Experiences of parents whose children participated in a longitudinal follow-up study.

BACKGROUND: Long-term follow-up is necessary to understand the impact of perinatal interventions. Exploring parents' motives and experiences in consenting to their children taking part in longitudinal studies and understanding what outcomes are important to families may enhance participation and mitigate the loss to follow-up. As existing evidence is largely based on investigators' perspectives using Western samples, the present pilot study explored parents' perspectives in a multicultural New Zealand context. METHODS: Data were generated using semi-structured interviews with parents whose children had participated in a longitudinal study after neonatal recruitment. Parents' experiences of being part of the study were analysed thematically using an inductive approach. RESULTS: Parents (n = 16) were generally happy with the outcomes measured. Additionally, parents were interested in lifelong goals such as the impact of parental diabetes. We identified three themes: (1) Facilitators: Research participation was aided by motives and parent and research characteristics such as wishing to help others and straightforward recruitment; (2) Barriers: A hesitancy to participate was due to technical and clinical research aspects, participation burden and cultural barriers, such as complex wording, time commitment and nonindigenous research and (3) Benefits: Children and parents experienced advantages such as the opportunity for education. CONCLUSIONS: Parents reported positive experiences and described the unexpected benefit of increasing families' health knowledge through participation. Improvements for current follow-up studies were identified. Different ethnicities reported different experiences and perspectives, which warrants ongoing research, particularly with indigenous research participants. PATIENT OR PUBLIC CONTRIBUTION: No active partnership with parents of patients took place.

Association of Neonatal Hypoglycemia With Academic Performance in Mid-Childhood.

Importance: Neonatal hypoglycemia is associated with increased risk of poor executive and visual-motor function, but implications for later learning are uncertain. Objective: To test the hypothesis that neonatal hypoglycemia is associated with educational performance at age 9 to 10 years. Design, Setting, and Participants: Prospective cohort study of moderate to late preterm and term infants born at risk of hypoglycemia. Blood and masked interstitial sensor glucose concentrations were measured for up to 7 days. Infants with hypoglycemic episodes (blood glucose concentration <47 mg/dL [2.6 mmol/L]) were treated to maintain a blood glucose concentration of at least 47 mg/dL. Six hundred fourteen infants were recruited at Waikato Hospital, Hamilton, New Zealand, in 2006-2010; 480 were assessed at age 9 to 10 years in 2016-2020. Exposures: Hypoglycemia was defined as at least 1 hypoglycemic event, representing the sum of nonconcurrent hypoglycemic and interstitial episodes (sensor glucose concentration <47 mg/dL for ≥10 minutes) more than 20 minutes apart. Main Outcomes and Measures: The primary outcome was low educational achievement, defined as performing below or well below the normative curriculum level in standardized tests of reading comprehension or mathematics. There were 47 secondary outcomes related to executive function, visual-motor function, psychosocial adaptation, and general health. Results: Of 587 eligible children (230 [48%] female), 480 (82%) were assessed at a mean age of 9.4 (SD, 0.3) years. Children who were and were not exposed to neonatal hypoglycemia did not significantly differ on rates of low educational achievement (138/304 [47%] vs 82/176 [48%], respectively; adjusted risk difference, -2% [95% CI, -11% to 8%]; adjusted relative risk, 0.95 [95% CI, 0.78-1.15]). Children who were exposed to neonatal hypoglycemia, compared with those not exposed, were significantly less likely to be rated by teachers as being below or well below the curriculum level for reading (68/281 [24%] vs 49/157 [31%], respectively; adjusted risk difference, -9% [95% CI, -17% to -1%]; adjusted relative risk, 0.72 [95% CI, 0.53-0.99; P = .04]). Groups were not significantly different for other secondary end points. Conclusions and Relevance: Among participants at risk of neonatal hypoglycemia who were screened and treated if needed, exposure to neonatal hypoglycemia compared with no such exposure was not significantly associated with lower educational achievement in mid-childhood.

School readiness screening and educational achievement at 9-10 years of age.

AIM: To determine whether a multi-domain school readiness screening, the Before School Check (B4SC), identifies children at risk of low educational achievement and to compare the educational outcomes between those referred for intervention and those with B4SC concerns who were not referred. METHODS: In this longitudinal cohort study of children born at risk of neonatal hypoglycaemia (N 331), the B4SC was performed at 4.5 years of age and a standardised curriculum-based measure of educational achievement was completed at 9-10 years of age. Outcomes of school readiness screening were categorised into 'school readiness concern' or 'no school readiness concern' while 'below standard' and 'well below standard' ratings of educational achievement were combined into a single category of 'low educational achievement'. RESULTS: Overall, 52% of children had ≥1 school readiness concerns at the B4SC, predominantly about behaviour (46%). Having ≥1 school readiness concern was associated with a nearly twofold increase in the likelihood of low academic achievement (OR 1.85, 95% CI 1.14, 3.02), which was apparent only for behaviour concerns. Of the 128 children with behaviour concerns, only 10 (8%) were referred for further interventions. There was a statistically non-significant increase in the rates of low academic achievement among those referred than those non-referred (60% vs. 47%). CONCLUSION: Identification of behaviour concerns during B4SC is associated with a moderate increase in the likelihood of low academic achievement at 9-10 years. Further, research is needed to determine how academic achievement can be improved in children with behaviour concerns at school entry.

Teacher rating versus measured academic achievement: Implications for paediatric research.

AIM: To determine whether teachers' reports of student academic performance can suffice for research purposes by comparing it with a curriculum-based standardised test. METHODS: In this longitudinal cohort study of children born at risk of neonatal hypoglycaemia, teachers' global assessment of student performance was compared with assessment tools for teaching and learning (asTTle) at 9-10 years. Performance on asTTLe was rated as being below, at or above that expected on the national curriculum for year and term of schooling. Teachers similarly rated the child's performance against the national curriculum. RESULTS: Of 125 children assessed, 104 had paired data for analysis. On asTTLe, 28% were rated below, 55% at and 17% above the expected curriculum level in reading and 24, 54 and 22%, respectively, in mathematics. Equivalent teacher ratings were 23, 58 and 19% in reading and 36, 55 and 9% in mathematics, respectively. However, there was limited agreement between asTTle and teacher rating of achievement in reading (κ = 0.23 (95% confidence interval 0.07-0.40)) and no significant agreement in mathematics (κ = 0.07 (95% confidence interval -0.09-0.22)). Only 45% of children performing below the curriculum level in reading and 52% in mathematics were correctly identified by teachers. CONCLUSION: In cohort studies, teacher ratings cannot substitute standardised educational testing.

Te Reo Maori: indigenous language acquisition in the context of New Zealand English.

This study assessed the status of te reo Maori, the indigenous language of New Zealand, in the context of New Zealand English. From a broadly representative sample of 6327 two-year-olds (Growing Up in New Zealand), 6090 mothers (96%) reported their children understood English, and 763 mothers (12%) reported their children understood Maori. Parents completed the new MacArthur-Bates Communicative Development Inventory short forms for te reo Maori (NZM: CDI sf) and New Zealand English (NZE: CDI sf). Mothers with higher education levels had children with larger vocabularies in both te reo Maori and NZ English. For English speakers, vocabulary advantages also existed for girls, first-borns, monolinguals, those living in areas of lower deprivation, and those whose mothers had no concerns about their speech and language. Because more than 99% of Maori speakers were bilingual, te reo Maori acquisition appears to be occurring in the context of the acquisition of New Zealand English.

Towards a Vocal and Acoustic Description of Kapa Haka.

OBJECTIVE: The purpose of this study is to analyze the voice used in kapa haka, a contemporary indigenous vocal performance from New Zealand, which includes the well-known haka. This is the first study of its kind and is a preliminary investigation into the vocal and acoustic description of kapa haka. A significant goal of this study is to contribute ideas and potential definitions of vocal qualities to the community of kapa haka trainers that were specific to the genre. This strengths-based project raises up these vocal practices as legitimate and authentic colors within a vocal tradition that has seen generational learning disrupted by colonial interventions and is now flourishing within the community. METHODS: Eight kapa haka performers (three females, five males) were involved in the study, they were all experienced performers; furthermore, two had formal classical voice training. They were individually recorded speaking and performing three different genres of kapa haka (moteatea, waiata, and haka); all recordings were in te reo Maori (the Maori language). In addition, electroglottograph (EGG) signals were collected. An auditory-perceptual evaluation of the kapa haka voice was completed by three singer-researcher-pedagogues familiar with Western and non-western genres of singing. They all have experience appropriately collecting and analyzing data from indigenous communities, and they all understand the sociopolitical context of the vocal genre within the local colonial history. A specific evaluation instrument was created, and the results were validated. The acoustic and time-aligned EGG data was annotated at the phoneme level, and the signal analysis was performed in MATLAB. Averaged EGG pulses from /a/ segments were investigated, along with long-term average spectrums of the performances obtained from both the audio signal and the EGG signals. RESULTS: The perceptual analysis suggests the biggest difference in vocal styles was between the haka and the other two genres (and speech). The acoustic and EGG results support these findings. CONCLUSIONS: Common characteristics, perceptually and acoustically, were identified in the kapa haka performance styles across the eight performers.

Evaluation of risk stratification strategies in pediatric patients with febrile neutropenia.

OBJECTIVE: To evaluate the performance of risk stratification protocols for febrile neutropenia specific to the pediatric population. METHODS: Retrospective study of a cohort of pediatric patients undergoing cancer treatment with episodes of neutropenia due to chemotherapy and fever, treated at the emergency department of a tertiary cancer hospital from January 2015 to June 2017. Patients who were bone marrow transplant recipients and patients with neutropenia due to causes other than chemotherapy were excluded. Six protocols were applied to all patients: Rackoff, Alexander, Santolaya, Rondinelli, Ammann 2003, and Ammann 2010. The following outcomes were assessed: microbiological infection, death, ICU admission, and need for more than two antibiotics. The performance of each protocol was analyzed for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operator characteristic (ROC) curve. RESULTS: This study evaluated 199 episodes of febrile neutropenia in 118 patients. Microbiological infection was identified in 70 samples from 45 distinct episodes (22.6%), 30 patients used more than two antibiotics during treatment (15%), eight required ICU admission (4%), and one patient died (0.8%). Three protocols achieved high sensitivity indices and NPV regarding the outcomes of death and ICU admission: Alexander, Rackoff, and Ammann 2010; however, Rackoff showed higher sensitivity (0.82) and NPV (0.9) in relation to the microbiological infection outcome. CONCLUSION: The Rackoff risk rating showed the best performance in relation to microbiological infection, death, and ICU admission, making it eligible for prospective evaluation.

Evaluation of risk stratification strategies in pediatric patients with febrile neutropenia

Abstract Objective To evaluate the performance of risk stratification protocols for febrile neutropenia specific to the pediatric population. Methods Retrospective study of a cohort of pediatric patients undergoing cancer treatment with episodes of neutropenia due to chemotherapy and fever, treated at the emergency department of a tertiary cancer hospital from January 2015 to June 2017. Patients who were bone marrow transplant recipients and patients with neutropenia due to causes other than chemotherapy were excluded. Six protocols were applied to all patients: Rackoff, Alexander, Santolaya, Rondinelli, Ammann 2003, and Ammann 2010. The following outcomes were assessed: microbiological infection, death, ICU admission, and need for more than two antibiotics. The performance of each protocol was analyzed for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operator characteristic (ROC) curve. Results This study evaluated 199 episodes of febrile neutropenia in 118 patients. Microbiological infection was identified in 70 samples from 45 distinct episodes (22.6%), 30 patients used more than two antibiotics during treatment (15%), eight required ICU admission (4%), and one patient died (0.8%). Three protocols achieved high sensitivity indices and NPV regarding the outcomes of death and ICU admission: Alexander, Rackoff, and Ammann 2010; however, Rackoff showed higher sensitivity (0.82) and NPV (0.9) in relation to the microbiological infection outcome. Conclusion The Rackoff risk rating showed the best performance in relation to microbiological infection, death, and ICU admission, making it eligible for prospective evaluation.