression analysis with robust variance was used to estimate the independent relationship between covariates and breastfeeding outcomes.

ResultsBreastfeeding was initiated for 97% of the children. Median (IQR) duration of exclusive and of any breastfeeding were 4 months (2.0-5.0) and 7 months (4.0-12.0) respectively. Exclusive breastfeeding lasted ≥4 months for 53.4% of the children and any breastfeeding for ≥6 months for 65.6% of the children. The factors independently associated to exclusively breastfeed for ≥4 months were maternal ethnicity (Māori, RR=0.80,95%CI 0.73-0.87; Pacific, RR=0.90,0.83-0.98; Asian, RR=0.80,0.74-0.86 versus European), age (20-29 years old, RR=1.24,1.04-1.49; ≥30, RR=1.36,1.14-1.62 versus <20), education (tertiary education, RR=1.14,1.08-1.21), pregnancy planning (planned, RR=1.14,1.08-1.21) or older siblings (yes, RR=1.31,1.17-1.47). The factors independently associated to breastfeed for ≥6 months were maternal age (20-29 years old, RR=1.26,1.10-1.45; ≥30, RR=1.40,1.22-1.61 versus <20), education (tertiary education, RR=1.11,1.06-1.59), pregnancy planning (planned, RR=1.11,1.06-1.15), or older siblings (RR=1.04,1.00-1.08).

ConclusionWhile duration of any and exclusive breastfeeding in New Zealand is longer than a number of other The Organisation for Economic Co-operation and Development (OECD) countries, a large proportion of NZ children do not achieve the World Health Organization recommendations for duration of any or exclusive breastfeeding. Maternal age, education, parity and pregnancy planning identify infants at risk of shorter duration of any and exclusive breastfeeding, and maternal ethnicity for exclusive breastfeeding only. Maternal demographics identify groups for whom breastfeeding promotion should be prioritized.

Key-wordsBreastfeeding. Exclusive breastfeeding. Complementary feeding.

References1. World Health Organization. Report of the Expert Consultation on the optimal duration of exclusive breastfeeding: a

systematic review. Geneva: World Health Organization, 2002.2. World health Organization. Global data bank on Breastfeeding and complementary Feeding [online], 2006. Available at

http://www.who.int/nutrition/databases/infantfeeding/en. Acessed 02 augusto 2016.3. World Health Organization Indicators for Assessing Breast Feeding Practices. WHO/CDD/SER/91.14. Geneva: World

Health Organization, 1991.4. Morton SM, Ramke J, Kinloch J, et al. Growing Up in New Zealand cohort alignment with all New Zealand births. Aust.

N. Z. J. Public Health. 2015;39(1):82-87.



ANAPHYLAXIS: DIAGNOSIS AND MANAGEMENT IN PAEDIATRIC PATIENTS AT WAIKATO HOSPITALMiina F Karalus1, Melissa Niao1, Eleanor Carmichael2, Alex Wallace1,2

1 Waikato Clinical Campus, University of Auckland, Hamilton2 Department of Paediatrics, Waikato Hospital, Hamilton

BackgroundAnaphylaxis is a multi-organ condition and correct diagnosis and management is paramount to avoid fatal outcome, particularly in childhood.1 The Australian Society of Clinical Immunology and Allergy (ASCIA) provides evidence-based guidelines for the management of anaphylaxis.2 This audit aimed to assess compliance with these guidelines for children presenting to Waikato Hospital with anaphylaxis.

MethodsA retrospective chart analysis of children aged 0-15 years presenting with anaphylaxis to Waikato Hospital from January 2013 to December 2015 was undertaken. Data collected included demographics, allergens, adrenaline administration, complications and management thereof, steroid administration, duration of observation time, and completeness of discharge planning including instructions for recurrent symptoms, use of oral antihistamine, provision of an anaphylaxis action plan and auto-injector, and follow-up arrangements.

ResultsForty patients presented in the audit timeframe. 14 (35%) children were aged <2 years, 11 (27%) 2–5 years, and 15 (38%) >5 years (p=0.46). Food allergens were the most common precipitant (n=19, 47%). Acute ASCIA management guidelines were followed correctly for most patients, with 37 (93%) receiving the correct dose of intramuscular adrenaline, and all patients with upper airway obstruction receiving nebulised adrenaline. Thirty-seven (93%) patients received an antihistamine, and 37 (93%) received steroids. Only 2 (5%) patients were not observed for ≥4 hours. On discharge, while 34 (85%) received instructions to return in case of recurrent symptoms, 26 (65%) were prescribed antihistamines, and 25 (63%) advised to obtain an adrenaline auto-injector, only 13 (33%) were given an anaphylaxis action plan, and 16 (40%) had follow-up arranged.

ConclusionWhile the majority of patients were managed well acutely, deficiencies were identified in the education provided to whanau regarding the management of future events. As a result of this audit, a check-list and document pack has been developed to help provide more comprehensive care and follow-up for these patients.

References1. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2008.2. ASCIA guidelines - Acute management of anaphylaxis. Allergy.org.au. 2016.



HOW ARE WE MEASURING THE HEIGHT/LENGTH OF CHILDREN WITH SEVERE CEREBRAL PALSY IN NEW ZEALAND?Justine McCallum1, Phillipa Clark1, Peter Reed1, Rachael McLean2

1 Starship Children’s Hospital2 Departments of Preventive and Social Medicine and Human Nutrition, University of Otago

BackgroundMeasuring the height of children with moderate to severe Cerebral Palsy (CP) Gross Motor Function Classification Scale (GMFCS IV and V) is difficult but important for monitoring growth and development. We investigated how health professionals in New Zealand are currently measuring growth parameters including weight and height/length in children with moderate to severe CP.

MethodsAn exploratory electronic survey of measuring practices was undertaken from March to June 2016. The survey was distributed via the Paediatric Society of New Zealand server and via the Dietitians New Zealand SIG group server. Participants were asked to forward the survey to Outpatient Nurses and other relevant health professionals.

ResultsThe survey was sent to an estimated 469 health professionals (300 Paediatricians and 169 Dietitians) regardless of whether they were known to work with children with Cerebral Palsy or not. 48 people responded, all of whom worked with children with Cerebral Palsy (approximately 10%). 40% were Doctors, 31% were Dietitians, 19% were Nurses and 10% were Others. The respondents worked at 16 out of 20 New Zealand District Health Boards (DHBs). Respondents most commonly worked in the Paediatric Outpatient Clinic setting (67%).

The most common method for measuring height/length was lying supine and measuring from head to heel with or without a measuring board (48%). This was followed by measuring from bony landmark to bony landmark (10%). Ten respondents reported using segmental measures, the most common being knee height. 27% respondents reported that the height/length was not commonly measured in the setting they worked in.

ConclusionMeasurement of the height/length of children with severe Cerebral Palsy is inconsistent in New Zealand. The low response rate is a limitation of this study however representatives from most DHBs responded. Development of a standard method should be considered and would improve assessment of growth in these children.


14. Wednesday 16 November 2016 3.40pm – 4.40pm Concurrent Session 3B

GENDER DIVERSITY IN CHILDREN AND ADOLESCENTS BACK TO BASICS AND BEYOND!Rachel JohnsonCounties Manukau DHB Kidz First Centre for Youth Health

Both in New Zealand and internationally there has been an increase in the number of gender diverse children andadolescents seeking health care support. Kidz First Centre for Youth Health has been providing gender health care for thelast 10 years and is now supporting over a hundred young people and families.

This presentation will provide information to clinicians on working with gender diverse children and adolescents, andsupporting families. This will be based on our experiences and international literature. Links to useful resources will also beprovided.

Data from a brief survey of paediatric society members will be presented regarding the status of gender health carecurrently available in New Zealand. This will hopefully generate discussion around how we can best advocate for andsupport the further development of gender health care services for children and adolescents throughout New Zealand.


15. Wednesday 16 November 2016 4.45pm – 5.45pm Montgomery Spencer Oration

TRYING TO MAKE A DIFFERENCE John Newman

I will touch briefly on my early career before talking about my experiences as a specialist general paediatrician and morerecently as a specialist youth physician. I will talk about the reasons for changes in my practice and the professionaltransitions I have made.

I will dwell on the challenges and opportunities of youth health. In particular, I will contrast the more technologicaldirections that have evolved in paediatric medicine and contrast that with the socially, family and politically based solutionsfor youth health. I will talk about the particular issues, challenges and opportunities for youth practice with Maori.

My presentation will offer my own perspective on my career and on youth health, while borrowing the literature, as anexperiential discourse.


16. Thursday 17 November 2016 8.15am – 8.45am Plenary 2 and Awards Presentations

MEASUREMENT OF THE IMPACT OF CURE KIDS (CK) INVESTMENT IN CHILD HEALTH RESEARCH Bruce Scoggins1, Michelle Sullivan1, Tim Edmonds1

1 Cure Kids

Presentations in the Session will include: 1 Brief History of CHRF and CK- Bruce Scoggins (Chair of CK Medical and Scientific Advisory Committee).

Cure Kids was established as the National Child Health Research Foundation in 1978 with the support of Rotary. Today Cure Kids is the largest supporter of research into child health, after the HRC, investing around $5M annually through research grants, fellowships and the CK Chairs at University of Auckland and University of Otago.

2 Measurement of Impact of CK’s investment in child health research - Bruce Scoggins and Michelle Sullivan (Impact Evaluation NZ)

The impact evaluation was conducted on grants (including Fellowships) funded from 1976 to 2010. The evaluation used the methodology developed and validated by Haddy and Buxton in the UK. The evaluation assessed the impact of the CKs investment across the following metrics:

- knowledge production- catalysing further research- workforce development- impact on policy and practice- commercialization- international leadership

Data was collected by interview from 61 Principal Investigators who were responsible for 171 grants (73% of total for period of analysis). The impacts of CK’s investment were wide-ranging across the various metrics and clearly showed that the investment was delivering the outputs and outcomes sought by CK. The evaluation also confirmed the quality of the research workforce conducting child health research in New Zealand as assessed by the quantity and quality of the publications produced and their status within their international peer group.

3 CK’s Current Investment Strategy - Tim Edmonds (Research and Innovation Director at CK)

CK has in place a number of ways in which it invests in research to deliver better health to children. These include project grants, innovation seed fund grants, RFPs, Partnership funding, Fellowships and the CK Professorial Chairs. The Investment Strategy is reviewed to ensure it meets its objectives.

4 Profile of Grant Applicants to CK from 2009 to 2015 - Bruce Scoggins

An analysis has been conducted of the 160 project grant applications received by CK since 2009 to better understand what type of research was seeking funding (eg biomedical, clinical or public health) and to explore the extent to which applications were addressing key issues for child health. The information from the analysis can be used to assist CK in development of its Investment Strategy.


17. Thursday 17 November 2016 8.45am – 9.45am Plenary 2 and Awards Presentations

REDUCING VARIATION IN CARE – IS IT COOKBOOK MEDICINE?Mike South1

1 The Royal Children’s Hospital, Melbourne, Australia

Attempts to reduce the variation in clinical care provided to patients with the same problem is a hot topic in management and quality of care circles. Is this something we should aspire to achieve? Is it beneficial? Surely patients are all different. What about the ‘art’ of medicine? What about innovation? How do we find a pathway through these competing drivers?


18. Thursday 17 November 2016 9.45am – 10.00am PSNZ New Investigator Award Presentations

HOSPITAL ADMISSIONS FOR PRIMARY SCHOOL AGED CHIDLREN IN TONGA 2009-2014Fiona Langridge1, Cameron Grant2 , Sione Hufanga3

1 Pacific Health Department, The University of Auckland2 Paediatrics: Child and Youth Health Department, The University of Auckland3Biostatistics, Vaiola Hospital, Nuku’alofa, Tonga

BackgroundWith under 5-year old mortality rates decreasing in developing countries there is a need to use other measures to monitor child health. Our aim was to describe patterns of inpatient utilisation for primary school aged children living in Tonga.

MethodsWe described data on all children aged 5-11 years (inclusive) admitted to the main hospital in Tonga between January 2009 and December 2013. Distribution was described using proportions and means or medians depending upon the normality of the data distributions. Rates were calculated using 2011 census population data for aged 5-11 years.

ResultsThere were 1816 admissions. The annual admission rate (average 21.1/1000 95%CI 20.2-22.1) increased over the five year period (p<0.001). Accidents and injuries (28%), non-respiratory infectious diseases (19%), respiratory (16%), abdominal/gastrointestinal/surgical (13%) and dental conditions (9%) were the most frequent reasons for admission. Over the five year period the proportion of admissions for accidents and injuries (directional p value = 0.047) and dental conditions (directional p value < 0.0001) increased. A larger proportion of younger (5-7 years old) versus older (8-11 years) children were admitted for dental (16% vs 1%, P<0.001) or respiratory conditions (18% vs 14%, P = 0.02). A larger proportion of older children were admitted for abdominal/gastrointestinal/surgical conditions (15% vs 11%, P=0.008), other infectious diseases (21% vs 17%, P=0.04), other conditions (10% vs 6%, P=0.0009) and cardiac conditions (2% vs 1%, P=0.0004).

ConclusionIn primary school aged children in Tonga 85% of admissions accounted for by accidents and injuries, non-respiratory infectious diseases, respiratory, abdominal/gastrointestinal/surgical and dental conditions. These contemporary data and analyses can be used to inform priority areas for health care spending and to enable comparisons over time and between different countries in the Pacific region.



SCHOOL SORE THROAT PROGRAMMES LOWER ACUTE RHEUMATIC FEVER (ARF), FOR MAORI BOYS ESPECIALLY, IN HIGH ARF RISK EASTERN BAY OF PLENTY (EBOP) 2000-2015Liam Walsh1, Sandra Ball2, Thanjon Michniewicz3, Janine Wright4,, James Scarfe5, John Malcolm1,4,6 1University of Auckland2Eastern Bay Primary Health Alliance3University of Newcastle, Australia4University of Otago5Toi Te Ora, Public Health Service, Lakes/ Bay of Plenty, Rotorua6Whakatane Hospital, Bay of Plenty DHB

BackgroundARF is high in EBOP, several areas1 far exceeding National Heart Foundation (NHF) guidelines2 had school interventions implemented 2009-12. BOP ARF admissions are 90% Maori, 5% Pacific. This study, 2000-15, evaluates school ARF programme cases and rates.

MethodsRetrospective audit 2000-2015, of ICD10 ARF discharges, Bay of Plenty BOPDHB residents from 3 admitting hospitals Whakatane, Tauranga (BOPDHB), Rotorua (LakesDHB), EpiSurv MOH notifications, pre ARF Register database3 with electronic/ paper casenote scrutiny against NHFNZ benchmarks2. Cases pre/post implementation mid-point 2010 were compared from four Eastern BOP ARF school prevention programmes “intervention group”, with Ministry Education school population4 denominators. Three programmes are Hauora Iwi health provider, one Eastern Bay Primary Health Alliance EBPHA staffed, all led by one part-time EBPHA Registered Nurse Clinical Lead. The intervention twice weekly term-time school pupils sore throats swabbing (SSTS) by community health workers, precedes GP standing orders treating Group A Streptococcus (GAS)5,6,7. Both intervention and control areas have Public Health promotion/usual General Practice care. Two control group outcomes were compared, one EBOP, a high ARF risk (>50 cases/year/105) Whakatane area without SSTS programmes and lower risk (<50 cases/year/105) Western BOP. Case scrutiny permitted re-assignment of ARF cases where schooling outside residential area. Rates calculated for all ages, 5-14yrs, Maori 5-14yrs, gender, with relative rates before/ after programme implementation.

ResultsBOPDHB Maori school pupils 5-14yrs ARF Rates reduced significantly in school intervention programmes 131/105/year to 62/105/year (p=0.0416). Maori boys rates decreased significantly following intervention (p=0.0439), males contributing 72% BOPARF (peak ARF rates pre-intervention >200/105/year). ARF doubled without school interventions (highest ARF risk areas).

ConclusionThis methodology pools three case ascertainment tools, then case note scrutiny derives informed data-base with relevant exclusions/inclusions. BOPDHB School ARF programmes significantly improve ARF outcomes, especially for highest risk Maori boys, while Health Promotion/ usual GP care alone, achieves insignificant ARF rate changes.

References1. Loring B. (2008). Rheumatic Fever in the Bay of Plenty and Lakes District Health Boards: A review of the evidence and

recommendations for action. Toi Te Ora - Public Health Service, Tauranga2. Lennon D, & Peat B. (2009). Evidence-based best practice New Zealand Guidelines for Rheumatic Fever; Guideline 3.

Proposed Rheumatic Fever Primary Prevention Programme NHF, NZ. 3. Lennon D, Moxon Te A, Mills C, Malcolm J, Pennock V, McLean M, Reed P, Poskitt N, Crengle S Jackson C, Rheumatic

Fever Epidemiology Group New Zealand’s Unique Experiment: Primary prevention of rheumatic fever with a focus on schools World Congress Cardiology, Melbourne, 2014.

4. Ministry of Education MOE school rolls (http://www.educationcounts.govt.nz/)5. Lennon D, Stewart J, Farrell E, Palmer A, Mason H, ( 2009) School-Based Prevention of Acute Rheumatic Fever: A Group

Randomized Trial in New Zealand; Paediatric Infectious Disease Journal: 2009;28, 9 p787-794.6. Lennon D, Farrell, E, Anderson P, Gray S, Vogel A, Stewart J, (2011) Wiri Central School Manual of Operations , Primary

Prevention of ARF. 7. Jarman J. (2006). How a community controlled the streptococcus: school -based rheumatic fever primary prevention in

New Zealand. Northland District Health Board, AFPHM Annual Scientific Meeting Auckland

Acknowledgements Patients & their whanau for their Acute Rheumatic Fever, admission Data audited.Pathlab BOP; GAS school sore throat swab analysis 2000-15; Murray Robinson, Lead Scientist. Hauora; Iwi Health Providers; delivering sore throat swabbing and interventions in Schools; Te Wheke Atawhai (Whakatohea) Opotiki, Te Kaokao o Takapau & Tuhoe Hauora (Ngai Tuhoe) Taneatua, Hinepukohurangi Trust Ruatahuna, Te Ika Whenua (Ngati Manawa and Ngati Whare) Murupara, Minginui.


Eastern Bay Primary Health Alliance EBPHA, ARF team delivering to Kawerau, Te Teko, Te Mahoe Schools. Eastern Bay Primary Health Alliance; Clinical Nurse Lead, programme and Sector Group Support, Russell Ingram-Seal analysis Bay of Plenty DHB Funding and Planning; Brian Pointon; Programme funding, 3 providers above, except Ngai Tuhoe which was funded via Ministry of Heath till devolved 2016 to DHB.Bay of Plenty BOPDHB; Director of Maori Health Amohaere Tangitu, Lani Marama Te Kahika Whakahaere Operations Manager discussion re audit; Kelly Orrell, Charille-Ann Schoeman Decision Support Analyst WCF.Medical Information/ Records; EBOP at Whakatane Hospital and WBOP Tauranga Hospital sites. Lakes DHB; Dr Barry Smith, Maori Health Funding, Planning, Maori Research Ethics consultation. Medical, Records for Rotorua admitted Murupara patients Nigel Foote Data Analyst, Drs Neil Poskitt, Rheumatic Fever Register, Rotorua Area Primary Health Services & RGPG Ltd, Dr Johan Morreau Paediatrician, Members Lakes BOP Rheumatic Fever Steering Committee.Toi Te Ora Public Health Service; EpiSurv notifications, Lindsay Lowe, Communicable Disease Nurse, Health Protection Team, Dr J Miller and Dr Phil Shoemack, Medical Officers HealthBOPDHB Clinical School; Summer Studentship for Lead Author 20014-15 & 2015-16

ContributionsLiam Walsh; Pre audit consultations, data-base development, case note scrutiny at 3 sites, analysis, statistics, write-up. Development of methodology with supervisor and statistical advisors, discussion initial dissemination to ARF Sector Group, Funding and Planning & Toi Te Ora Public Health ServiceSandra Ball, ARF Nurse Clinical Lead. Proposals for ARF School Intervention to BOPDHB Funding and Planning, ongoing Clinical Nurse Supervision evaluation of programmes, Staff sector support Thanjon Michniewicz, exploratory analysis Whakatane TLA non-intervention area ARF with JWJames Scarfe, Toi Te Ora Public Health; Excel analysis and initial statistical analysis consultations Janine Wright, University of Otago; statistical analysis and training for Liam W and Thanjon M, John Malcolm, Supervision.



HOME PARENT SUPPORT FOR HIGH-RISK FAMIIES/WHANAU ATTENDING THE INCREDIBLE YEARS® PARENT PROGRAMMEDianne Lees1

1 Clinical Psychologist, Bay of Plenty District Health Board, ICMAHS

BackgroundAntisocial behaviour and adult criminality have their origins in childhood and are best addressed early in the child’s life using evidence-based treatments such as the ‘Incredible Years® Parent Programme’. However, families with additional risk factors do not always make sufficient change while attending such programmes and these families may benefit from additional support. The aim this research was to evaluate the efficacy of adding a structured home parent support (HPS) intervention to improve outcomes for high-risk families attending the Incredible Years Parent Programme (IYP).

MethodsA single blind, randomised controlled trial. Eligible participants were randomly allocated to receive HPS or to the control group of IYP treatment alone. Randomisation was undertaken using a computer-generated sequence in a 1:1 ratio to the two treatments arranged in permuted blocks. Stratification was by age, sex, and ethnicity. Data on standard child behaviour measures was collected at pre- post and six month follow-up. All data was included in the analysis, using an Intention-To-Treat design.

ResultsThere was small additional benefit for HPS at post treatment. At follow-up there was a significant difference between the groups on all measures. Maori responded equally as well. Attendance and retention was greater in HPS and satisfaction was high in both groups.

ConclusionDurable change in child behaviour takes time to establish. Additional benefit of HPS was not evident until follow-up. HPS families were able to maximise the benefits of IYP by having personalised support to address barriers for change, remain engaged, tailor strategies to their families and to implement them successfully. This is an effective addition to IYP to enhance outcomes for the most vulnerable families.


21. Thursday 17 November 2016 11.00am – 11.15am RACP Trainee Research Award for Excellence Presentations

CHILDHOOD OBESITY: ARE PAEDIATRICIANS MEASURING UP?Anna Timmings1, David Jones2

1 Paediatric Basic Trainee, Tauranga Hospital2 Paediatrician, Tauranga Hospital

Introduction Childhood obesity is a growing public health issue in New Zealand. It is estimated that one in three NZ children aged two to fourteen years are overweight or obese. Childhood obesity increases the risk of obesity into adulthood with its associated health consequences. The importance of this is recognised in the recent Ministry of Health’s Childhood Obesity Plan in 2016. One role health practitioners can play is identifying and managing children who are overweight or obese. Our project aimed to determine the prevalence of obese and overweight children attending Tauranga Hospital’s Paediatric outpatient department, and evaluate whether clinicians identify overweight and obese children, provide counselling or refer onto appropriate agencies.

Methods All children aged two to fifteen years that attended Tauranga Hospital General Paediatric outpatient clinic in April 2016 were identified. Anthropometric data was obtained from the clinical record with BMI centiles calculated using the CDC charts. Children were identified as overweight if their BMI was > 85th centile and obese if > 95th centile. Clinic letters were reviewed to determine those children that had a BMI recorded, counselling provided and/or a healthy lifestyle programme/dietitian referral offered.

Results306 children attended clinic and of the 271 children with BMI data available, 14% were overweight and 12% were obese. Of the overweight and obese group (N=67), only 19% of clinic letters documented a BMI, 18% documented counselling and 6% offered referral to a healthy lifestyle programme or dietitian.

ConclusionsOver one in four children who attended Paediatric Outpatient clinic were overweight or obese. This appeared largely undocumented and unaddressed by clinicians. Under the Childhood Obesity Plan, district health boards can expect an increase in referrals for childhood obesity. As leaders in child health, Paediatricians will need to take a more active role in identifying and managing childhood obesity.



IDENTIFYING DEVELOPMENTAL CONCERNS IN PRESCHOOL CHILDREN ADMITTED TO STARSHIP CHILDREN’S HOSPITALR Alekzander1, T Hayward, A Leversha3

1 Kidz First Children’s Hospital2 Auckland City Hospital3 Starship Child Health, University of Auckland

IntroductionScreening and identifying developmental concerns early provides the opportunity for early intervention to achieve the best health outcomes for children and their families. Each interaction with a preschool child represents an opportunity for screening for developmental concerns and delays. The aim of this study was to determine the frequency of developmental screening and assessment for preschool children admitted to Starship Children’s Hospital.

MethodsRetrospective audit of admissions of preschool children to Starship Hospital during a one-month period. Clinical notes were examined to identify the frequency and level of developmental history and assessment, identification of new and existing developmental issues, documentation in the discharge summary, and onward referral to appropriate services. Rates of developmental assessment were compared across demographic characteristics, specialty, whether there was a pre-existing developmental problem, and the presence of a known risk factor for developmental concerns.

Results449 of the 562 children admitted to Starship Children’s Hospital during the study period were eligible for the study. Twenty percent (n=91) children had some level of developmental history, and 9.8% (n=44) had some level of developmental examination documented. Five percent (23 children) had both a developmental history and examination. Assessments were mostly summative (‘no problems’) or one developmental domain only (e.g. ’walked at 12 months’). Only 1 child (0.2%) had both a detailed developmental history and a detailed developmental examination. Māori children and those children living in the most disadvantaged quintile were less likely to have a developmental assessment documented.

ConclusionDevelopmental assessment comprises a key component to paediatric care, however, is rarely undertaken for children admitted to a children’s hospital. Assessment of developmental status occurs in an ad hoc manner even for those with a known risk factor for developmental difficulty or an already existing developmental problem. This represents a significant missed opportunity and is potentially increasing inequities.



CUMULATIVE SOCIOECONOMIC DISADVANTAGE INCREASES THE RISK OF MULTI-MORBIDITY IN EARLY CHILDHOODJin Russell1, Cameron Grant2, Susan Morton1

1 Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland2 School of Medicine, University of Auckland, Auckland Background and AimIn contrast with multi-morbidity during adulthood, the relationship of childhood multi-morbidity with socioeconomic position (SEP) is poorly understood. We aimed to describe early childhood multi-morbidity and investigate the relationship of this multi-morbidity with SEP.

MethodsWithin a large New Zealand child cohort we performed multivariate logistic regression analyses to determine associations of SEP with multi-morbidity (≥2 chronic conditions) at age 2 years, replacing missing values by multiple imputation with chained equations. Mothers were ranked from least to most disadvantaged in five categories according to a SEP index constructed from variables describing maternal education, employment, financial stress, beneficiary status, housing tenure, overcrowding and residential mobility. Independent associations of SEP with multi-morbidity were described using adjusted odds ratios (OR) and 95% confidence intervals (CI) for available cases and imputed cases.

ResultsOf the 6853 children of 6822 pregnant women that established the child cohort, 5737 (84%) mother-child dyads had complete antenatal data and were interviewed at age 2 years. Multi-morbidity was present in 9.7% (370 of 3797) of available cases and 9.95% of imputed cases of the cohort children. Of the 5737 children, the mothers of 42% had none, 31% one, 15% two, 8% three and 5% four or more markers of socioeconomic disadvantage. After imputation and adjustment for multiple confounders, the odds of multi-morbidity varied with SEP. In comparison with the children of women with no indicators of socioeconomic disadvantage the odds of multi-morbidity were increased for the children of women who had ≥4 indicators of socioeconomic disadvantage (OR 1.64, 1.09-2.47).

ConclusionsMulti-morbidity is common in young children. Cumulative social disadvantage increases the risk of multi-morbidity at an early age. Our data imply that chronic disease prevention should start in early childhood, and challenge a single-disease framework health care delivery model.

AcknowledgementsHealth Research Council of New Zealand


24. Thursday 17 November 2016 11.45am – 12.00pm RACP Trainee Research Award for Excellence Presentations

BEYOND FIRST DEGREE HEART BLOCK IN THE DIAGNOSIS OF ACUTE RHEUMATIC FEVERJoshua Agnew1, Nigel Wilson2, Jonathan Skinner2, Ross Nicholson3

1Paediatric Department, Tauranga Hospital, Bay of Plenty District Health Board2 Paediatric Cardiology Department, Starship Children’s Hospital, Auckland3KidzFirst Children’s Hospital, Middlemore Hospital, Auckland

IntroductionFirst degree heart block is a minor manifestation of acute Rheumatic fever (ARF). Advanced AV block (AAVB) and junctional acceleration (JA) occur less commonly.

AimsWe aimed to report patients presenting with these two ECG abnormalities and determine there diagnostic utility in ARF.

MethodsPatients meeting NZ Rheumatic fever guideline criteria for ARF between January 2010 and December 2014 at our institution were retrospectively identified from regional RF Registry and local data. Clinical, haematolgic, electocardiographic and echocardiographic records for these patients were reviewed. ECG’s were considered to show advanced AV conduction abnormality (AAVCA) if there was AAVB (2nd or 3rd degree heart block) or JA. Comparative data for patients with AAVCA without a diagnosis of ARF was also collected from local data.

Results201 patients met inclusion criteria. Seventeen (8%) patients had AAVCA. Five (2%) with AAVB (Three 20HB, one 3oHB) and 12 patients (6%) with JA. AAVCA was associated with a lack of clinical and subclinical carditis, as well as an elevated ESR and CRP. AAVCA was a specific marker of ARF, with a specificity of 99.9%, positive predictive value of 94% and negative predictive value of 98.8%. The QTc was prolonged in 26 (13%) patients, with 13 (6.5%) having QTc > 500msec.

ConclusionsThis large contemporary ARF cohort shows 8% of patients have either AAVB or JA. AAVCA is a specific marker of rheumatic fever, and could be considered as a new Jones major criterion in our population. An ECG showing AAVCA should alert clinicians to consider a diagnosis of ARF in regions where rheumatic fever is endemic. Prolongation of the QTc, sometimes extreme, is a previously underreported feature of acute Rheumatic carditis.


25. Thursday 17 November 2016 12.00pm – 12.15pm RACP Trainee Research Award for Excellence Presentations

MATERNAL MENTAL HEALTH AND SLEEP PATTERNS IN EARLY CHILDHOODYunmi Kim1, Amy Bird 2-4, Cameron Grant 2, 4, 5 1 Starship Children’s Hospital, Auckland District Health Board, Auckland2 Growing Up in New Zealand, The University of Auckland, Auckland 3 Department of General Practice and Primary Health Care, The University of Auckland4 Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland5 Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland

BackgroundAntenatal and postnatal depression is common and mothers with depression are more likely to report infant sleeping problems. However the relationship of ante- and postnatal depression with infant sleep is poorly understood. We aimed to determine if maternal depression was independently associated with infant sleep patterns.

MethodsWithin a child cohort established by recruitment of 6822 pregnant women during 2009-2010 we determined the presence of ante- and postnatal depression at interviews completed during pregnancy and infancy respectively. Child sleep duration and night time awakenings were determined by parental report when the children were two years old.

Maternal depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Maternal demographics, physical health and family relationships; and child health and feeding were measured. Independent associations of maternal depression with child sleep patterns were determined using multivariate logistic regression analysis, and described using adjusted odds ratios (OR) and 95% confidence intervals (CI).

ResultsOf 5568 women for whom both antenatal and postnatal depression were defined, antenatal depression only was present in 487(8%), postnatal depression in 266(5%) and both ante and postnatal depression in 172(3%). Less than the recommended 11 hours sleep each per day and night was reported for 734/6288(12%), and 1062/6313(17%) of children had ≥2 awakenings per night.

After adjustment for maternal, relationship and child factors there was no association between maternal depression (antenatal (OR=1.06, 95%CI 0.77-1.45), postnatal (1.28, 0.86-1.88) or both (1.03, 0.61-1.66) and shorter sleep duration. After adjustment for maternal and child factors, the odds of having ≥2 night time awakenings were increased for children whose mothers had antenatal (1.36, 1.07-1.73) but not postnatal (1.22, 0.88-1.68) or both ante- and postnatal depression (0.89, 0.56-1.36).

ConclusionNeither antenatal nor postnatal depression is associated with the duration of sleep during early childhood. Antenatal depression is independently associated with increased odds of more frequent night time awakenings in early childhood.


26. Thursday 17 November 2016 1.15pm – 2.15pm Concurrent Session 4A

MINDFULNESS WITH CHILDREN: PUTTING EVIDENCE INTO ACTIONGrant Rix

This presentation will explore the emerging evidence base highlighting the case for bringing mindfulness to children, including the evidence for New Zealand’s own unique mindfulness in schools programme; Pause, Breath, Smile. In the interests of ‘putting evidence into action’ this presentation will also invite attendees to engage in short mindfulness practices based on those used with children in schools, which adults such as school teachers have also found to be personally beneficial.


27. Thursday 17 November 2016 1.15pm – 2.15pm Concurrent Session 4B

TIHEI MAURI ORA: ENGAGING MAORI IN HEALTH AND RESEARCHAnna Rolleston

As a health professional how do you make the step from acknowledging a Maori worldview and a Maori model of health, to actively engaging with your Maori patients and research participants within their worldview? How do you integrate aspects of a medical model of service, or a scientific research approach, with principles from the Maori world, when the rules that dictate medicine and science are acultural?

Nau mai, haere mai!


28. Thursday 17 November 2016 2.20pm – 2.35pm Concurrent Session 5A – Free Papers

AETIOLOGY AND COMPARISON OF CLINICAL AND LABORATORY FEATURES IN CHILDHOOD BACTERIAL AND ASEPTIC MENINGITIS – FINDINGS FROM THE UK CHILDHOOD MENINGITIS AND ENCEPHALITIS PROSPECTIVE COHORT STUDY (UK-CHIMES)Natalie Martin1,2, Manish Sadarangani1, Louise Willis1, Rebecca Beckley1, Annabel Coxon1, Dominic F Kelly1, Andrew J Pollard1

and the UK-ChiMES study investigators1Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom2Department of Paediatrics, Christchurch School of Medicine, University of Otago

BackgroundIn the UK, retrospective studies show a decline in childhood bacterial meningitis hospital admission rates following the implementation of conjugate vaccine programmes, and a recent increase in viral meningitis admissions for infants. We undertook a prospective study to assess the current epidemiology.

Methods3000 children were recruited to a prospective cohort study in 31 UK hospitals from December 2012-June 2016. Inclusion criteria: child <16 years hospitalised with suspected meningitis or encephalitis and/or having a lumbar puncture for infection evaluation. Meningitis was defined as isolation of a cerebrospinal fluid (CSF) pathogen and/or CSF white blood cell (WBC) count >5/μL (≥20/μL in neonates). Clinical and laboratory features were compared for children with bacterial and aseptic meningitis. Enterovirus Real-Time Polymerase Chain Reaction (EV RT-PCR) was performed on non-CSF samples.

ResultsOf 2251/3000 children with available data, 592(26%) had meningitis: 128/2251(5.7%) had bacterial meningitis, 259/2251(11.5%) had viral meningitis, 201/2251(8.9%) had no pathogen identified, and 4/2251(0.2%) other cause. Of 946 children, infants with bacterial compared with viral meningitis had higher median CSF WBC (533/μL vs 73/μL, p<0.001) and protein (1.8g/L vs 0.6g/L, p<0.001), lower CSF:plasma glucose ratio (0.29 vs 0.49, p=0.033), higher blood CRP (115mg/L vs 15mg/L, p<0.001), more vomiting (p=<0.001) and non-blanching rash (p=0.039). Children with bacterial compared with viral meningitis had higher median CSF WBC (705/μL vs 15/μL, p<0.001) and protein (0.7g/L vs 0.5g/L,p=0.036), higher blood CRP (143mg/L vs 23mg/L, p=0.001), more fever (p=0.041) and vomiting (p=0.012). Stool samples were EV-PCR+ in 15/15 children with CSF EV+ and pleocytosis, 12/13 with CSF EV+ without pleocytosis and 7/19 with meningitis and no pathogen identified.

Conclusion78% of childhood meningitis was aseptic, with no pathogen identified in 43% of these cases. Some features differentiated bacterial from viral meningitis. In EV meningitis, EV was frequently detected in stool. Better diagnostic tests for meningitis are needed.



INTERMITTENT USE OF INHALED CORTICOSTEROIDS FOR PRESCHOOL WHEEZE – A SYSTEMATIC REVIEWJimmy Chong1, Cheyaanthan Haran1, Bhupendrasinh Chauhan2, Innes Asher1

1 University of Auckland2 The Children’s Hospital Research Institute of Manitoba BackgroundChildren with preschool wheeze represent a diverse clinical population. Although inhaled corticosteroids (ICS) do not alter disease course or prognosis, there may be a role for intermittent therapy in reducing the severity of exacerbations. The aim of this systematic review was to compare the efficacy and safety of intermittent ICS versus placebo in the management of children with preschool wheeze.

MethodsWe searched the Cochrane Airways Group Specialised Register, ClinicalTrials.gov and WHO trials portal up to March 2015. Search results and data were extracted independently by two authors. Randomised controlled trials with a minimum duration of 12 weeks were screened for eligibility. This included children aged 1-6 years, with a diagnosis of asthma, or moderate to severe wheezing. Co-interventions were not permitted other than short-acting bronchodilators. Trials were excluded if participants were on regular ICS medication.

ResultsFour studies (490 children) met the inclusion criteria with study durations between 12 to 52 weeks. The use of intermittent ICS at the onset of early symptoms reduced the likelihood of requiring rescue oral corticosteroids by a third (RR: 0.66; 95% CI 0.52, 0.84, I2 = 0%), NNT of 7 (95% CI 5 to 14). Improvements in day and night time symptom scores similarly favoured ICS (p<0.05). However, there was no statistical difference in hospitalisation rates. Treatment was not associated with any significant increase in adverse events.

ConclusionIntermittent use of ICS in preschool children with wheeze appears to improve symptoms and reduce the use of oral corticosteroids. Further investigation of this approach is warranted.



HOW DOES RHEUMATIC FEVER AFFECT THE HEART?Alison Leversha*1, F Mahony2, K Sullivan3

1 Starship Child Health, University of Auckland2 Starship Child Health, Auckland City Hospital3Digital Design Student, Design and Wellbeing Lab, Auckland University of Technology/Auckland City Hospital

BackgroundRheumatic Fever (RhF) and Rheumatic Heart Disease (RHD) rates are at third world levels in Māori and Pacific young people in New Zealand. We have a variety of resources to explain what RhF is, but have not checked back with young people about their understanding of the condition. The aim of this study was, therefore, to explore what young people know about RhF and how it affects their heart, and then amend or develop resources as appropriate.

MethodsA mixed method study was undertaken including 2 focus groups: 1) young people still at school and 2) young people who had left school and had poor adherence to bicillin. A design student at the Design and Wellbeing Lab at Auckland City Hospital was engaged to develop an animation which captured the concept of rheumatic heart disease and illustrated this is a simple, informative and engaging way. The resulting animation was tested, tweaked and retested with groups of young people, parents, nurses and clinicians. Further feedback was obtained during HYPE: a RhF day attended by over 60 young people with RhF.

ResultsKnowledge regarding RhF and heart health was variable even in the young people who had had rheumatic valve repair or replacement. Most students had seen the heart foundation leaflet and many reported confusion. Students overwhelmingly reported the animations were easier to understand than static pictures: 72% thought the animation was ‘far better’ than static pictures. 74% of students reported they were very good or fantastic in demonstrating how RhF affects the heart. A similar percentage preferred the combination of animation and conversation as the method of relaying information over talking alone, static pictures, existing educational leaflets, or doctor’s scratchings on paper.

ConclusionOur current health resources are missing the mark. Checking back with young people facilitated the development of an innovative educational resource.



PAEDIATRIC CLINIC LETTERS: ARE WE SENDING THEM TO FAMILIES AND CAN THEY UNDERSTAND THEM?Sarah Liley1, Su Min Nam1, Jun Young Kim1, Joanna Woo1, Young-Min Lee1, Alexandra Wallace1,2

1 Waikato Clinical School, University of Auckland2 Department of Paediatrics, Waikato Hospital

BackgroundPatient memory of medical information is poor, with 40-80% forgotten immediately and almost half remembered incorrectly (Kessels 219). Thus, clinic letters are an important component of health care, but to be useful they must be easily understood. At Waikato hospital, paediatric clinic letters are sent to General Practitioners; families are not always copied in. This project was undertaken to assess how often clinic letters are sent to families, and the readability of these letters.

MethodsLetters for all paediatric clinics attended in the first week of May 2016 were included. Whether letters were copied to families, and the readability of each letter, assessed using the Flesch Reading Score, were recorded. An acceptable Flesch Score was defined as >60, equating to a reading age of 13-15 years or below. In addition, parents/caregivers completed a survey assessing the importance they place on receiving clinic letters, and how easy they find them to understand.

Results102 patients attended a paediatric clinic at Waikato hospital in the study timeframe; letters were written for 91 (89%). 68 (75%) families were copied into letters. Consultants were more likely to send letters to families than registrars (82% vs 47%, p<0.01). The mean Flesch reading score of all letters was 54.3; consultant letters scored higher than those written by registrars (55.8 vs 48.7, p=0.001). 39 parents/caregivers completed the survey, 37 (95%) of whom wished to be sent a copy of their child’s clinic letter. Of 30 (77%) who had received at least one clinic letter previously, 24 (80%) found them easy to understand.

ConclusionMost clinic letters are copied to families, but sending letters to families automatically unless the clinician specifically requests otherwise would improve the frequency with which this occurs. Parents/caregivers value receiving clinic letters and found them easier to understand than predicted by the readability tool used.

ReferenceKessels, Roy PC. “Patients’ memory for medical information.” Journal of the Royal Society of Medicine 96.5 (2003): 219-222.


32. Thursday 17 November 2016 2.20pm – 3.20pm Concurrent Session 5B

CULTURE SHOCK - REFLECTIONS FROM PALLIATIVE CAREGemma Aburn, Jess Jamieson, Emily Chang

What do we mean by ‘culture’ and how does it influence palliative and end of life care? Using clinical experiences of the Starship palliative care team and research findings, this session will focus on how ‘culture’ affects the viewpoints, emotions and interactions between children, their families, and health care professionals -sometimes in unexpected and confronting ways.


33. Friday 18 November 2016 8.00am – 8.15am Concurrent Session 6A

PARENTAL GAMBLING AND CHILD HEALTH OUTCOMES: EVIDENCE FROM GROWING UP IN NEW ZEALANDCaroline Walker1, Sarah Berry1, Jatender Mohal1, Fiona Rossen2, Cameron Grant1,3,4, Susan Morton1

1Growing Up in New Zealand, Centre for Longitudinal research, School of Population Health, University of Auckland2Department of Social and Community Health, University of Auckland.3Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland4General Paediatrics, Starship Children’s Hospital, Auckland District Health Board

BackgroundThe harmful effects of gambling on the gambling participant, the wider family, and society are well established. However, the effect of parental gambling on child health is unknown. Our objective was to determine if gambling intensity of parents is associated with their child’s health.

MethodsWe utilised New Zealand’s contemporary child cohort study Growing Up in New Zealand into which were enrolled 6853 children born in 2009-10. When the children were nine months old gambling intensity of each parent was determined by assessing the frequency and weekly expenditure on gambling activities in the past 12 months. Parent reported child health outcomes examined included ear infections, chest infections, injury requiring medical care, immunisation completeness and child behaviour (assessed with Strengths and Difficulties Questionnaire).

Logistic regression models were created to determine if gambling intensity was independently associated with child health outcomes after adjustment for parental demographics, socio-demographics, health and wellbeing, and home environment. Associations were described using adjusted odds ratios (OR) and 95% confidence intervals (CI)

ResultsApproximately half (54.7%) of all mothers and almost two-thirds (64.7%) of partners had gambled on at least one activity in the last 12 months. In comparison with non-gamblers, low-intensity gambling (≤monthly) by mothers or partners was associated with increased likelihood of their child having ear (mothers: OR=1.22, 95%CI 1.06-1.39; partners: OR=1.20, 1.03-1.39) or chest infections (mothers: OR=1.16, 1.01-1.33; partners: OR=1.27, 1.09-1.48). Low-intensity gambling by mothers and moderate-to-high intensity (>monthly) gambling by partners was associated with increased likelihood of their child having incomplete immunisations (mothers: OR=0.72, 0.51-0.99; partners: OR=0.72, 0.51-0.99). Low-intensity gambling by mothers was associated with increased likelihood of their child having behavioural problems (OR=1.58, 1.12-2.22).

ConclusionGambling intensity of mothers or their partners is associated with several adverse child health outcomes at 2 years of age.



ONE YEAR REVIEW OF ENGAGEMENT IN HEALTH RECOMMENDATIONS MADE FOLLOWING GATEWAY ASSESSMENT FOR CHILDREN IN CAREJoevy Lim1, Sneha Sadani21 University of Auckland2 Waikato DHB

BackgroundThe Gateway program was developed to identify and address the physical, developmental, mental, educational and social needs of children who come in to contact with Child, Youth and Family (CYF) that have not previously been recognised or attended to. Recommendations are made following a comprehensive assessment and an Interagency Service Agreement (ISA) document is formed, which outlines services responsible for each recommendation.

This audit was carried out to identify the number of health recommendations children engaged with at one year from the Gateway assessment and the breakdown of agencies involved in providing health services.

MethodsThe ISA’s of children assessed through Gateway at Waikato Hospital between 1st February and 30th April 2015 were reviewed. Information on the outcome was gathered from social worker e-mails, the National Immunisation Register, the clinical workstation and the children’s case files. The primary outcome was engagement in health services recommended. The outcomes were documented as engaged, not engaged or unaccounted for.

Results135 health recommendations were identified in the 64 children assessed. 80 health recommendations were DHB agencies and 55 were caregiver responsibilities. At the time of assessment, there was engagement with 74 health recommendations. 11 out of the 16 groups of agencies measured 50% or more in engagement. 4 out of 16 agencies had a 100% engagement at one year. These agencies were Paediatric Medicine, DHB Immunisation, Community Audiology and GP Immunisation. Out of the DHB agencies, Primary Mental Health had the highest number of referrals but the lowest engagement.

ConclusionChildren requiring the input of CYF are vulnerable and have many health needs that are not met. Gateway assessments are effective in identifying and addressing these needs. However, more work is required in interagency communication and cooperation to achieve all the health recommendations to ensure the best outcomes for these children.

KeywordsChild Youth and Family (CYF), Gateway, Interagency Service Agreement (ISA)


35. Friday 18 November 2016 8.00am – 8.15am Concurrent Session 6B

THE CAUSES OF LONG HOSPITALISATIONS IN NEW ZEALAND CHILDRENJudith Adams1, Liz Craig 2, Nigel Dickson3

1 New Zealand Child and Youth Epidemiology Service, University of Otago2 Department of Women’s and Children’s Health, University of Otago3 Department of Women’s and Children’s Health, University of Otago

BackgroundIt is now rare for a child, other than a premature baby, to stay in hospital for more than a few days. Nevertheless, the children who have lengthy hospital stays use a significant proportion of children’s hospital bed days. This study aimed to investigate the reasons for lengthy hospital stays in children aged 29 days to 14 years, through an analysis of New Zealand’s National Minimum Dataset for the period 2003 to 2012.

MethodsRates of total hospitalisations and total hospital bed days used by length of stay were calculated. The most common diagnoses associated with longer and shorter lengths of stay were determined.

For each of the seven conditions identified as being among the most common reasons for long hospital stays (21+ days) the distribution of lengths of stay was explored to determine whether long stays were usual or exceptional.

ResultsNeonates used almost 40% of all children’s hospital bed days. For other children, most admissions lasted only one or two days, however the 3.6% of admissions that lasted seven days or longer accounted for 26% of all bed days and the 0.61% of admissions that lasted 21 days or longer accounted for almost 13% of all bed days. The most common causes of long (21+ days) admissions are injuries including burns, cancer, congenital abnormalities, mental and behavioural disorders, osteomyelitis and pyogenic arthritis, and acute rheumatic fever or chronic rheumatic heart disease. Long hospital stays are usual for children admitted with cystic fibrosis, acute rheumatic fever and osteomyelitis or pyogenic arthritis.

ConclusionThe most common reasons for lengthy hospital stays in children are serious conditions which are not all preventable given the current state of medical knowledge.


36. Friday 18 November 2016 8.15am – 8.30am Concurrent Session 6B

STARSHIP PAEDIATRIC EARLY WARNING SYSTEM: IS IT FIT FOR PURPOSE?Greg Williams1, Claire Sherring1, John Beca1, Stuart Dalziel1

1 Starship Children’s Health

BackgroundFollowing involvement in an international cluster randomised trial of a Paediatric Early Warning Score (PEWS) system, Starship hospital moved from using a standard observation chart to a comprehensive PEWS chart. In 2014 we designed the Starship PEWS chart to include recently published population data of physiological norms for hospitalised children, and to improve overall usability of the chart. After implementing this new PEWS chart we undertook an audit to assess compliance,, analyse performance of the chart for patients that generated Code calls, and compare outcomes with what would have happened if we had retained the previous system.

MethodsChart audit of 384 inpatient records encompassing a 12 month period from 1/7/2014 – 30/6/2015. All 186 charts were analysed for patients who generated a Code Blue or Code Pink emergency call. 198 charts were randomly selected, age matched, and analysed for comparison, for patients who did not require a Code, call. Data was gathered for a 24-hour period from each chart. We undertook descriptive statistical analysis.

ResultsStarship PEWS chart recordings were completed accurately 40% of the time, mainly limited by missing observation data items. When charts were completed accurately, recommendations were followed 98% of the time. For patients with a Code, the PEWS was elevated prior 88% of the time. Of all scores analysed, 61% were low (<4), 17% moderate (4-5), and 21% high (>5).

ConclusionWe identified poor compliance with PEWS score completion. When accurately completed, PEWS recommendations were almost always followed. We will discuss barriers and solutions to score completion. The new Starship PEWS appears safe, identifies patients at risk of physiologic deterioration, and avoids inappropriately escalating care for patients at low risk for deterioration.



FROM AWARENESS to RESILIENCE and COMPETENCEHelen Holmberg

Professional supervision is often misunderstood so seldom effectively utilised. It should cover how you ‘show up’ when you approach and react to your work.

This session will be a facilitation of self-reflective practise. Some pointers to help develop critical thinking will also be covered.

We’ll cover how to recognize poor supervision. And how to seek out and use competent Supervision.

What it will not be:• Death by power point.• Yet another stress management presentation.• Involving role plays (unless by popular demand!).

What it will be:• Practical and useful• Insightful (hopefully)• Evidence based


38. Friday 18 November 2016 8.35am – 8.40am Rapid Fire Posters 7B

A REVIEW OF THE TRANSITION PATHWAY FOR YOUNG PEOPLE WITH BRONCHIECTASIS FROM PAEDIATRIC TO ADULT RESPIRATORY SERVICES IN THE GREATER AUCKLAND REGIONAlana Ainsworth1,2, Bridget Farrant 1,2 Naveen Pillarisetti 2,3 Catherine Byrnes 2,3

1 Centre for Youth Health, Kidz First Children’s Hospital and Community Health, Auckland, New Zealand2 Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand3 Department of Paediatric Respiratory Medicine, Starship Children’s Hospital, Auckland, New Zealand

Background:Bronchiectasis remains a significant health problem in New Zealand with increasing numbers of children diagnosed. Good quality transition from paediatric to adult services is important to ensure appropriate follow-up and disease management. CMDHB has had an established transition pathway from Starship to adult services since 2008. Transfer to the ADHB/WDHB adult services is by written referral. The aim of this review is to assess if having a dedicated transition pathway improves ongoing pateint engagement.

Methods:We reviewed the Starship Bronchiectasis Database and identified 76 young people born between 1990 and 1999 who transitioned from Starship Bronchiectasis Clinic to adult respiratory services. Their hospital medical records were reviewed and GP contacted to ascertain engagement in ongoing medical care.

Results:Median age at transition was 16.6 years (range 13-18.8) with the median time since transition of 4.4 years (range 0.3-12.5). 15(19.7%) were discharged directly to their GP, 37(48.7%) transitioned to CMDHB, and 24(31.6%) to ADHB/WDHB services. All of the 37 young people transitioned to CMDHB had at least one adult respiratory review (median 6 clinics) and 11(29.7%) currently remain under respiratory services. Of the young people transferred to ADHB/WDHB services, only 15(62.5%) were seen at least once (median 2 clinics) and 6(25%) initially referred remain under the respiratory service.

Since transition 5/37(13.5%) transitioned to CMDHB died. 19/37(51.4%) transferred to CMDHB were discharged. The reason for discharge included DNAs(8), stability(5), moved area(4) and normal repeat scans(2). 14/24(70%) of those transferred to ADHB/WDHB were discharged because of DNAs.

The GP was contacted for 24 young people in CMDHB and their median number of reviews in the past 12 months was 4(range 0-14).

Conclusion:An established transition pathway for young people with bronchiectasis, appears to improve linkage and retention with the adult respiratory services.



PSYCHOLOGICAL AND PHYSICAL HEALTH DURING PREGNANCY: ASSOCIATIONS WITH ADVERSE BIRTH OUTCOMESAmy Bird 1,2, Cameron Grant 1,3-5 and Susan Morton 3,4

1Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand2Department of General Practice and Primary Health Care, The University of Auckland, New Zealand 3Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand4Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand5Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand BackgroundAdverse birth outcomes of low birth-weight (LBW) and pre-term birth (PTB) have consequences for both infant mortality and longer-term child development. Although a range of maternal pregnancy health indicators have been associated with increased risk of adverse birth outcome among high-risk populations, we know far less about how risk factors cluster together in the general population. Our aim was to describe a range of pregnancy physical health risks, including maternal depression, and examine associations with adverse birth outcomes among a broadly representative sample of contemporary New Zealand children.

MethodsWe enrolled a sample of 6,822 pregnant New Zealand women living in the Auckland and Waikato regions during 2009-2010. We assessed a number of maternal health indicators including smoking, alcohol use, BMI and weight change, and depression. Birth weight (LBW < 2500g) and pregnancy gestation (PTB <37 weeks gestation) were determined via linkage with maternity hospital perinatal databases. Associations were described using adjusted odds ratios (OR) and 95% confidence intervals (CI).

ResultsWomen with a doctor-diagnosed physical illness, who continued to smoke or consume alcohol, who had a BMI in the overweight or obese range, who failed to gain weight during pregnancy, or who had elevated Edinburgh Postnatal Depression Scale (EPDS) symptoms and/or doctor-diagnosed depression were at increased risk of LBW or PTB. Multivariable regressions indicated a significant association between depression and birth outcomes after adjusting for socio-demographic variables, and physical health risks.

ConclusionUsing a large population cohort with comprehensive measures of both physical and mental health also allowed us to demonstrate that the association between depression and adverse birth outcomes is not simply due to increased risk of poorer physical health. Pregnancies at particular risk are those where mothers have depression, a physical illness, continue to smoke and consume alcohol, elevated BMI or fail to gain weight.



ANTENATAL SMOKE EXPOSURE AND RESPIRATORY OUTCOMES TO 12 MONTHS OF AGEJenny Chung1,2, Anna De Beer1,3, Phil Weston4, Alexandra Wallace1,5

1 Waikato Clinical School, University of Auckland2 Auckland District Health Board, Auckland3 Waikato District Health Board, Hamilton4 Neonatal Intensive Care Unit, Waikato Hospital5 Department of Paediatrics, Waikato Hospital

BackgroundAntenatal smoke exposure has been associated with increased rates of rehospitalisation for preterm infants in the first year of life.1 19.5% of pregnant women in Waikato report smoking during pregnancy compared to 15% nationwide.2 Furthermore the incidence of neonatal chronic lung disease is greater in Waikato compared to the national average (37.3% cf 24.1%).3 This audit was undertaken to investigate an association between antenatal smoke exposure and rates of chronic lung disease and subsequent respiratory-related admissions in preterm infants.

MethodsClinical records of infants born ≤32 weeks at Waikato Hospital from 1st January to 31st December 2013 and their mothers were reviewed. Data collected included antenatal smoking status, ethnicity, pregnancy and delivery details, neonatal respiratory support, and subsequent respiratory admissions in the first year of life. Outcomes were compared in antenatally smoke-exposed and non smoke-exposed babies.

Results55 infants of 50 mothers were included. Maternal smoking status was documented in all antenatal notes and 25 (46%) neonatal notes. 25 (50%) mothers smoked during pregnancy, of which 13 (52%) were of Maori or Pacific ethnicity, compared to 2 (8%) non-smokers (p=0.001). 28 (51%) infants were smoke-exposed antenatally. There were no differences between smoke-exposed and non smoke-exposed infants for gestational age, sex, birth weight, duration of respiratory support, or incidence of chronic lung disease. 18(33%) infants were readmitted with a respiratory illness in the first year of life. Of these, 12 (67%) were antenatally smoke-exposed (p=0.089).

ConclusionThis study revealed poor documentation of antenatal smoke exposure in neonatal notes and high rates of smoking in pregnancy for Maori and Pacific mothers. An association between antenatal smoke exposure and poorer respiratory outcome in the first year of life could not be confirmed in this cohort. Further work is planned to investigate this association in a larger cohort of babies from the Waikato.

1. Ralser E et al. Acta Paediatrica, 2012.2. Ministry of Health New Zealand, Maternity tables 2013, 2015.3. Chow S et al. Report of the Australian and New Zealand Neonatal Network 2013, 2015.



CHILDHOOD OBESITY – E-GROWTH CHART MONITORING IN SECONDARY CAREGloria Dainty, David Reith, Barry Taylor Department of. Paediatrics and Child Health, Dunedin School of Medicine, University of Otago and Southern DHB

BackgroundChildhood obesity has been identified as a leading health issue for New Zealand children. The Southern District Health Board anthropometry database is an electronic growth monitoring module set up in 2010. This study aimed to look at how the e-growth module has been used as well as describe obesity prevalence in children presenting to secondary care. We also aimed to describe the management of obese children by the clinical team in terms of diagnosis, investigation and management plans.

MethodsAfter obtaining ethics approval, all the records collected between 19/07/2010 – 16/07/2015 in the SDHB anthropometry database were examined. Records were extracted after matching to demographic and clinical setting data from the hospital IPM system. Clinical records were analysed for obese children regarding clinical management.

Results30,670 data entries were downloaded for analysis, representing 8,551 children. Use of the database had increased over time. The highest rates of data collection were from the outpatient department (44% of available encounters), with inpatient collection being much lower (11%).

Obesity prevalence was comparable to national rates with increased odds ratios for obesity in Maori (OR 1.7 CI 1.3 – 2.1) and Pacific Island (OR 2.5 CI 1.6 – 3.7) children.

Of the 333 obese children whose clinical records were reviewed, 45% received an obesity diagnosis. Of those diagnosed 25% had investigations performed and management plans were given to 73%. Investigations and plans however, often varied from recommended practice. There was a trend toward decreased rates of clinical intervention in the Maori and Pacific Island children.

ConclusionThe introduction of an anthropometry database in the SDHB has been successful with increased uptake over time. Inequalities between demand and provision for Maori and Pacific Island children have been highlighted. Clinicians may benefit from additional education regarding classification of obesity, populations at risk, suitable investigations and management options.



AUDIT OF HIP SURVEILLANCE IN CHILDREN WITH CEREBRAL PALSYGiri PratimaKidz First Children’s Hospital, Middlemore, Auckland

Background:Hip surveillance aims to identify and monitor early critical indicators of progressive hip displacement. 30-60% of children with cerebral palsy (CP) not walking at five years develop subluxation or dislocation. Hips are normal at birth in CP but displace due to asymmetrical muscle activity and reduced load bearing on bones. Hip displacement causes pain and influences the ability to sit and manage hygiene. Most recent guidelines of hip surveillance in children with CP are predominantly based on assessments of Gross Motor Functional Classification System (GMFCS) levels and Reimers’ migration percentage (MP).

Methods:We audited Hip surveillance in children with CP at Kidz First Outpatients between July 2013 to June 2014. We used the Australian Hip Surveillance Guidelines, 2014 based on GMFCS levels as our audit tool. We reviewed the medical and radiology record including the first-ever hip X-ray and X-ray in the year of the audit.

Results:71 children were reviewed in the outpatients between July 2013-June 2014. GMFCS levels were reported in 25/71 (35%) children. 19/68 (26.8%) had the first-ever surveillance hip X-ray performed within first 24 months of life, 49/68 had their first hip X-ray after two years of age, including some children who had had their first X-ray well into school age. In the year of the audit, surveillance hip X-ray was performed in 45/49 (91%) children when it was indicated. MP was reported in 5/45 (11.11%) children. 64/71 (90.1%) children had an orthopaedic review.

Conclusion:There was a delay in the first hip surveillance X-ray in this group of children. Most children had their hip surveillance X-ray in the year of the audit. GMFCS levels and MP were under-reported in our audit. As per current guidelines, these should be an integral part of ongoing hip surveillance in children with CP.



HOW DO ADOLESCENTS, PARENTS, AND HEALTHCARE PROFESSIONALS VIEW CONFIDENTIALITY?Rebecca Kerry1, Kendall Crossen1

1. Tauranga Hospital, Tauranga

Please note, this is currently an incomplete audit, data collection and analysis has been completed for adolescents and parents already. This audit has now been extrapolated to include the views of healthcare professionals. This data is being collected in August 2016 and the results will be analysed well in time for the conference.

BackgroundConfidentiality is a cornerstone of medical ethics. Adolescents who perceive healthcare is not confidential often forego healthcare. The purpose of this study was to compare adolescents, their parents and their healthcare professionals understanding of what confidentiality means with regards to adolescents.

MethodsAdolescents (age 12-18) and their parents were asked their opinion of confidentiality as part of the Tauranga Adolescent Friendly Hospital Survey over a 5 week period in 2015. Data was collected in Outpatient, Inpatient and the Emergency Department settings at Tauranga Public Hospital, New Zealand.

Healthcare professionals were asked their opinion via an online survey. All data collected was anonymous.

ResultsOf 800 eligible candidates, 319 (40%) adolescents and 230 (29%) parents completed the survey. 46% and 55% of adolescents identified the correct hospital policy on confidentiality within inpatient and outpatient settings respectively. Parents were correct 41% and 52% of the time in the same settings.

XXX (X%) of 1693 healthcare professionals who form part of the adolescent treating team at Tauranga Hospital completed the online survey (results are currently being collected). X% of healthcare professionals identified the correct hospital policy on confidentiality.

ConclusionA significant proportion of adolescents and parents do not understand confidentiality. As healthcare professionals we have a duty of care to not only provide access to confidential services, but also to explain these rights to adolescents and their parents, in order to improve the doctor-family relationship.



INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN IN TONGAFlora Lutui1, Cameron Grant2 3, Emma Best2 4, Stephen Howie2 5, George Aho1 1Department of Paediatrics, Vaiola Hospital, Tonga (FL, GA); 2Department of Paediatrics: Child & Youth Health, University of Auckland; General Paediatrics3 and Infectious Diseases4, Starship Children’s Hospital; and Paediatrics & Newborn Services5, Waitakere Hospital, Auckland, New Zealand.

BackgroundIn Tonga the pneumococcal conjugate vaccine (PCV) is not a scheduled immunisation yet. We aimed to describe the epidemiology of invasive pneumococcal disease (IPD) in children in Tonga.

MethodsWe completed a retrospective review of children <15 years old admitted with IPD to Vaiola Hospital (the sole hospital on the main island Tongatapu) from 2010 to 2013. To identify IPD cases we used hospital discharge diagnosis and microbiological laboratory data. We identified all children with an ICD-10 codes for meningitis (G00.1-G03.9), pneumococcal sepsis and pneumonia (A40.3, J13). Hospital laboratory record books were reviewed to identify blood, cerebrospinal (CSF), and other body fluid samples from which Streptococcus pneumoniae was cultured.

A case was defined as any child <15 years old with S. pneumoniae isolated from normally sterile body fluid. Because of laboratory capability variability we used a second case definition of highly likely IPD, defined as clinical meningitis, with CSF microscopy indicative of bacterial meningitis and gram positive diplococci on gram stain of CSF or blood.

ResultsThere were 28 cases of IPD in 26 children, one child had 3 episodes. Twenty-four were culture positive for S. pneumoniae and four, with clinical meningitis, were highly likely IPD. Of the 5 who died, 4 had meningitis and one had sepsis.

The average annual rate (95% CI) per 100,000 person-years was 113 (68-177) for children <2 years, 50 (31-77) for children <5 years and 25 (17-36) for children <15 years. The case-fatality rate for children <5 years old was 25%.

ConclusionIPD incidence in Tonga is comparable to that reported from other Pacific nations prior to their introduction of PCV (NZ 110/100,000 <2 years, 56/100,000 <5 years, 22/100,000 <15 years; Fiji 26.5/100,000 <5 years). The incidence rate and high case-fatality rate indicate the need for PCV in Tonga.



ENGAGEMENT WITH ORAL HEALTH SERVICES: AN AUDIT OF PRESCHOOL-AGED PAEDIATRIC INPATIENTSOlive Ngan1, Polly Atatoa-Carr1,2, Tracy Jackson3, Alexandra Wallace1,4

1 Department of Paediatrics, Waikato Hospital, Hamilton 2 National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton3 Rural and Community, Waikato District Health Board, Hamilton4Waikato Clinical School, University of Auckland

BackgroundSince mid-2015, Waikato DHB has delivered a comprehensive opportunistic screening tool, Harti Hauora, to all inpatients within Child Health Services at Waikato Hospital, with the aim of improving wider health outcomes for tamariki and their whanau. One of the areas assessed is oral health. Children who are reportedly not enrolled with oral health services, or those found to have poor dentition using a “Lift-the-Lip” assessment, are referred to Community Oral Health. The aim of this study was to assess the implementation of this aspect of the Harti Hauora tool, and its impact on oral health outcomes.

MethodsA retrospective chart review was conducted on children aged 0 – 5 years admitted to Waikato Hospital’s paediatric medical and surgical wards in July and August 2015. Completed Harti Hauora forms were collated and reviewed. Enrolment status with Community Oral Health was verified using the iPM and DentIS databases.

ResultsOf 433 admissions, 369 (85%) had a Harti Hauora form completed. Of the 206 patients who reported no enrolment with oral health services, or unsure, 52 (27%) were referred to Community Oral Health on the ward, 3 (1.5%) were provided with a list of dentists, 44 (21%) chose not to be enrolled, and 107 (52%) had no action taken. Of 55 referred for enrolment, 47 (85%) are now enrolled with Community Oral Health. 309 (84%) children were assessed for dental decay using the “Lift-the-Lip” tool. Of these, 16 (4%) had dental decay identified, with 4 of these (25%) referred for treatment.

ConclusionAlthough the Harti Hauora tool is being utilised for most paediatric inpatients, there are missed opportunities for intervention and primary prevention. This audit of inpatient opportunistic screening has identified quality improvement processes for the next iteration of the tool in order to optimise oral health outcomes.



ADOLESCENT AND WHĀNAU PERCEPTIONS OF THEIR HOSPITAL EXPERIENCEMelanie Steedman, Nigel Calder University of Waikato

BackgroundThere is growing recognition that adolescents have particular needs that are not always addressed by health care providers. Some studies have found that an adolescent orientated environment is associated with shorter stays, decreased psychological morbidity and improved control of chronic illness among adolescent patients. The purpose of this study was to determine adolescents and their parents’ perceptions of the healthcare provided by a large provincial city hospital.

MethodsAll patients aged 12 to 18 (and their whānau) presenting to the hospital over a 5-week period were invited to participate, except for those attending the Child and Adolescent Mental health unit. The questionnaire was based on the Royal Children’s Hospital Melbourne Adolescent Friendly Hospital Questionnaire. This paper reports on the open-ended question while simultaneously referencing the quantitative aspects.

ResultsInteractions with staff and an age-appropriate environment were highly important aspects of receiving appropriate care for adolescents and their caregivers. Overall, adolescents and their parents reported a high level of friendliness and respect from staff members. However, staff did not always provide the level of communication and privacy informants expected. Many adolescents appeared to struggle in environments designed for children or adults. Adolescents who had access to environments designed for them appeared to thrive. The data also indicated that caregivers held different expectations regarding their involvement in medical appointments.

ConclusionA greater commitment to quality communication and patient privacy coupled with adjustments to the hospital environment would address the majority of concerns raised. Age-appropriate environments should include consideration of adolescent needs for privacy, access to the Internet, age-appropriate resources and opportunities to mix with same-age peers.



WHAT’S FOR DINNER? RELATIVE AND ABSOLUTE DIFFERENCES IN FOOD PRICESMavis Duncanson1, Grace Boston2, Dr Winsome Parnell3, Dr Jean Simpson1

1 New Zealand Child and Youth Epidemiology Service, University of Otago2 Dunedin School of Medicine, University of Otago3 Department of Human Nutrition, University of Otago

BackgroundWomen with children experiencing food insecurity report difficulty affording healthy food and express concern that high fat processed food and sugar sweetened beverages are often less expensive than fresh fruit, vegetables and meat. The New Zealand food price index monitors changes in price of various food items relative to their price in 2006. This presentation will examine how prices of food items have changed over time and consider how this may impact on the diet of children and young people in New Zealand.

MethodsAnalysis of data from the 2016 Food Price Index to identify for which goods prices have remained most similar to 2006 and which goods have had the greatest relative increase in price. Weighted average retail prices in June 2016 were used to compare absolute differences in price of food items at that point in time.

ResultsThe price of pastry goods such as pies, sausage rolls and custard squares increased 5% from 2006 to 2016, the price of processed meat increased around 10% whereas the price of beef and veal increased by 50%. The largest single rise of 65% was seen for fruit. The least expensive single item in the June 2016 list of weighted average retail prices was white bread and the most expensive items were fresh meats. At $3.98 a hot meat pie was the least expensive item in the ‘ready-to-eat’ food subgroup.

ConclusionIncreasing disparities in the relative prices of foods is likely to have contributed to material hardship and food insecurity in New Zealand. For households with children highly processed foods may be the most economic food choices, and may be the only choices available to those living in income poverty.



APP DEVELOPMENT 101: HACKATHON, NZHIH, MVP, SPRINTS AND SCRUMS A Leversha1, F Mahony2, A Hudgell3, N Meredith4, A Ko4, D Marsh4, A Scroggins5, and M Sinnock5

1 Starship Child Health, University of Auckland2 Starship Child Health, Auckland City Hospital3 Planning and Funding, Auckland District Health Board4Co-design group, Auckland5 Enspiral Services

BackgroundSecondary prophylaxis with IM Bicillin every 28 days is key to preventing recurrence of Rheumatic Fever (RF) with worsening Rheumatic Heart Disease (RHD). Bicillin adherence is excellent whilst young people with RhF are at school but rapidly falls to less than 50% as a young adult. The aim of this project was to work with young people to develop an app which would assist with self-care and promote on-time administration of bicillin.

MethodsApp concept developed during self-care hackathon. Enspiral services contracted via NZHIH to develop the app using a series of co-design workshops with young people. The tools and resources: a Facebook group, angular framework, health information security framework, the health information privacy code and some willingness from a friendly DHB CIO, solution architect and new friends along the way.

ResultsYoung people were actively involved throughout the development of the app leading to several learnings and innovations. The co-design process elicited how much young people wanted non-confrontational ways to express their experience of the injections. The application therefore has an injection rating system that can anonymously give feedback to nursing staff about their experience. A working application 2.5 months from the start of development, ready for trial with core functionality working and working well. Young people can request and book their appointments, contact clinical staff (without having to remember any phone numbers), rate their injections, plan ahead, and see how their ‘protection’ against Rheumatic Fever stacks up.

ConclusionYoung people with RhF are keen to collaborate with health professionals on the design of health services for RhF disease management. Our process allowed friendships to develop and reminded us all of the importance of community as our co-design youth enjoyed the experience of meeting others ‘like me’ and working together to create a functioning app.


50. Friday 18 November 2016 9.40am – 10.40am Plenary 3

21ST CENTURY SYSTEMS OF CAREJane Burns, Tracey Davenport, Ian HickieFaculty of Health Sciences and Brain Mind Centre


51. Friday 18 November 2016 11.10am – 12.10pm Concurrent Session 8A

JAZZ AND JEDIS: THE ART AND SCIENCE OF DECISION MAKINGJustin Wilde

In recent years, there has been a greater appreciation of the need to teach reasoning skills to clinicians. Medicine is both an art and a science, and clinicians are faced with large knowledge gaps and areas of uncertainty. Using examples from both art and science, this talk presents some key concepts that can help us understand clinical reasoning.


52. Friday 18 November 2016 11.10am –11.25am Free Papers

CONVERSATIONS ABOUT REALISTIC EXPECTATIONSFiona MilesPICU Starship Hospital, Auckland DHB

BackgroundChildren with chronic or life limiting illness admitted to intensive care units often do not have clear advance plans about which treatments are, or are not, appropriate for that particular child. This results in whanau/families participating in difficult decision making at a very stressful time. This study aimed to ascertain whether paediatricians consider themselves to be the appropriate, trained person to initiate conversations about advanced treatment plans with families of children who have chronic or life limiting conditions and also to explore current practices and attitudes relating to these discussions.

MethodsPaediatricians in NZ were invited to voluntarily participate in an online questionnaire sent out via the Paediatric Society and Starship hospital paediatric email lists. The results were collated by a single investigator.

Results 33% (122/369) of paediatricians in NZ responded to the survey. 93% were hospital based and 53% general paediatricians. 99% discuss treatment options with families. 65% are comfortable discussing limitations of treatment. 81% consider the primary specialist should initiate discussions. 90% discuss limitations if a child’s prognosis is poor, 41% if prognosis is uncertain and 95% with a change or deterioration in the child’s condition. 55% received training in how to have these discussions. 36% consider language differences to be a barrier. 74% of families were perceived as open to discussions and none were hostile. Most respondents considered additional resources and training would be useful.

ConclusionThis study contributes to an understanding of current peer practice and opinion around a topic relevant to all paediatricians and highlights areas of strength and areas in which paediatricians could be better supported when discussing appropriate treatments for children with life limiting conditions. Access to training and to specialist resources may improve paediatricians’ confidence and empower families to participate fully in shared decision making in their familiar environment.


53. Friday 18 November 2016 11.25am – 11.40am Free Papers

RETROSPECTIVE AUDIT OF THE PAEDIATRIC PALLIATIVE CARE POPULATION IN THE WAIKATO DISTRICT HEALTH BOARD REGION JANUARY 2010 – DECEMBER 2015Renee Streatfield*1, Deepika Singh 2

Waikato District Health Board, HamiltonWaikato District Health Board, Hamilton

BackgroundAdvances in medical technology have led to increasing numbers of children who are living with life-limiting conditions. The objective of this audit was to identify the prevalence of children and adolescents with life-limiting and life-threatening conditions in the Waikato who are likely to require palliative care services.

MethodsA retrospective audit of inpatient and outpatient data was carried out in April 2016 by the authors. An ICD-10 customised coding framework was developed to identify children and young people aged 0 – 16 years with life limiting and life threatening conditions who live in the Waikato DHB region. The coding framework was based on the ‘Directory’ of life limiting conditions in children developed by Dr Richard Hain (Hain, Devins , Hastings, & Noyes, 2013). This directory of unique codes was used to identify a dataset of children admitted to Waikato Hospital from January 2010 to December 2015. National Health Index numbers identified in the inpatient data were used to ascertain an outpatient dataset.

ResultsThe dataset obtained provides evidence of increasing annual numbers of children who are likely to require palliative care in the Waikato. Patient numbers steadily rose from 12.06/10,000 children in 2010 to 45.73/10,000 in 2015.

Palliative care provided in a hospital setting reduced from 35% in 2010 to 7% in 2015 while outpatient care increased from 65% in 2010 to 93% in 2015.

ConclusionThe paediatric palliative care population in the Waikato is steadily growing and care is increasingly being provided in an outpatient setting. The demand for paediatric palliative care services is rising and future planning is required to meet the needs of this population.

References1. Bycroft, K., Drake, R., Glavish, N., Forbes, M., Gestro, L., Coulter, B., & Forman, J. (2012). Integrated paediatric palliative

care services in New Zealand: Guidance Document. Wellington: Ministry Of Health.2. Fraser, L. K., Miller, M., Aldridge, J., McKinney, P. A., & Parslow, R. C. (2011). Life-limiting and life-threatening conditions

in children and young people in the United Kingdom; national and regional prevalence in relation to socioeconomic status and ethnicity. Leeds: Division of Epidemiology, University of Leeds.

3. Hain, R., Devins , M., Hastings, R., & Noyes, J. (2013). Paediatric palliative care: development and pilot study of a ‘Directory’ of life limiting conditions. BMC Palliative Care, 12(43). doi:10.1186/1472-684X-12-43

4. Naylor, W. (2011). National health needs assessment for palliative care: Phase 1 report: Assessment of palliative care need. Wellington: Cancer Control New Zealand.

5. Statistics New Zealand. (2014, April 29). 2013 Census district health board tables. Retrieved from Statistics New Zealand: http://www.stats.govt.nz/Census/2013-census/data-tables/dhb-tables.aspx


54. Friday 18 November 2016 11.40am – 11.55am Free Papers

A SMART APPROACH TO NEONATAL INFORMATION FOR PARENTSNathalie de Vries1, Paula Spargo2

1Department of Child Health, MidCentral Health2Neonatal Unit, MidCentral Health

BackgroundParents of newborn babies who are admitted to a NNU or SCBU will get a lot of information which can be overwhelming. Having parents well informed reduces anxiety and improves bonding. Having information available from a reliable source on a mobile App will give parents the opportunity to access it any time of the day and at any place. This will also give parents the opportunity to discuss and share the information with their whanau/extended family.

MethodsOur aim was to develop a smart phone App for parents who have a baby in the NNU. We conducted a semi structured interview with 7 sets of parents and multiple brainstorm sessions. We were then granted funding from the MidCentral Health Innovation Fund. A project group was formed consisting of Neonatal Unit staff, parents, a software developer, a designer and a photographer. ResultsThe App called “Babble, baby talk from MidCentral DHB” was released in May 2016 and is available free on the App Store and Google Play (Fig 1). It contains all the information parents need to know when they have a baby in the NNU (Fig 2). Also, parents are able to write a journal and load photo’s which they can share with their friends and family (Fig 3). Other families have also shared their stories on the App for parents to read. The parents involved in the review and testing are very enthusiastic.

The app can be used by other NNU’s around New Zealand as well, since a lot of the information included is general in nature. Other DHB’s have already expressed their interest.

ConclusionsFacilitating information by using smart phone technology is possible and achievable. The Babble App can be very useful for all parents who have a baby in a Neonatal Unit in New Zealand.

Figure 1

Figure 2 Figure 3


55. Friday 18 November 2016 11.55am – 12.10pm Free Papers

CAN TEAM HANDOVERS BE VALUABLE LEARNING EXPERIENCES?Stephen Bradley1, Dr John Egan2, Dr Marcus Henning3

1 Lakes District Health Board2,3 University of Auckland

BackgroundHandovers represent an important means by which patient safety is maintained. Paediatric team handovers involve medical professionals and students at different levels of experience, and provide repeated opportunities for learning to occur. The research question was to what extent such opportunities exist within paediatric team handovers in New Zealand secondary hospitals.

MethodsA qualitative, two-site case study was performed within two paediatric departments in 2014 and 2015. Semi-structured interviews were undertaken, with purposive sampling of 29 participants, including medical students, junior doctors and consultants. Thematic analysis was undertaken using a general inductive approach.

ResultsThe study confirmed that patient safety was a critical aspect of handover, and specifically that safe transfer of pertinent patient information between clinicians was crucial. Learning within handover represented a form of workplace learning. Most learning opportunities were described as informal and represented opportunistic learning opportunities related to the patients who were discussed within specific handovers. Participants described a reflective approach to learning, in which they considered uncertainty within patient presentations, posed relevant questions and obtained feedback regarding performance. The handover team atmosphere was perceived as a potential barrier or enabler to learning occurring, and created an environment within which role modeling occurred.

ConclusionLearning opportunities exist within paediatric team handovers, and learning generally occurs in an opportunistic, informal manner, directed by learner needs, and related to patients being considered within specific handovers. A focus on brief learning moments within handover, and adoption of a reflective approach to these opportunities is likely to result in improved educational experiences for handover participants. Attention to enablers and barriers to learning in this setting may be valuable for paediatric teams to consider.


56. Friday 18 November 2016 12.15pm – 1.15pm Concurrent Session 9A

ARF/RHD SCHOOL PREVENTION, NEW STRATEGIES, OUTCOMES, ADOLESCENTS, TOOLS AND ART OF DELIVERY

KIRI ORA; TREAT SCHOOL SKIN SEPSIS AND GAS SORE THROATS IN ARF PREVENTION Lizzie Farrell, Sandra Ball

FIRST ROBUST EVIDENCE; SCHOOL BASED ARF PRIMARY PREVENTION IS POSSIBLEDiana Lennon

LAKES ARF AUDIT INSIGHTS, RECURRENCES AND “BICILLIN” DURATION Neil Poskitt

ADOLESCENTS, WHAT THEY KNOW, THEIR RHD HEART CONDITION AND ADHERENCEAlison Leversha

OUR ARF/RHD ADOLESCENTS AND AWHI, NEGOTIATING THAT MINEFIELDBelinda Paku


57. Friday 18 November 2016 12.15pm – 1.15pm Concurrent Session 9B

THE POWER OF LANGUAGE: DECONSTRUCTING PROBLEMS, CONSTRUCTING SOLUTIONSJohn Fitzgerald

Language influences thinking. It privileges attributes of objects and people in ways which can empower and disempower in equal share. The specific words we use and the discourses we are a party to shape our own experiences and the experiences of those around us. If ever you wanted an example of this you only need to listen to the comments of some parents standing on the side-line of their child’s weekend sports fixture, and observe the effect on players and other parents. Heidegger wrote, “Words, like the chisel of the carver, can create what never existed before rather than simply describe what already exists.”

Against this backdrop I will explore the power of professional language both within the community of health practitioners and within the community of those who consult with health practitioners. Consideration will be given to the role of language in both facilitating meaningful engagement and impeding it, along with some tips for building more collaborative alliances with service users based on the principles of positive ethics. The empowering use the language with children, young people and their families can assist, both generally and specifically, in the deconstruction of problems and the construction of creative and effective solutions within clinical practice.


58. Friday 18 November 2016 2.15pm –3.15pm Concurrent Session 10A

PRINCIPLES OF OXYGEN THERAPY IN NEWBORNSKiran MoreDepartment of Neonatology, Christchurch Women’s Hospital, Christchurch, New Zealand

BackgroundOxygen(O2) is a most common drug used in NICU. Goal of oxygen therapy is to achieve adequate delivery of oxygen totissues without creating oxygen toxicity.

Oxygen Therapy Neonate Vs Older ChildrenIn Newborn O2 reserve less and O2 requirement per weight is higher. Small change in FiO2 cause large change in PaO2.Unrestricted O2 therapy has potential for pulmonary / extra pulmonary implications.

Modes Of Oxygen DeliveryLow Flow Devices: Flow changes as per patient’s breathing, variable performance. e.g. Nasal Cannula, Nasal Prongs,Nasopharyngeal Catheter etc. Must be use with humidifier, FiO2 difficult to measure and flow not more than 3 lit. / min.

High Flow DeviceFlow is fixed or exceeds the patient’s inspiratory flow, fixed performance.e.g. Oxygen mask/ hood, Venturi Mask, Humidified High-Flow (HHF) oxygen/air etc.Flow min 3 L/min to max 10 – 15 L/min. May be given without humidification, higher FiO2 can be given. No need to changefrequently and less chances of nasal blockage with mucus plug.High Flow Devices difficult to give oxygen while feeding / kangaroo care. High chance of displacement and risk ofHypercarbia. No Nasal damage, less chances of infection and less risk of gastric distension compared to CPAP.

ConclusionUse O2 as a medicine- right patient, right drug, right dose, right time, right route and right documentation.O2 is a drug, use only when needed, use as rescue and do NO HARM.


59. Friday 18 November 2016 2.15pm – 3.15pm Concurrent Session 10B

TECHNOLOGY TOOLS TO HELP US CARE FOR OUR PATIENTS AND OURSELVESMatthew Valentine

This session will have two parts. The first half will cover a selection of tools (mostly smartphone apps) that help busyclinicians take care of their patients. As demands on clinical services grow, having the right information at your fingertips, atthe moment you need it, can make your care more effective, efficient, and safer.

The second half will discuss a variety of apps, services and strategies for managing a busy professional life. It’s not justclinical work that’s growing – more and more non-clinical responsibilities are being expected of clinicians, not to mentionthe organisation required to manage our personal lives as well. Fortunately there are solutions, and different options amongthem will be reviewed.


60. Friday 18 November 2016 3.20pm – 4.20pm Combined Session: Best Papers

THE PIMS STUDY – WHAT IV FLUIDS SHOULD WE BE USINGMike South1

1 The Royal Children’s Hospital, Melbourne, Australia

140 mmol/L of sodium versus 77 mmol/L of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial The Lancet, p1190 Vol 385 March 28, 2015


61. Friday 18 November 2016 3.20pm – 4.20pm Combined Session: Best Papers

EARLY LIFE ANTIBIOTIC EXPOSURE AND RISK OF OBESITY DURING CHILDHOODCameron Grant


POSTERS


Poster 14

DID OUR ACTIONS TO IMPROVE IMMUNISATION PRACTICE AT STARSHIP HAVE THE INTENDED OUTCOME?E Ng*1, C Ingham2, N Desmond3, L Alley3, E Wilson4, A Leversha5

1 Faculty of Health and Medical Sciences, University of Auckland2 Faculty of Health and Medical Sciences, University of Auckland3 Planning and Funding, Auckland District Health Board/Waitemata District Health Board 4 Starship Children’s Health5 Starship Children’s Health, University of Auckland

BackgroundIn 2012, multiple issues in immunisation practice were identified for children admitted to Starship Children’s Hospital. As a result, several system improvements were made. This study examines the change in immunisation practice in Starship and primary care to identify further areas for systematic and targeted improvement.

MethodA retrospective analysis of immunisation practice for all preschool children admitted to Starship Children’s Hospital in March 2015. Clinical records were reviewed for the inclusion of (1) the immunisation status query report from the National Immunisation Register (NIR); (2) the stamp indicating the status of the child and action recommended; and (3) immunisation status and identification of eligibility for special immunisations on the electronic discharge summary (EDS). All records were cross-checked with the NIR. Primary care records were reviewed to determine if the recommendations were actioned.

ResultsThe NIR status query was present in almost all clinical records of inpatient and day stay patients as per the phase one implementation. Immunisation status and action plan stamps were variably completed with immunisation status documented 62% of the time. Overall 88% of the children were UTD. The remaining children were either due or overdue immunisations. Of these 34 children, 4 had an action documented on the stamp (12%). Eligibility for special immunisations was infrequently identified despite almost 40% of children being eligible. Information about usual childhood immunisations was documented in 75% of EDS, but special immunisations only 0.6%. Primary care action as a result of immunisation recommendations did not occur.

ConclusionsThere have been some improvements in immunisation practice at Starship, but there remains a significant missed opportunity to identify children eligible for special immunisations. The special immunisation section on the EDS should become mandatory. Subsequent improvements will require active implementation across primary care and Starship, including increased health professional education and regular monitoring and feedback.


Poster 15

CONSTIPATION: A COMMON COSTLY COMPLEX CONDITIONMavis Duncanson1, Glenda Oben1, Andrew Wicken1, Simon Morris1, Judith Adams1, Sarah Gallagher1, Jean Simpson1

1 New Zealand Child and Youth Epidemiology Service, University of Otago

BackgroundThe New Zealand Child and Youth Epidemiology Service 2015 reports to DHBs on the health status of children and young people found that constipation is a common reason for acute and arranged hospitalisations of New Zealand children, particularly in the 0–14 age group, and for ambulatory sensitive hospitalisations of 0–4 year olds. Community prevalence may be as high as 30% and the condition results in a significant burden to children, their families and to health services in terms of resource use and funding. This presentation will include the epidemiology of hospitalisations for constipation in New Zealand 0–24 year olds from 2000 to 2015 and consider recent evidence for good practice at a health service level.

MethodsAnalysis of data from the National Minimum dataset with Statistics New Zealand Estimated Resident Population denominators to describe hospitalisation rates over time and demographic characteristics of individuals hospitalised with a primary or contributory diagnosis of constipation. Rapid literature review to summarise good practice in reducing hospitalisation rates for constipation.

ResultsHospitalisation rates of 0–24 year olds for constipation have risen significantly from 2007 to 2015. The increase in hospitalisation rates was observed in all age groups and ethnic groups, with the highest rates for 0–4 year olds. Among 0–24 year olds between 2011 and 2015 hospitalisation was least likely for those living in areas with low scores on the NZDep2013 index of deprivation, for Asian/Indian children and young people and for boys compared with girls.

ConclusionThe common problem of constipation is contributing increasingly to use of health service resources in New Zealand, particularly to ambulatory sensitive hospitalisations in 0–4 year olds. Cost-effective services can reduce this impact and contribute to better outcomes for children and families.


Poster 16

BEING OPEN: TIMELY ACCESS NZCYES PUBLICATIONSSarah Gallagher1, Mavis Duncanson 2

1 NZ Child and Youth Epidemiology Service, University of Otago, Dunedin2 NZ Child and Youth Epidemiology Service, University of Otago, Dunedin

IntroductionAccess to accurate, up to date information in child and youth health is important for the successful development and delivery of targeted services to our diverse communities in New Zealand. The NZCYES is commissioned to write a number of reports reflecting the status and determinants of health of New Zealand’s children and young people for NZ District Health Boards and the Ministry of Health. The information these reports contain is, however, of relevance to a plethora of health care services and workers in the child health space.

Case descriptionNZCYES has had a web presence for some years. In the last 6 months we have rebuilt our website, rebranded our service and have adopted more sustainable information management practices to ensure the longevity of our reports as well as their findability and accessibility. This has involved utilising the University of Otago’s research repository as well as a cloud storage system and social media.

DiscussionThis presentation will detail the process we have undertaken and demonstrate how to find and download the reports and set up an alert to receive the latest reports as they are published. We will discuss our changes in delivery system to the DHBs and mention our use of Twitter to disseminate our publications more widely.

ConclusionChanges in NZCYES information management practices have been implemented to improve dissemination of child health information so that it can be used more effectively in child health service planning and funding and to inform clinical service provision.

Justification for presentationPaediatric Society is a key stakeholder in the work of NZCYES and contract holder for national reports. This presentation will help all PaedSoc members easily access information created by the NZCYES.


Poster 17

MONITORING FOR CHILDREN’S WELLBEING: LOOKING TO THE FUTUREJean Simpson, Mavis Duncanson, Glenda Oben, Andrew WickenNew Zealand Child and Youth Epidemiology Service, University of Otago

BackgroundThe Marmot Review of 2011 identified health inequalities as arising from inequalities of income, education, employment and neighbourhood circumstances. Such inequalities affect the lives people can lead. In New Zealand data on income, material hardship, housing, assault and neglect, and mortality and hospitalisations for certain medical conditions indicate that too many children will bear a disproportionate burden of poor outcomes in the future. In addition, research indicates that nations where such inequalities exist also bear a long term burden. However, while we gather data on the children’s deficits such as illness, poor education and deprivation, we are less able to assess the appropriateness and effectiveness of the implementation and service delivery of strategies to reduce poor outcomes for children.

MethodsData from administrative data sets gathered in New Zealand were analysed with respect to factors associated with children living in poverty. Nationally gathered data on non-income measures of poverty provide greater depth of information on those affected by increasing levels of material hardship. Selected indicators that might reflect upstream performance of policy or service action are examined.

ResultsHigh percentages of household spending on housing, family type, ethnicity, number of children in the household and main source of income for parents are some of the factors experienced by those living in material hardship. Few reflect strengths based measures. Very few indicators measure or monitor the performance of strategies, service delivery or policy development.

ConclusionWe need to expand assessment and monitoring on two fronts: to include measures of children’s wellbeing, and to develop nationally gathered, publicly available, measures to monitor performance upstream.


Poster 18

A CASE OF GHB (GAMMA HYDROXYBUTYRATE) TOXICITY IN A 2 YEAR OLDCarolyn Aird1, John Goldsmith 2, Tilak De Almeida3

1 Waikato Hospital 2 Waikato Hospital

IntroductionGHB occurs naturally in the human body. It is a metabolite of the brain neurotransmitter GABA. Synthetic GHB usually exists as either a colourless liquid in its pure form or a white powder.1 It has an increasing prevalence as a recreational drug of abuse within New Zealand.2

Case descriptionA 2 year old boy was brought to the emergency department unresponsive and hypothermic. His father initially volunteered the possible presence of GHB within the home. Approximately 4 hours following arrival, the child woke up without complications. He was admitted to the ward overnight for observations where he remained well. A urine sample taken at 6 hours post-presentation, confirmed a significantly elevated level of GHB. This was well above physiological levels, suggestive of accidental overdose with illicit GHB.

DiscussionThis case demonstrated a temporal clinical picture compatible with GHB toxicity. Positive toxicology supported this as the primary cause for unresponsiveness. There are no previously reported cases of paediatric toxicity within New Zealand to date.

Conclusion and Justification for presentationWith the increasing popularity of GHB as a drug of abuse, it is important that paediatricians are aware of the features of its presentation, safe management, and appropriate testing techniques:• Consider GHB toxicity in any child presenting with unexplained coma.• Remember GHB is not detected by routine toxicology.• GHB toxicity management is symptomatic and coma usually resolves within 7 hours.

References:1. WHO report on GHB (Internet). Available at: http://www.who.int/medicines/areas/quality_safety/5GHBPreReview.pdf2. National Drug Policy. The Expert Advisory Committee on Drugs (EACD) Advice on: Gamma-hydroxybutyric Acid and

related substances (‘Fantasy’) December 2001


Poster 19

LIFE AFTER ECMO: OUTCOMES AND COMPLICATIONS FOLLOWING PROLONGED ECMO THERAPY IN AN 11 MONTH OLD CHILDMorven DockeryPaediatric Registrar, Southland Hospital, Invercargill

IntroductionExtracorporeal membrane oxygenation (ECMO) is used to support patients with refractory cardiac and respiratory failure. It was first introduced in New Zealand in 1993 and around 25-30 patients undergo ECMO each year. (Auckland District Health Board) ECMO is more frequent in neonates and adults, and consequently, less is known about outcomes and complications in paediatric populations.

We describe the progress of an 11 month old with severe viral bronchopneumonia who required prolonged ECMO.

Case description11 month old boy presented with respiratory distress on a background of prematurity, recurrent bronchiolitis and developmental delay. Polymerase chain-reaction testing identified adenovirus and enterovirus. Respiratory support with non-invasive ventilation failed, patient was intubated and transferred to a tertiary care centre. Admission there was 85 days, and included 34 days of ECMO.

Following ECMO, neurological, developmental and respiratory difficulties were noted. There was new seizure activity and swallowing reflex appeared reduced. Development had regressed across all areas. Magnetic Resonance Imaging demonstrated cerebral atrophy and scattered haemorrhages. There was a persistent oxygen requirement and Computed Tomography and Bronchoscopy at 22 months demonstrated changes consistent with bronchiectasis and bronchiolitis obliterans.

DiscussionPaediatric data from Extracorporeal Life Support Organisation suggests incidence of clinical seizures following ECMO is 5.7%, with intracranial haemorrhage occurring in 6% cases. (Mehta A, 2013) Duration of ECMO is an independent predictor of functional morbidity and reduced quality of life outcomes in intensive care patients. (Ebrahim S, 2013) Further hospital admissions occur in 62% surviving patients, most commonly with respiratory illness. (Jen HC, 2010) Difficulty lies in distinguishing complications of ECMO from effects of underlying disease process.

ConclusionECMO is associated with long-term complications and morbidity. Further research is required to allow more accurate long-term prognosis and improved management.

Justification for presentationECMO is a highly interesting topic and is being increasingly utilised in paediatric patients, yet knowledge of outcomes and complications may be limited, particularly in those working outside intensive care.

References Auckland District Health Board. (n.d.). ECMO Information for Families. Retrieved August 2016, from AUckland DHB: www.adhb.govt.nz/picu/information_for_families.hdm

Ebrahim S, S. S. (2013). Adaptive behavior, functional outcomes, and quality of life outcomes of children requiring urgent ICU admission. Pediatr Crit Care Med , 14 (1), 10-8.

Jen HC, S. S. (2010). Hospital Readmissions and Survival After Nonneonatal Pediatric ECMO. Pediatrics , 125 (6),

Mehta A, I. L. (2013). Neurologic complications and neurodevelopmental outcome with extracorporeal life support. World J Crit Care Med , 2 (4), 40-47.


Poster 20

COMPLICATIONS ARISING FROM TONGUE-TIE (ANKYLOGLOSSIA) TREATMENTM Hale1, R Broadbent2, L Edmonds3, D Barker4, N Dickson5, N Mills6, P Dawes7, B Drumond8 B Wheeler9

1-5,9 Department of Women’s and Children’s Health, University of Otago, Dunedin School of Medicine5 Department of Preventive and Social Medicine, University of Otago, Dunedin6 Department of Paediatric Otorhinolaryngology, Starship Children’s Hospital, Auckland7 Associate Professor of Otolaryngology, University of Otago, Dunedin School of Medicine8 Professor of Dentistry (Paediatrics), Dental School, University of Otago, Dunedin

Research Underway: Start Date 3rd August 2016

BackgroundTongue-tie (or ankyloglossia) is usually treated with a simple frenotomy. Some paediatricians in New Zealand are concerned about an increase in the diagnosis and treatment of these, believing it may not always be appropriate and lead to unnecessary intervention and complications if they occur. There is little data in the New Zealand context on the prevalence of tongue ties and treatment, or the incidence of their treatment complications.

ObjectivesWe aim to ascertain the incidence of complications arising from any form of treatment for tongue-tie over a 1-year period in infants and children under one year of age. We will also gather demographic and medical information which will assist in the identification of risk factors for development of complications, which may assist in the evaluation of current treatment provision and standards of care.

MethodsWe are currently using the New Zealand Paediatric Surveillance Unit (NZPSU) network to identify cases on a national level that come to the attention of paediatricians. This unit regularly contacts all NZ-based Paediatricians requesting cases of rare conditions, or rare complications of common conditions, that are currently under investigation through them. We are underway, having been requesting cases since 3rd August 2016. We also intend to identify cases through national Otorhinolaryngology (ENT) and Dental colleagues.

ResultsOnce a case has been notified by a clinician they will be mailed a questionnaire asking for details of the case. This data will include details of the incident and presentation itself, as well as background demographic, medical and relevant family history. These will then be collated and analysed to examine the descriptive epidemiology of treatment complications, although a challenge will be to know how many frenotomies are undertaken annually.

Potential ConclusionsWe may find that there is an unacceptable level of complications, which may provide the impetus to review tongue-tie management. If there are not significant complications then this data could be used to reassure clinicians, and the descriptive data will provide further insights for service provision and help inform practice.


Poster 21

EPIDEMIOLOGY AND RISK FACTORS FOR GASTROSCHISIS - A 20-YEAR EXPERIENCE IN A REGIONAL NEONATAL SURGICAL CENTREG Hariharan*1, 3, T Walwyn2, PA Dargaville1, 3, 4, M Ee1, 3 , AG De Paoli 1, 3

1Royal Hobart Hospital, Hobart, Tasmania, Australia2 Princess Margaret Hospital, Perth, Western Australia3Clinical school, University of Tasmania, Hobart, Australia4Menzies Research Institute, Hobart, Tasmania.

BackgroundGastroschisis is a major neonatal congenital gastrointestinal condition of unknown aetiology. We aimed to describe prevalence, antenatal risk factors and outcome of neonates born with Gastroschisis.

MethodA retrospective analysis of all Gastroschisis cases in Tasmania between 1996 to 2006 was undertaken. Antenatal, natal and postnatal events associated with gastroschisis were reported. The prevalence of gastroschisis was compared between two 10-year periods, January 1995 - December 2015(epoch 1) and July 2006 to July 2016(epoch 2). Further analysis was done on the data collected for epoch 2.

Results59 cases of Gastroschisis were diagnosed during the 20-year period [(epoch 1- 29 cases including one stillbirth); epoch 2- 30 cases including four stillbirths)]. The prevalence of gastroschisis was 4.6 per 1000 and 4.8 per 1000 pregnancies in epoch 1 and 2 respectively. There were four postnatal deaths in epoch 1 but none in epoch 2. Majority of gastroschisis cases were diagnosed in mothers who were </=25 years [(72%; 21/26) in epoch 1 versus (69%; 18/26) in epoch 2). Epoch 2 analysis: Gastroschisis cases admitted to NICU during this epoch had a median hospital stay of 31 days (median neonatal intensive care stay- 20 days). 84.6% of these neonates were born to primi gravida (22/26 cases) and 50% (13/26) of the neonates were small for gestational age. Four cases of gastroschisis were complicated by adhesive intestinal obstruction (day of presentation ranged from 32 days to 3 years) and 23% of cases had the postoperative period complicated by feed intolerance.

ConclusionsThe outcome of Gastroschisis has improved in the regional surgical centre and is comparable to other major centres in Australia. The prevalence of the condition has remained similar over the 20-year period. Young maternal age appears to be a predisposing factor for Gastroschisis although causality could not be established.


Poster 22

REVIEW OF LATE DIAGNOSES OF CYSTIC FIBROSIS IN A PAEDITRIC CLINIC Mirjana Jaksic1,2, Jan Tate 2, Cass Byrnes1,2

1 Department of Paediatrics and Child Health, University of Auckland 2 Starship Children’s Health, Auckland District Health Board

BackgroundNewborn screening for cystic fibrosis (CF) in NZ from 1997 has used a two stage procedure with determination of a positive immunoreactive trypsin (highest 1%) followed by detection of 1-2 genes. The method for the latter step has used determination of three commonest genes to 2010, then MELT technology to 2014 then genetic determination of exons 10 & 11. Our aim was to review our clinic for children with a late diagnosis of CF and determine the reasons that they were not detected on newborn screening.

MethodsThis was a retrospective review of children attending the Starship CF clinic born from January 1997 to December 2015.

ResultsSeventy seven children attended our CF clinic in this time period. There were a total of 20 late diagnoses made: 10 children born abroad only one in a country that had newborn screening CF programmes, leaving 10 born here. Of those; 1 refused screening, 1 had meconium ileus was not positive on newborn screening but detected with the clinical picture, 7 had low IRT and therefore did not go to the second stage, 1 had a positive IRT but no detectable genes with the method used.

ConclusionIn our clinic a total of 11% (8 missed out of 67 born in NZ) were missed in the CF Newborn Screening programme. The diagnosis should still be considered with appropriate clinical picture, especially if children were born abroad.

AcknowledgementsThis will ultimately contribute to data for a Ministry of Health, Newborn Metabolic Screening Technical Committee review.


Poster 23

MEASURING THE HEIGHT/LENGTH OF CHILDREN WITH CEREBRAL PALSY IN NEW ZEALANDJustine McCallum1, Phillipa Clark1, Peter Reed1, Rachael McLean2, Catherine Wheeler3

1 Starship Children’s Hospital2 Departments of Preventive and Social Medicine & Human Nutrition, University of Otago3 KidzFirst Community Health

BackgroundIt is difficult to measure the height/length of children with Cerebral Palsy (CP), and there is no method currently recognised as ‘best practice’ in New Zealand. This study investigated the reliability and acceptability of using a single segmental measure (tibial length) and a recumbent measurement (using continuous segmental length) as proxies for height in children with CP in order to determine which method should be recommended for use.

MethodsThe study included ?? sets of measurements made in X children with CP who attended outpatient appointments at the Paediatric Rehabilitation Centre or a Special School in Auckland during July to December 2016. Children were either measured by two observers to assess inter-observer reliability and/or twice by one person to assess intra-observer reliability. Measurements were made of tibial length and recumbent length (using continuous segmental measures) and standing height if practical. Each individual measurement was taken twice and the average used in the analysis. Following each measurement, patients and caregivers were surveyed regarding their acceptability.

ResultsResults to be presented at the conference include: (number) children were measured by two observers to calculate inter-observer reliability. A further (number) were measured by one observer to calculate intra-observer reliability. The acceptability of each of measurement study was also determined.

ConclusionMeasuring height/length is important for monitoring growth in children with CP. In New Zealand there is a need for ‘best practice’ guidelines for measuring the height/length of children with CP when it is not possible to obtain an accurate standing height. This study aims to address this and provide a recommendation.


Poster 24

ASSESSMENT OF IMPLEMENTATION OF THE GUIDELINE FOR SUPPLEMENTATION OF AT RISK INFANTS WITH VITAMIN D IN NEW ZEALANDJudith Nitert1, Pat Tuohy 2

1 Capital and Coast DHB, Wellington2 Ministry of Health (MoH), Wellington

BackgroundIn 2013 the MoH published a Companion Statement on vitamin D and sun exposure1. This advises that breastfed infants in described risk groups should be supplemented with vitamin D to prevent nutritional rickets. Anecdotal information suggests that most of these infants are not getting supplements, resulting in documented cases of rickets and hospital admissions for complications of hypocalcaemia2.

There is no published literature on how many of the infants that fall in these risk groups are being prescribed vitamin D supplementation.

MethodsDatabase analysis (containing nationwide maternity and birth data) to identify infants who were at risk for vitamin D deficiency, were matched with data on prescriptions for Vitadol C.

A nationwide online survey of GP’s, midwives and Well child/Tamariki Ora nurses was conducted, assessing their awareness of and current practice around vitamin D supplementing as well as eliciting suggestions for discussion and change.

ResultsDatabase analysis showed being dark skinned was the strongest indicator for being prescribed Vitadol C, but the rate of prescription was a low 9-17%, depending presence or absence of other risk factors. Being born in winter or on the South Island did not seem to be a strong indication for prescribing Vitadol C. (Figure 1)

A small sample survey of pharmacies showed high rates of over the counter sales of Vitadol C.

The health professional survey elicited that less than half were aware of the current guideline and a lack of knowledge around vitamin D deficiency and supplementing. (Figure 2)

ConclusionThere are poor prescription rates of vitamin D supplements in high risk groups of infants, poor awareness of current guidance and poor knowledge of vitamin D deficiency and supplementing in infants among health professionals.Suggestions were made to improve uptake, including changing the current guideline and adding to the Well Child book.


Poster 25

NEW ZEALAND PAEDIATRIC SURVEILLANCE UNIT: PLEURAL EMPYEMA IN NEW ZEALAND CHILDREN AGED < 15 YEARSEmma Best1, Jacob Twiss1, Lesley Voss1, Catherine Byrnes1, James Hamil1, Stephen Evans1, Richard Matsas, Katherine Rix-Trott1, Deborah Williamson3, Tony Walls4

1 Starship Children’s Hospital2 Counties Manukau District Health Board3 Institute of Environmental Science and Research4 University of Otago

BackgroundEmpyema is an uncommon complication of childhood bacterial pneumonia and refers to the presence of pus within the pleural space. Empyema causes prolonged hospitalisation, longer duration of antibiotic therapy and can require invasive intervention. International trends demonstrate increasing rates of childhood empyema, possibly in the context of new pneumococcal vaccine. New Zealand already reports a significant burden of bacterial pathogens known to cause empyema such as Streptococcus pneumoniae and Staphylococcus aureus.

Empyema in young children often leads to surgical intervention; therefore identifying empyema via discharge coded diagnosis is possible. However some cases may be diagnosed radiologically and managed medically with subsequent hospital discharge coding not capturing the possible empyema complication. The prospective nature of NZPSU collection adds an important further dimension for laboratory contact and more thorough pathogen detection through molecular techniques.

In the context of changing pneumococcal vaccine schedule and with an already high burden of respiratory childhood infections, it is import to document the New Zealand experience of paediatric empyema to inform management as well as incidence and potential vaccine preventable aspects of this disease.

Objectives1) To document the burden of empyema in NZ children including infectious aetiology, demographics and underlying conditions.2) To describe the management of the disease both surgical and medical, complications and short term outcomes.

Secondary aims: 3) To compare the reported burden via NZPSU with hospital discharge coding data in the same time period 4) To review cases where NZPSU notification and discharge coding data do not match for validation of NZPSU and evaluate over/underreporting

REPORTING INSTRUCTIONS

CASE DEFINTION

Child (0-14yrs) hospitalised with empyema as defined by

Pneumonia and pleural effusion lasting >7 daysORAny pneumonia and pleural effusion with radiologic features of empyema1 ORAny pneumonia and pleural effusion necessitating drainage

REPORTING INSTRUCTIONSPlease report any infant or child with suspected or confirmed empyema aged less than or up to 15 years

Please request culture negative pleural specimens collected are referred for further molecular diagnosis to ESR (attention: Dr Deborah Williamson).

Follow up of positive returnsA questionnaire requesting further details will be forwarded to practitioners who report a case.

Some cases will be admitted under surgical colleagues who may not be participants in the NZPSU surveillance. Although other efforts will be made to ascertain these cases through surgical networks, please notify of any cases fulfilling criteria.

If you have any questions please contact: Dr Emma BestDepartment of Paediatrics, University of Auckland Level 12 Support Building Auckland Hospital, Park Road, Ph: 021241 7719 or fax 09 3737486 [email protected] or [email protected]

1 For example echogenic material or loculated pleural fluid


InvestigatorsDr Emma Best, Paediatric Infectious Diseases, Starship Children’s HealthDr Jacob Twiss, Paediatric Respiratory Specialist, SCHDr Lesley Voss, Paediatric Infectious Diseases Specialist, SCHDr Catherine Byrnes, Paediatric Respiratory Specialist, SCH Dr James Hamil, Paediatric Surgeon, SCHDr Stephen Evans, Paediatric Surgeon, SCHDr Richard Matsas, KidzFirst, Counties Manukau District Health Board Dr Katherine Rix-Trott Advanced Trainee, Paediatrics Dr Deborah Williamson, Microbiologist, Institute of Environmental Science and Research, Wellington Dr Tony Walls, Senior Lecturer Paediatrics, Christchurch School of Medicine, University of Otago


Poster 26

THE 1000 DAYS TRUST PILOT – EARLY FINDINGS FROM AN AMBITIOUS EARLY INTERVENTION RESIDENTIAL PROGRAM FOR ‘AT RISK’ WHANAU IN SOUTHLANDViliame Sotutu1, Renee Stevenson 1, 2

1 Southern District Health Board2 Plunket

BackgroundA growing body of research emphasizes the importance of the first 1000 days, during which time Adverse Childhood Experiences (ACEs) may contribute to an array of poor health outcomes. Healthy relationships in a nurturing home may buffer these toxic effects. A clear interplay of nature (genes) and nurture (environment) exists, providing an opportunity for early intervention with whanau as a strong driver of healthy development.

MethodsThe 1000 Days Trust (DT), a residential service for ‘at risk’ mothers and babies (0 – 1y), and their whanau, was launched in November 2015, with funding for a 1 year pilot. Mothers and babies referred to the Trust by midwives, well child providers, hospital staff, and community workers, are met by Trust Navigators, and a Monday – Friday residential stay planned, usually occurring 2 – 3 weeks later. Further community follow-up is usually needed. An emphasis on healthy relationships and attachment undergirds this work, along with a close collaboration with existing community providers. Our multi-disciplinary team include Nursing, Midwifery, Social Work, Early Childhood Education, Psychology, Psychotherapy and Paediatric professionals. We embrace a whanau-ora approach, attempting to help whanau realize their best ambitions, drawing on their strengths and capacities, whilst acknowledging those factors with the potential to derail their aspirations.

ResultsNumerous challenges have been encountered. There have been predictable difficulties with obtaining funding, along with less predictable implications of this financial uncertainty upon staffing. Aligning the disparate views of the passionate professionals behind the 1000DT, to clarify the model, has been difficult. Refining the model further for whanau remains a ‘work in progress’. We report on our experiences, with a preliminary review of the families that have been involved in the pilot.

ConclusionInnovative, comprehensive, early intervention services are needed to provide babies with a healthy start and help whanau thrive. Early results with the 1000DT pilot are promising.


Poster 27

EVALUATION OF PUAWAITAHI, NEW ZEALAND’S FIRST MULTIAGENCY CENTRE FOR CHILD PROTECTIONRachel Stevenson1, Patrick Kelly 2, Fred Seymour 3

1 University of Auckland2 Auckland District Health Board3 University of Auckland

BackgroundPuawaitahi was established in Auckland in 2002 as New Zealand’s first multiagency service for child abuse and neglect. It incorporates health, child protection, Police, evidential interviewing, and therapy services at one centralised location. This programme evaluation sought to examine the processes and procedures within the multiagency and compared findings with the standards for Child Advocacy Centres outlined by the National Children’s Alliance in the USA. The overall objectives were to help staff improve the quality of service and examine viability of this multiagency model for implementation elsewhere in New Zealand.

MethodsFocus groups and interviews were conducted with staff, referrers and children and families who had been seen within the service. Transcripts were analysed to identify common themes in relation to the multiagency’s processes and procedures, the organisation’s culture, accessibility, coordination, timeliness, quality of care, and areas for programme improvement.

ResultsThe programme evaluation found that Puawaitahi meets the majority of its own vision and mission statement goals and performs well in relation to the standards described for Child Advocacy Centres elsewhere. In particular, the multiagency processes and procedures provided effective case coordination, and the physical environment, child focused service delivery, staff cultural competence, and interactions with stakeholders were rated highly by most participants across staff, referrer and consumer groups. Desired improvements included better access to therapy, changes to client referral and case coordination processes to further reduce delay, better client follow up procedures, and provision of the multiagency model across every region in Auckland.

ConclusionThis evaluation shows that a model inspired by USA Child Advocacy Centres has been effectively implemented and stands as a model for implementation elsewhere in New Zealand.


Poster 28

COMMUNITY ONSET INVASIVE STAPHYLOCOCCUS AUREUS DISEASE IN AUCKLAND CHILDREN: INVESTIGATING ETHNIC DISPARITIESAnnie Borland1,2, Alison Vogel1,3, Adrienne Morales1, Alisha Vara1, Joshua Freeman2, Susan Taylor3, Philippa Anderson3, Maraekura Horsfall4, Dragana Drinković4, Diana Lennon1,2,3

1 The University of Auckland Faculty of Medical and Health Sciences2 Auckland District Heath Board3 Counties Manukau District Health Board4 Waitemata District Health Board

BackgroundStaphylococcus aureus (SA) causes serious invasive disease in children. Accurate data on the incidence of invasive Staphylococcus aureus (iSA) disease is necessary for assessing current prevention strategies and developing future interventions. This study is part of a wider evaluation of community school clinics targeting skin and throat infections.

MethodsA retrospective, cross sectional analysis of hospitalised children aged 0-14 years residing in Auckland, Counties, and Waitemata DHB’s from January 2011 – December 2015 was performed. Laboratory databases and SA-related ICD-10 discharge codes from each DHB 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.

Results329 children with iSA were identified. The most common site of infection was musculoskeletal (n=232) (predominantly osteomyelitis (n=175)), followed by respiratory (n=51), skin and soft tissue with bacteraemia (n=34), endovascular (n=10), central nervous system (n=9), bacteraemia site not specified (n=9), and intra-abdominal (n=4). There were 18 patients with multifocal disease (infection at >1 one site). All deaths (n=7) had respiratory infections, the majority (n=6) were patients <2 years. Over half of the patients (n=171, 52%) lived in the most deprived areas of Auckland (NZDep 9 or 10). The average yearly incidence of iSA was 21/100,000 population. Pasifika children had an incidence of 49/100,000 population, Māori 27/100,000, NZ European and other 11/100,000, and Asian 8/100,000. When stratified for age, the incidence for Pasifika infants <1 year was ten times greater than NZ European and other infants (118/100,000 population vs 12/100,000).

ConclusionThere are marked ethnic and socioeconomic disparities in iSA disease among Auckland children. Those most at risk are Pasifika and Māori infants, although this bias persists throughout all age groups. Prevention strategies must be focussed on these vulnerable populations to reduce these disparities.


Poster 29

CHICKENPOX COMPLICATIONS AT WELLINGTON REGIONAL CHILDREN’S HOSPITAL: A SIX-YEAR RETROSPECTIVE REVIEWIsaac Tranter-Entwistle1, Brendon Bowkett2

1 University of Otago, Wellington2 Department of Paediatrics, Wellington Children’s Hospital, Wellington

BackgroundTo assess the number of hospital admissions and associated morbidity and mortality related to varicella zoster virus (chickenpox) infection.

MethodsA six-year retrospective review of all chickenpox cases, from 2009 to 2014, admitted to Wellington Children’s hospital was performed.

ResultsThere were 39 admissions to Wellington Hospital over the six-year period. The mean age was 2.9 years, with a mean length of admission of 2.87 days. Of those admitted, 51.3% were female and 48.7% male. Māori and Pacific Islanders represented 28.2% and 17.9% of admissions respectively.

The most common cause of admission was secondary bacterial infection. The overall trend was for increasing admissions year on year.

Over the six-year study period a further 134 cases, with a mean age of 3.92 years, presented to the Emergency Department and were discharged. Of whom 47.8% were female and 52.2% male. Ethnicity data was not available for this group.

ConclusionChickenpox infection causes significant mortality and morbidity. In some cases this can be severe enough to result in intensive care unit admission and death. Māori and Pacific islanders are disproportionately affected. In light of this there is a clear need for a universal vaccination programme.


Poster 30

ACUTE RHEUMATIC FEVER (ARF) BOPDHB DEMOGRAPHICS 2000-15: MORE MAORI BOYS GET ARF, EVEN WITH LESS DEPRIVATIONLiam Walsh1, Thanjon Michniewicz 2,Megan Tozer1, Jonathan Humby3, John Malcolm1,4

1University of Auckland, 2University of Newcastle, Australia, 3University of Newcastle UK, 4Whakatane Hospital, BOPDHB.

Methods Retrospective audit ICD10 ARF discharges, Bay of Plenty, BOPDHB residents 3 hospitals, EpiSurv MOH notifications, pre ARF Register database1, with electronic/ paper case-note scrutiny against National Heart Foundation (NHF)NZ 20062 & 2014 benchmarks. Self-declared3 compared to DHB coded ethnicity, NZ Deprivation index4 of census area residence, ARF diagnostic certainty and echocardiographic severity noted. Kawerau School Group A Streptococcus (GAS) prevalence5 & Pathlab sore throat swabs (STS) & GASSTS reviewed by gender.

Results ARF First episodes are 85% paediatric, primary/early high-school, and 90% <19yr age. Of ARF patients 15% present to Adult physicians. Male predominance 72% continues, at all ages. Kawerau data show boys more frequently GAS colonized, present for STS less, deriving similar positive GAS sore throats. Manual ethnicity miscoding submitted to MOH underestimated Maori/ Pacific by 7% with ARF admissions 95% Maori/Pacific, M90%, P5%. While 86% BOPARF patients reside NZDepDeciles 7-10, 65% in homogeneously deprived East, in Western BOP (heterogeneous Deprivation) 29% deciles 1-6, ethnicity predicts ARF more closely than deprivation. Mean age Definite ARF 12yr, and Possible/Probable 16yr. Cardiac involvement and severity is largely unchanging. Recurrences 5% largely confined to area under served by adjacent DHBs. BOPDHB ARF 5-14yrs 2000-15 was 25.7/105; Maori 5-14yr ARF 2000-10 rate 69/105 declined to 51/105 years 2011-15 (P= 0.1546, CI 0.4832 to 1.1223).

Conclusion BOPARF affects 90% Maori, 5% Pacific. School programmes, public health, primary care, delivering to school age pupils into first 2yr high school address 85% current ARF; Where ARF is rarer, (adult) physicians should consult (paediatric) colleagues/ NHF guidelines. Accurate data entry into an IT app may improve Ethnicity coding, given training limitations. Making it “cool to korero” speak up about “sore throats” matters especially to boys, addresses health needs/ ongoing ARF gender disparity. Health workers’ practice must address; ARF risk for Maori/Pacific continues even where SES improves.

References 1. Lennon D, Moxon Te A, Mills C, Malcolm J, Pennock V, McLean M, Reed P, Poskitt N, Crengle S, Jackson C, Rheumatic

Fever Epidemiology Group New Zealand’s Unique Experiment: Primary prevention of rheumatic fever with a focus on schools World Congress Cardiology, Melbourne, 2014.

2. Atatoa-Carr P, Lennon D, Wilson N, & et al. (2006). New Zealand Guidelines for Rheumatic Fever 1. Diagnosis, Management and Secondary Prevention: Cardiac Society of Australia and New Zealand, The National Heart Foundation of New Zealand 2014

3. Ministry of Health. 2004. Ethnicity Data Protocols for the Health and Disability Sector. Wellington: 4. Salmond C, Crampton P, & Atkinson J. (2007). NZDep2006 Index of Deprivation: Department of Public Health,

Wellington School of Medicine and Health Sciences. 5. Ball S, Malcolm J, Hartley L, Wana L, Bennett M, Ingram-Seal R, Stewart J, Lennon D; Pharyngeal Group A streptococcal

prevalence declines with school based sore throat swabbing, Kiri Ora, healthy skin programmes, and appears to parallel declining Acute Rheumatic Fever ; Australasian Society of Infectious Disease March 2015 Poster.

AcknowledgementsPatients & their whanau for their Acute Rheumatic Fever, admission Data audited.Pathlab BOP; GAS school sore throat swab analysis 2000-15; Murray Robinson, Lead Scientist. GAS Kawerau Prevalence funding; 2010 Kawerau PHO, 2013 EBPHA, 2014 HRC Prof D Lennon Joanna Stewart, Statistical analysis of GAS prevalence, comparisons, stats analysis, confidence intervals; Eastern Bay PHA Rheumatic Fever Clinical Lead Sandra Ball, Lisa Wana Kawerau Office Administrator, and Lead Community Health Worker Rheumatic Fever and BOP ARF Sector Group. Bay of Plenty DHB; Director of Maori Health Amohaere Tangitu, Lani Marama Te Kahika Whakahaere Operations Manager discussion re audit; Kelly Orrell, Charille-Ann Schoeman Decision Support Analyst WCF, Medical Information/ Records; EBOP at Whakatane Hospital and WBOP Tauranga Hospital sites. Lakes DHB; Dr Barry Smith, Maori Health Funding, Planning, Maori Research Ethics consultation. Medical. Records for Rotorua admitted Murupara patients Nigel Foote Data Analyst, Drs Neil Poskitt, Rheumatic Fever Register, Rotorua Area Primary Health Services & RGPG Ltd, Dr Johan Morreau Paediatrician, Members Lakes BOP Rheumatic Fever Steering Committee.Toi Te Ora Public Health Service; EpiSurv notifications, Lindsay Lowe, Communicable Disease Nurse, Health Protection Team, Dr J Miller and Dr Phil Shoemack, Medical Officers Health


BOPDHB Clinical School; Summer Studentship for Lead Author 20014-15 & 2015-16

Contributions:Liam Walsh; Pre audit consultations, Data-base development, case note scrutiny at 3 sites, analysis, statistics, write-up. Development of methodology with supervisor and statistical advisors, discussion initial dissemination to ARF Sector Group, Funding and Planning & Toi Te Ora Public Health ServiceThanjon Michniewicz; GAS Sore throat swab Pathlab analysis, Megan Tozer, ARF Cardiac severity audit Jonathan Humby, ARF Deprivation analysis John Malcolm, Supervision.


Poster 31

SUPER-GIANT CORONARY ANEURYSM SECONDARY TO ATYPICAL KAWASAKI DISEASE, S/P QUADRUPLE CORONARY BYPASS AND GRAFTING IN AN 11-YEAR OLDMariko Jennifer L YamanakaCardinal Santos Medical Center, Metro Manila, Philippines

IntroductionKawasaki Disease (KD) is an acute febrile illness of early childhood. Its highest incidence occurs worldwide in Asian male children under 5 years old.1 Candidates not fulfilling the clinical criteria of classic KD are called Atypical. A major sequelae involves the coronary arteries, leading to aneurysms and occlusions.

Case descriptionThis is a case of an 11-year-old male diagnosed with Atypical KD, wherein Gammaglobulin and Aspirin were given. Diagnostic imaging showed severe three-vessel coronary artery disease with chronic total occlusion of the right coronary and left mid-circumflex artery and an aneurysmal dilation of the proximal left anterior descending artery measuring 12.4x11.3x25.5mm. He is the first paediatric patient in the Philippines who underwent quadruple coronary bypass and grafting.

DiscussionKD is a generalized systemic vasculitis commonly involving the coronary arteries.1 Dilatation occurs during the sub-acute phase, generally peaking 4 weeks post-onset of illness and is diagnosed by echocardiogram.2 Identified aneurysms are classified by size; a super-giant is greater than 10mm.1,3 7-20% of aneurysms persist and lead to occlusions increasing the risk for stenosis or myocardial infarction, and these generally have the worst prognosis.4

TreatmentCardiac catheterization with selective coronary angiography is performed to determine the extent of collateral perfusion and approach for re-vascularization.1 Cardiac bypass is highlighted to be a better option for treatment. Bilateral internal mammary arteries grafts demonstrated a favourable patency rate if done before 12 years-old.5,6 The survival is excellent and the increase in cardiac events can successfully be managed with re-interventions.7

ConclusionThis case features the significance of early diagnosis and treatment of Kawasaki Disease and most importantly, regular cardiologic follow-up, taking into consideration the potential late complications of this paediatric disease.

Justification for presentationIt’s a case of super-giant aneurysm secondary to KD and he is the first paediatric patient in the Philippines who underwent quadruple coronary bypass and grafting.

Keywords:Key Words: Kawasaki Disease, Coronary Aneurysm, Quadruple Coronary Artery Bypass and Grafting, Paediatrics

References:1. Newburger, J.W., Takahashi, M., Gerber, M.A., Gewitz, M.H., Tani, L.Y., Burns, J.C., Shulman, S.T., Bolger, A.F., Ferrieri,

P., Baltimore, R.S. and Wilson, W.R., 2004. Diagnosis, treatment, and long-term management of Kawasaki disease a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation, 110(17), pp.2747-2771.

2. Kim, D.S., 2006. Kawasaki disease. Yonsei medical journal, 47(6), pp.759-772.3. Imai, Y., Sunagawa, K., Ayusawa, M., Miyashita, M., Abe, O., Suzuki, J.I., Karasawa, K., Sumitomo, N., Okada, T.,

Mitsumata, M. and Harada, K., 2006. A fatal case of ruptured giant coronary artery aneurysm. European journal of pediatrics, 165(2), pp.130-133.

4. Nelson’s Textbook of Pediatrics. 20th Edition Kliegman et al. 2015.5. Yoshikawa, Y., Yagihara, T., Kameda, Y., Taniguchi, S., Tsuda, E., Kawahira, Y., Uemura, H. and Kitamura, S., 2000. Result of

surgical treatments in patients with coronary-arterial obstructive disease after Kawasaki disease. European Journal of Cardio-Thoracic Surgery, 17(5), pp.515-519.

6. Tsuda, E. and Kitamura, S., 2004. National survey of coronary artery bypass grafting for coronary stenosis caused by Kawasaki disease in Japan. Circulation, 110(11 suppl 1), pp.II-61.

7. Kondo, C., 2004. Myocardial perfusion imaging in pediatric cardiology. Annals of nuclear medicine, 18(7), pp.551-561.


EXHIBITION FLOOR PLANThe Performing Arts Centre, Bethlehem College


EXHIBITOR DIRECTORY Stand number

Abbott Nutrition 4

Cure Kids 1

Danone Nutricia Early Life Nutrition 14

Fisher & Paykel Healthcare 12

GSK 13

Muscular Dystrophy Association of New Zealand Inc 15

New Zealand Medical & Scientific Ltd 11

Nutricia Advanced Medical Nutrition 8

Paediatric Society of New Zealand 6

Promed Technologies 3

Seqirus (NZ) Ltd 9

Southern Cross Health Society 7

The Royal Australasian College of Physicians 2

Wyeth Nutrition 10

EXHIBITOR INFORMATION

ABBOTT NUTRITIONStand 4PO Box 22801 T: +64 9 573 7404Otahuhu E: [email protected] 1060www.abbottnutrition.co.nzContact: Keryn Chilcott

Products on display:1. EleCare – 3 x variants of 400g tins and marketing materials2. PediaSure – PediaSure powder 850g tin and sample sachets and materials3. Pedialyte – 2 x 500ml bottles of Pedialyte Bubblegum flavour hydration solution and marketing materials

Abbott Nutrition is a division of Abbott Laboratories, a global healthcare company devoted to discovering new medicines,new technologies and new ways to manage health. Abbott Nutrition NZ has a large range of nutritional supplementsincluding EleCare for children with Cow’s Milk Protein Allergy and PediaSure for underweight children over 1 year. AbbottNutrition also specialises in FreeGO pumps for delivery of enteral nutrition tube feeds to paediatric and adult patients.Please contact us for further information on how we can help you.


AUCKLAND RECORDING SERVICE LTDPO Box 8292 T: +64 9 625 5554AUCKLAND 1150 E: [email protected]: David Hardgrave

For a number of years Auckland Recording Service has been recording our conferences, originally on cassettes, and morerecently on CDs with one session per CD.

This year marks a significant change of idea and format. Auckland Recording Service Ltd will be recording all sessions inmp3 format. This means that the entire conference will fit onto just one CD, playable on all computers with a CD drive andcars built in the last 10 years. This means that the cost will come down very significantly, so after the conference they willbe posting a conference CD to every registered delegate, and no extra charge to them.

The committee trust you enjoy and benefit from this.

CURE KIDSStand 1PO Box 90907 T: +64 9 370 0222Victoria Street West E: [email protected] www.curekids.org.nzContact: Tim Edmonds

Our vision is a healthy childhood for everyone. We are on a mission to be a catalyst for improving the health of children; driving the discovery of new treatments and cures through research. Since our establishment in 1971, we have provided over $37 million in funding to New Zealand’s leading child health researchers.

DANONE NUTRICIA EARLY LIFE NUTRITIONStand 1456-58 Aintree Avenue T: +61 2 8870 0482Airport Oaks AUCKLAND 2022

Products on display:1. Aptamil Gold + 12. Aptamil Pepti Junior3.

Founded in 1896, Danone Nutricia works with parents, carers and healthcare professionals to educate about early life nutrition through advice and support, as well as products and services. For over 100 years Danone Nutricia has been at the forefront of research in infant nutrition and our pioneering efforts continue today. At the heart of our work is our commitment to stand by mums, dads and caregivers to nurture new lives through science-driven research and development, as well as quality manufacturing.

FISHER & PAYKEL HEALTHCAREStand 12PO Box 14348 T: 0800 503 553Panmure E: [email protected] 2013www.fphcare.comContact: Martyn Gibson

Products on display:1. Optiflow™ Junior

‘We are a leading designer, manufacturer and marketer of products and systems for use in respiratory care, acute care, and the treatment of obstructive sleep apnea. Our products and systems are sold in over 120 countries worldwide.

Optiflow™ Junior is a revolutionary system for providing simple and effective delivery of oxygen therapy to infants in respiratory distress and may reduce the requirement for CPAP and intubation in some clinical scenarios.’


GSKStand 13Private Bag 106600 T: +64 9 367 2900DowntownAUCKLAND 1010www.gsk.com

Product on display:1. Resources

GlaxoSmithKline (GSK) is a research-based pharmaceutical and healthcare company operating in more than 100 countriesaround the world. Our mission is to improve the quality of human life by enabling people to do more, feel better and livelonger.

We have a proud history in New Zealand, tracing our origins back to one of our founding companies, Glaxo Laboratories,which grew out of a dairy business founded in the Manawatu in the 1880s. Today as one of the largest pharmaceuticalcompanies in the world we provide medicines and vaccines for a wide range of disease areas and consumer products thatare household names. Globally we invest around $7 billion every year in research. Our vaccines protect thousands of NewZealanders and we are the largest supplier of childhood vaccines to the National Immunisation Schedule.

MUSCULAR DYSTROPHY ASSOCIATION OF NEW ZEALAND INCStand 15PO Box 12063 T: 0800 800 337Penrose E: [email protected] 1061www.mda.org.nz

Product on display:1. Muscular Dystrophy Information Sheets2. In Touch Magazine copies3. Beyond DNZ books

The MDA provides information, social support and practical assistance to individuals and families/whanau living withneuromuscular conditions.

NEW ZEALAND MEDICAL & SCIENTIFIC LTDStand 112a Fisher Crescent T: +64 9 259 4062Mt Wellington E: [email protected] 1644www.nzms.co.nzContact: Karen Clegg

Products on display:1. Medicina ENFIT enteral feeding products2. Medicina Enteral feeding pump3. Accuvin vein illuminator4. Criticool targeted temperature management

New Zealand Medical & Scientific are dedicated to bringing leading edge medical devices to the Healthcare community. Our Medical Division will be displaying the new ISO 80369 compliant Medicina ENFIT enteral feeding system, Accuein vein illuminator, Criticool targeted patient temperature management system.


NUTRICIA ADVANCED MEDICAL NUTRITIONStand 8PO Box 1007 T: +61 2 8875 0312North Ryde BCNSW 1670AUSTRALIAwww.nutriciaclinical.co.nzContact: Natalie Victor

Products on display:1. Neocate2. Fortini

Nutricia Advanced Medical Nutrition is a global leader in Medical Nutrition offering a comprehensive and unique range of products and services for improved clinical outcomes. Nutricia seeks to use nutrition as a tool to improve health and manage disease. Our value added services support both health professional and the patient at home.

PAEDIATRIC SOCIETY OF NEW ZEALANDStand 6PO Box 22 234 T: +64 4 938 4827WELLINGTON 6441 E: [email protected]: Denise Tringham

The Paediatric Society of New Zealand believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing. By working as a coordinated national network of health professionals the society dedicates its efforts and resources to this end.

PROMED TECHNOLOGIESStand 3Unit B, 14-22 Triton Drive T: 0800 477 663North Harbour E: [email protected] 0632www.promedtech.co.nzContact: Jan Smeath

Products on display:1. Masimo ROOT with Rad 7 Touchscreen 2. Masimo ROOT with Rad 7 Touchscreen3. SISS Apnoea Monitor, Bitmos 801+, PureKeys Infection Control keyboard & mouse4. RD Set cable and sensors

Promed represents a wide range of products for distribution in NZ. Our focus is generally on the introduction of products which have unique performance, features or clinical benefit, with an emphasis throughout the range of highest quality and value for money.

Promed have particular expertise in the Paediatric area with our Masimo SET technology, warming systems and Apnoea monitors.

Our company ethos and approach is one of true partnership, with an emphasis on training, education and unrivalled support. We are not just a supplier of products, but a resource healthcare professionals can call on for specialist help and advice.


SEQIRUS (NZ) LTDStand 9PO Box 62590 T: +64 9 526 3532Greenland E: [email protected] 1546www.seqirus.co.nzContact: Donna Green

Products on display:1. Gardasil 92. Advantan3. Fucithalmic

Seqirus NZ Ltd (formerly bioCSL NZ Ltd) is an innovative pharmaceutical company that sources and provides a range of products to meet local healthcare needs. We are strategic partners with a number of large international companies and have a number of products and vaccines in different therapeutic areas in NZ. Some of these include: Gardasil 9®, Advantan® and Fucithalmic®.

SOUTHERN CROSS HEALTH SOCIETYStand 7Level 1, Ernst & Young Building T: +64 21 931 1292 Takutai Square E: [email protected] 1010Contact: Emma Trotman

As a not-for-profit health insurer, we aim to ensure a wide range of New Zealanders have timely, affordable and sustainableaccess to private healthcare. As a result, we are evolving how our members access the healthcare services they needthrough our Affiliated Provider programme.

Affiliated Providers are general practitioners, specialists and facilities that provide Southern Cross members with healthcareservices at agreed prices. By contracting with providers, we aim to minimise the impact of rising healthcare costs onmembers’ premiums.

THE ROYAL AUSTRALASIAN COLLEGE OF PHYSICIANSStand 2PO Box 10 601 T: +64 4 472 6713WELLINGTON 6035 E: [email protected]: Sue Bull

Products on display:1. Brochures and reading material2. Packaged mints

The Royal Australasian College of Physicians (RACP) connects, represents and trains over 15,000 Physicians and 7,500 trainee Physicians in Australia and New Zealand. The RACP provides accredited specialist training to doctors who have completed their medical degree and wish to practise as Physicians in Australia or New Zealand. Stop by Booth 2 and say hello!

WYETH NUTRITION, NESTLE NZ LTDStand 10PO Box 1784 T: +64 9 367 2800Shortland Street E: [email protected] 1140www.meandmychild.co.nzContact: Rowan Stenberg-Calder

Products on display:1. S-26 Gold Premgro2. Pre Nan RTF Low Birth Weight Infant Formula3. Pre Nan Human Milk Fortifier 4. S-26 Gold RTF Infant Formula

Wyeth Nutrition, the makers of S-26, have over 100 years of infant nutrition research and have developed products to suit the unique nutrition needs of formula fed babies at every stage. Breastfeeding is best for babies. We recommend consulting with a doctor or healthcare professional for advice before using infant formula. Wyeth Nutrition, part of Nestlé New Zealand Limited.


NOTES

EXHIBITOR QUIZ

Complete the quiz by getting an answer and signature from one of the company representatives on each of the stands, place your form in the competition box at the registration desk and

go in the draw to WIN an Apple Product!

PLEASE TURN THE PAGE TO ENTER

NAME: ……….………………………………………………………….…………………….

ORGANISATION: …………………………………..………………………………………

PHONE NUMBER: …………………………………..……………………………………

ABBOTT NUTRITION

Q: What product is available in 3 variants for children with allergies to cow’s milk protein?

A:

CURE KIDS

Q: What is the approximate ratio of caucasian Ameri-cans who carry a cystic fibrosis gene mutation?

A:

DANONE

Q: Aptamil helps provide long term allergy protection through_______________________________

A:

FISHER & PAYKEL HEALTHCARE

Q: What is the highest flow that you can deliver via the Optiflow Junior Cannula?

A:

GSK

Q: How many changes will be made to the National Immunisation Schedule in 2017?

A:

MUSCULAR DYSTROPHY ASSOCIATION OF NZ INC

Q: Name the most common type of muscular dystro-phy that affects young males

A:

NEW ZEALAND MEDICAL & SCIENTIFIC

Q: What is the name of the new ISO standard for En-teral feeding connections?

A:

NUTRICIA ADVANCED MEDICAL NUTRITION

Q: Where can your patients get the support, answers and inspiration they need throughout the allergy journey?

A: PAEDIATRIC SOCIETY OF NEW ZEALAND

Q: What is the current total membership of PSNZ?

A:

PROMED TECHNOLOGIES

What is the most accurate and clinically recognised oximetry technology worldwide?

A:

SEQIRUS (NZ) LTD

Q: What age is Advantan indicated from?

A:

SOUTHERN CROSS HEALTH SOCIETY

Q: How many specialist consultations did Southern Cross fund in the last financial year?

A:

THE ROYAL AUSTRALASIAN COLLEGE OF PHYSICIANS

Q: Name one of the types of training that the RACP offers Physicians and Trainee Physicians

A:

WYETH NUTRITION

Q: What is the name of the Human Milk Fortifier with the highest level of protein

A:

If you have tried more than 3 times to find a representative at a stand,

please ask someone at the conference registration desk to sign off for you!

VENUE FLOOR PLAN

M101

M102

M103

M104

M105 M106 M107 M108

M109

M110

M111

Pre-School

Maintenance

Chapel

E Block D Block

Uniform Shop

C Block C Block

PE ShedP

ool

Gymnasium

A Block

TB

lock(S

econdary)

R Block (Secondary)

Q Block

(Secondary)

Bethlehem Institute

Careers

Science

Liv

ing

Room

Primary

Music Room

School Principal

International School

Primary/Secondary Admin

LibraryB Block

Tennis Courts

CET House

Centrum

New EntrantsLearning Support

Performing ArtsCentre

(M Block)

Map 4a of the Bethlehem College CampusPerforming Arts Centre - Level 1

Primary Hall

Entrance

Entrance

Moffa

t Road

Elder Lane

Parking Area

Entrance at bottom

Parking

Auditorium

Wednesday 15 to Friday 17 November 2017Special Interest Group Meetings - Tuesday 14 November 2017

RYDGES LATIMER CHRISTCHURCH

2017

PAEDIATRIC SOCIETY OF NEW ZEALAND 69TH ANNUAL SCIENTIFIC MEETING 2017

OUR FOUNDATIONS

STRENGTHENING

www.psnz2017.co.nz

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