Health outcomes of children in state care in Aotearoa New Zealand.

AIM: This study aims to provide an overview of the association between being in the custody of the chief executive of Oranga Tamariki (the child welfare agency of the New Zealand (NZ) government) and all-cause hospitalisation and mortality. METHODS: This was a national retrospective cohort study using linked administrative data from the Integrated Data Infrastructure. Data were obtained for all 0-17 year-olds living in NZ on 31 December 2013. In-care status was ascertained at this point. Outcomes of all-cause hospitalisation and all-cause mortality were assessed between 1 January 2014 and 31 December 2018. Adjusted models incorporated age, sex, ethnicity, level of socioeconomic deprivation and rural/urban status. RESULTS: There were 4650 in-care children and 1 009 377 not-in-care children in NZ on 31 December 2013. Of those in care, 54% were male, 42% lived in the most deprived areas and 63% identified as Maori. Adjusted models showed that in-care children were 1.32 (95% CI 1.27-1.38) times more likely to be hospitalised than not-in-care children and 3.64 (95% CI 2.47-5.40) times more likely to die. CONCLUSION: This cohort study highlights that the care and protection system prior to 2018 was not preventing children in its care from experiencing severe adverse outcomes. Overseas research has previously been relied on when making practice and policy decisions around child care and protection in NZ, so this research will provide valuable insight into best practice in an NZ context.

Trends in deprivation in hospitalisations of Indigenous children and young people in Aotearoa New Zealand.

AIM: To examine the 20-year trends in socio-economic inequities in hospitalisations of Maori and non-Maori non-Pacific (NMNP) under-25-year olds in Aotearoa New Zealand. METHODS: Hospital discharge data for Maori and NMNP taitamariki aged under-25 years were extracted from the National Minimum Dataset for the period 2000-2019. Acute or arranged admissions to hospital were included where the primary diagnosis was for a medical condition. Age- and gender-standardised rates (per 1000, 0-24-year old) were calculated for both ethnic groups by area deprivation using the 2013 NZ census estimated resident population. For each ethnic group, inequity indices of socio-economic deprivation (Slope Index of Inequality and Relative Index of Inequality) were computed, using regression modelling, to quantify inequity of medical condition-related hospitalisations and its changes over time. RESULTS: Hospitalisation rates for medical conditions were consistently higher for Maori than for NMNP under-25-year olds from 2000 to 2019. Maori taitamariki residing in the most deprived (quintile 5) areas were more likely than NMNP to be hospitalised for a medical condition at each time point. Deprivation inequities existed for both ethnic groups and were greater for Maori. Despite reducing deprivation inequities over time, ethnic differences persist on both absolute and relative scales. CONCLUSION: Deprivation inequities in hospitalisation for medical conditions persist for Maori taitamariki compared with NMNP and highlights society's tolerance of enduring inequity in health outcomes.

Delayed access to care and late presentations in children during the COVID-19 pandemic New Zealand-wide lockdown: A New Zealand Paediatric Surveillance Unit study.

AIM: Describe paediatricians' experience of adverse health outcomes for children during the New Zealand-wide level 4 lockdown in response to the COVID-19 pandemic. METHODS: Weekly national survey of paediatricians with an open-ended questionnaire. RESULTS: During the 6-week study survey period, the New Zealand Paediatric Surveillance Unit received 33 reports about 55 instances where paediatricians believed care may have been compromised, about half (56%) relating to infants aged from birth to 6 weeks. Compromised care was for acute presentations in 75%, acute complications of a chronic illness in 14%, with 11% for chronic conditions. Paediatricians reported the outcome as moderately severe (short-term morbidity, increased length of stay, higher level of care) in 38 cases (69%) and in a further 4 (7%) as severe (potential to be life-threatening or result in permanent disability). CONCLUSION: Despite clear messaging, hospital avoidance and reduced access to primary and secondary care were associated with significant potential harm for children in New Zealand during a strict lockdown, with newborn infants disproportionately affected. During the implementation of interventions to eliminate community transmission of COVID-19, New Zealand paediatricians note the importance of face-to-face post-natal visits for newborns and primary care services for children with acute illness, to avoid preventable harm.

Multisystem Inflammatory Syndrome in New Zealand Children.

New Zealand (NZ) initially adopted an elimination approach to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pre-Omicron variant, the NZ pediatric population was immunologically naïve to SARS-CoV-2. This study, utilizing national data sources, describes the NZ incidence of multisystem inflammatory syndrome in children (MIS-C) following infection with the Omicron variant. MIS-C incidence was 1.03 of 100,000 age-specific population and 0.04 of 1000 recorded SARS-CoV-2 infections.

High Incidence of Congenital Syphilis in New Zealand: A New Zealand Pediatric Surveillance Unit Study.

BACKGROUND: Syphilis, a disease once in decline, has made a resurgence worldwide. New Zealand has had increasing syphilis rates since enhanced syphilis surveillance was initiated in 2013. This study reports epidemiologic, descriptive and treatment data on management of infants prenatally exposed or vertically infected with syphilis across New Zealand as reported by pediatricians. METHODS: Over a 26-month period from April 2018 to May 2020 (inclusive), pediatricians throughout New Zealand notified potential, probable and confirmed cases of congenital syphilis to the New Zealand Pediatric Surveillance Unit. National reporting numbers were concurrently ascertained to demonstrate reporting accuracy. RESULTS: Thirty-two cases were notified, comprised of 25 infants born to women with positive antenatal syphilis serology (5 whom developed congenital syphilis), and 7 infants diagnosed with congenital syphilis after birth where syphilis was not diagnosed in pregnancy. There were 12 cases of congenital syphilis; an incidence rate of 9.4 cases per 100,000 live births. Nine of the 12 infants had clinical features of congenital syphilis. One-third of maternal infections were early syphilis, and the women who gave birth to infected infants were less likely to have received antenatal care, adequate treatment and follow-up monitoring of treatment for syphilis during pregnancy. CONCLUSIONS: This study quantifies an important burden of disease from congenital syphilis in our population. Case finding and treatment of syphilis in pregnancy are critical to prevent this. Our findings support the urgent need for measures such as repeat maternal syphilis screening in early third trimester; whether by affected region or instituted for all, in the context of rising cases.