Child morbidity as described by hospital admissions for primary school aged children in Tonga 2009-2013.

AIMS: To describe inpatient utilisation patterns for primary school aged children in Tonga. METHODS: We described admissions for children aged 5-11 years to the main hospital in Tonga from January 2009 to December 2013. Rates with 95% confidence intervals (CI) were compared using rate ratios (RR). RESULTS: There were 1,816 admissions. The average annual admission rate was 20.2/1,000 (95% CI 19.3-21.1). Hospital admission rates were higher in younger than older children (5-7 versus 8-11 years, RR=1.28, 95% CI 1.18-1.41) and in boys than girls (RR=1.52, 95% CI 1.38-1.68). Injury and poisoning (28%), non-respiratory infectious diseases (19%), respiratory conditions (16%), abdominal/surgical conditions (13%) and dental (9%) were the most frequent admission reasons. A larger proportion of younger versus older children were hospitalised for dental (16% vs 1%, P<0.001) or respiratory conditions (18% vs 14%, P=0.02). A larger proportion of older children were hospitalised for abdominal/surgical conditions (15% vs 11%, P=0.008), other infectious diseases (21% vs 17%, P=0.04), other conditions (10% vs 6%, P<0.001) and cardiac conditions (2% vs 1%, P<0.001). CONCLUSIONS: In children 5-11 years in Tonga, 85% of admissions were for five groups of conditions. These data inform priority areas for healthcare spending and enable comparisons over time and between different Pacific countries.

Retinal haemorrhage in infants with pertussis.

AIMS: It has been hypothesised that paroxysmal coughing in infantile pertussis (whooping cough) could produce retinal haemorrhages identical to those seen in abusive head trauma. We aimed to test this hypothesis. METHODS: This is a prospective study of infants hospitalised with pertussis in Auckland, New Zealand, from 2009 to 2014. The clinical severity of pertussis was categorised. All infants recruited had retinal examination through dilated pupils by the paediatric ophthalmology service using an indirect ophthalmoscope. RESULTS: Forty-eight infants with pertussis, aged 3 weeks to 7 months, were examined after a mean of 18 days of coughing. Thirty-nine had severe pertussis and nine had mild pertussis. All had paroxysmal cough, and all were still coughing at the time of examination. No retinal haemorrhages were seen. CONCLUSIONS: We found no evidence to support the hypothesis that pertussis may cause the pattern of retinal haemorrhages seen in abusive head trauma in infants.

Vitamin D status of exclusively breastfed infants aged 2-3 months.

BACKGROUND: New Zealand in 2008 adopted WHO policy which recommends that all infants are exclusively breast fed until 6 months of age. The benefits of this policy for the infant are undisputed; however, this policy has the potential to adversely impact on infant vitamin D status. A number of countries now recommend that all breastfed infants receive daily vitamin D supplementation of 400 IU to prevent rickets. New Zealand has no policy on the vitamin D supplementation of 'low-risk' breastfed infants. There are no data on the vitamin D status of exclusively breastfed infants in the first few months of life in New Zealand. AIM: To describe serum 25-hydroxy-vitamin D (25(OH)D) concentrations in exclusively breastfed infants aged 2-3 months. DESIGN/METHODS: Healthy term exclusively breastfed infants who were receiving no vitamin D supplements were enrolled over a 15-month period. A capillary blood sample was obtained from each infant. Serum 25(OH)D was measured using isotope-dilution liquid chromatography-tandem mass spectrometry. RESULTS: 94 infants were enrolled (mean age 10 weeks). Median 25(OH)D concentration was 53 nmol/l (IQR 14-100 nmol/l). 23 (24%) infants had serum 25(OH)D concentration <27.5 nmol/l. Infants enrolled during winter had a median (IQR) 25(OH)D serum concentration of 21 nmol/l (14,31). Infants enrolled during summer had a median (IQR) 25(OH)D concentration of 75 nmol/l (55 100) (winter vs summer, p<0.0001). CONCLUSIONS: Vitamin D deficiency is prevalent in exclusively breastfed infants in New Zealand. Vitamin D supplementation should be considered as part of New Zealand's child health policy.