AbstractAimThe aim of this study was to evaluate predictors of neurodevelopmental outcome following hypoxic‐ischemic encephalopathy (HIE) and neonatal seizures in the randomized controlled trial cohort from the NEOLEV2 study.MethodSeizure burden, randomized levetiracetam versus phenobarbital antiseizure medication, and duration of breastfeeding were studied as predictors of neurodevelopmental outcome.ResultsOutcome could be assessed in 115 patients with HIE and/or seizures; 89 patients with HIE (50% of 178 patients with HIE in the original cohort), and 60 patients with seizures (63% of 96 patients with seizures in the original cohort), and including 34 patients who had both HIE and seizures. A strong association between seizure burden and outcome was shown. However, the association was not statistically significant after correction for known predictors of outcome: magnetic resonance imaging severity of injury score, Sarnat score, and hypothermia treatment. This study was underpowered to assess for effect of randomized antiseizure medication or duration of breastfeeding on neurodevelopmental outcome; however, no large trends were seen.InterpretationThis study adds to the debate as to whether neonatal seizures have an independent detrimental effect on neurodevelopmental outcome. Larger studies with longer neurodevelopmental follow‐up are needed to investigate these questions.

Objectives To assess the validity of an International Classification of Diseases (ICD) code based definition of non-fatal head trauma caused by child abuse (abusive head trauma) for population surveillance in New Zealand.Design A retrospective cohort study of hospital inpatient records.Setting A tertiary children’s hospital in Auckland, New Zealand.Participants 1731 children less than 5 years of age who were discharged after a non-fatal head trauma event over a 10-year period from 1 January 2010 to 31 December 2019.Outcome measures The outcome of assessment by the hospital’s multidisciplinary child protection team (CPT) was compared with the outcome of ICD, Tenth Revision (ICD-10) discharge coding for non-fatal abusive head trauma (AHT). The ICD-10 code definition of AHT was derived from an ICD, Ninth Revision, Clinical Modification definition developed by the Centers for Disease Control, Atlanta, Georgia, which requires both a clinical diagnosis code and a cause-of-injury code.Results There were 1755 head trauma events with 117 determined as AHT by the CPT. The ICD-10 code definition had a sensitivity of 66.7% (95% CI 57.4 to 75.1) and specificity of 99.8% (95% CI 99.5 to 100). There were only three false positives but 39 false negatives, with 18 of the false negatives coded with X59 (exposure to unspecified factor).Conclusions The ICD-10 code broad definition of AHT is a reasonable epidemiological tool for passive surveillance of AHT in New Zealand but it underestimates the incidence. Its performance could be improved by clear documentation of child protection conclusions in clinical notes, clarifying coding practice and removing the exclusion criteria from the definition.

Abstract Mother-infant bonding and breastfeeding are critical factors in the long-term outcomes of neonates. This is a first-of-its-kind exploratory study that reports the maternal bonding status and provision of breastmilk for families whose infants suffered from hypoxic ischemic encephalopathy (HIE) or neonatal seizures. Eighty-six mothers who participated in the NEOLEV2 neonatal seizure clinical trial were interviewed. Researchers surveyed mothers using the Parent Bonding Questionnaire (PBQ) and subjects provided additional qualitative comments on their experiences bonding and breastfeeding in the hospital as well as at home with their high-risk newborns. Participant interviews highlighted the impact of stressors surrounding the health and progress of their neonates that negatively impacted maternal-infant bonding as well as contributed to their inability to provide breastmilk. New mothers, in particular, reported a desire to continue breastfeeding, but felt that there was inadequate support for them. Further considerations of Whole Person Care in maternal-infant bonding, breastfeeding, mental, and postpartum support for parents of high-risk neonates could reduce long-term challenges for this vulnerable population.

Abstract Objective Acute kidney injury (AKI) may contribute to the risk of diabetic kidney disease, however, there have been limited studies of the incidence of AKI in well‐defined populations of children with type 1 diabetes. The aim was to quantify AKI in children presenting with new onset type 1 diabetes from the regional paediatric diabetes service, Auckland, New Zealand. Research Design and Methods A retrospective analysis of a prospectively identified cohort study of children and adolescents presenting from 2006 to 2016 with type 1 diabetes aged <15 years. AKI was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. Results There were 586 subjects: 52% male, with mean (SD) age 8.9 (3.8) years, with 151(25.8%) in diabetic ketoacidosis (DKA). AKI was present in 47%, 278/586, AKI was increased in those with DKA (125/151 (83%) DKA vs. 153/435 (35%) no‐DKA). Univariable analysis showed that increased HbA1c, higher glucose levels, lower BMI SDS, lower bicarbonate and pH levels were all associated with AKI (p < .001). In multivariable analysis, AKI was associated with DKA and higher glucose levels independently. The majority of cases were stage 1 (203/278 [73%]), or stage 2 AKI 62/278 (22%). 13/278 (5%) had severe, Stage 3 AKI, and all presented in DKA (13/151 (8%) vs. 0/435 (0%) without DKA, p < .001). Conclusion In this regional paediatric, cohort AKI is a common complication of children presenting with new onset type 1 diabetes. AKI is independently associated with higher glucose levels and DKA, and all cases of Stage 3 AKI were associated with DKA.

Aim The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand. Methods A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Parapneumonic effusion/empyema was defined as pneumonia and pleural effusion persisting >= 7 days, and/or any pneumonia, and pleural effusion necessitating drainage. Notifying pediatricians completed standardized questionnaires. Results Annual pediatric parapneumonic effusion/empyema incidence was 5.6/100,000 (95% confidence interval [CI]: 4.7-6.9). Most children (80%) required surgical intervention and 31% required intensive care. A causative organism was identified in 71/102 (70%) cases. Although Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) infection rates were equal, prolonged hospitalization and intensive care admission were more common in children with S. aureus PPE/E. Maori and Pasifika children were over-represented at 2.2 and 3.5 times, their representation in the New Zealand pediatric population. Pneumococcal vaccination was incomplete, with only 61% fully immunized and 30% unimmunized. Haemophilus influenzae type b vaccine uptake was near complete at 89/94 (95%), with influenza immunization only 3/78 (4%). Conclusions New Zealand has a high incidence of pediatric complicated parapneumonic effusion/empyema with significant morbidity. S. aureus was a significant cause of severe empyema in New Zealand, particularly for Maori and Pasifika children. Improvements in vaccine coverage are needed along with strategies to reduce S. aureus disease morbidity.

Objective Prolonged continuous video-electroencephalography (cEEG) is recommended for neonates at risk of seizures. The cost and expertise required to provide a real-time response to detected seizures often limits its utility. We hypothesised that the first hour of cEEG could predict subsequent seizures. Design and setting Retrospective multicentre diagnostic accuracy study. Patients 266 term neonates at risk of seizure or with suspected seizures. Intervention The first hour of cEEG was graded by expert and novice interpreters as normal, mildly, moderately or severely abnormal; seizures were identified. Main outcome measures Association between abnormalities in the first hour of cEEG and the presence of seizures during total cEEG monitoring. Results 50/98 (51%) of neonates who developed seizures had their first seizure in the first hour of cEEG monitoring. The 'time-to-event' risk of seizure from 0 to 96 hours was 0.38 (95% CI 0.32 to 0.44) while the risk in the first hour was 0.19 (95% CI 0.15 to 0.24). cEEG background was normal in 48% of neonates, mildly abnormal in 30%, moderately abnormal in 13% and severely abnormal in 9%. Inter-rater agreement for determination of background was very good (weighted kappa=0.81, 95% CI 0.72 to 0.91). When neonates with seizures during the first hour were excluded, an abnormal background resulted in 2.4 times increased risk of seizures during the subsequent monitoring period (95% CI 1.3 to 4.4, p<0.003) while a severely abnormal background resulted in a sevenfold increased risk (95% CI 3.4 to 14.3, p<0.0001). Conclusions The first hour of cEEG in at-risk neonates is useful in identifying and predicting whether seizures occur during cEEG monitoring up to 96 hours. This finding enables identification of high-risk neonates who require closer observation.

Background: The New Zealand health system assigns a unique identifier to every user of health services. The National Child Protection Alert System enables an alert to be placed against this identifier, making child protection information available to health providers throughout the country. Local health-based multi-disciplinary teams receive requests for an alert and decide whether an alert should be placed, but the proportion of requests accepted for an alert varies widely across New Zealand. Objective: To examine whether eliminating variation in information presented to multi-disciplinary teams eliminates variation in the proportion accepted for an alert. Participants and setting: Health professionals working in multi-disciplinary child protection teams in publicly funded healthcare services across New Zealand. Methods: All multi-disciplinary teams were asked to consider a set of 25 standardized child protection cases following their usual practice. The proportion accepted for an alert was compared by agreement analysis. Results: Eighteen of 20 teams completed the study. The proportion accepted for an alert varied from 48 to 96% (median 88%, inter-quartile range 73-89%). The proportion where the local team agreed with the majority decision varied from 64 to 96% (median 88%, inter-quartile range 81-96%). The kappa coefficient for inter-rater agreement varied from 0.25 (95% CI 0.00-0.76) to 0.83 (95% CI 0.52 to 1.00). The overall kappa coefficient was 0.37. Conclusions: Eliminating variation in information provided does not eliminate variation in the proportion accepted for an alert. More research is needed into factors influencing alert decisions in the New Zealand National Child Protection Alert System.

Objective To measure the actual radiation dose delivered by imaging techniques commonly used in the radiography of suspected physical abuse and to make this information available to health professionals and families. Methods Data were collected retrospectively on children under 3 years referred for skeletal surveys for suspected physical abuse, non-contrast CT head scan or radionuclide imaging of the bones in Starship Children's Hospital, Auckland, New Zealand from January to December 2015. Patient size-specific conversion coefficients were derived from International Commission on Radiologic Protection tissue weighting factors and used to calculate effective dose. Results Seventy-one patients underwent an initial skeletal survey, receiving a mean effective dose of 0.20 mSv (95% CI 0.18 to 0.22). Sixteen patients had a follow-up survey with a mean effective dose of 0.10 mSv (95% CI 0.08 to 0.11). Eighty patients underwent CT head which delivered a mean effective dose of 2.49 mSv (95% CI 2.37 to 2.60). Thirty-nine patients underwent radionuclide bone imaging which delivered a mean effective dose of 2.27 mSv (95% CI 2.11 to 2.43). Conclusions In a paediatric centre, skeletal surveys deliver a relatively low effective radiation dose, equivalent to approximately 1 month of background radiation. Non-contrast CT head scan and radionuclide bone imaging deliver similar doses, equivalent to approximately 1 year of background radiation. This information should be considered when gaining informed consent and incorporated in patient education handouts.

AimIt is important to understand whether type 2 diabetes mellitus (T2DM) is increasing in childhood for health‐care planning and clinical management. The aim of this study is to examine the incidence of T2DM in New Zealand children, aged <15 years from a paediatric diabetes centre, Auckland, New Zealand.MethodsRetrospective analysis of prospectively collected data from a population‐based referral cohort from 1995 to 2015.ResultsHundred and four children presented with T2DM over the 21‐year period. The female:male ratio was 1.8:1, at mean (standard deviation) age 12.9 (1.9) years, body mass index standard deviation score +2.3 (0.5), blood sugar 15.3 (8.5) mmol/L, HbA1c 76 (28) mmol/mol. At diagnosis, 90% had acanthosis nigricans and 48% were symptomatic. In all, 33% were Maori, 46% Pacific Island, 15% Asian/Middle Eastern and 6% European. There was a progressive secular increase of 5% year on year in incidence. The overall annual incidence of T2DM <15 years of age was 1.5/100 000 (1.2–1.9) (95% confidence interval), with higher rates in Pacific Island (5.9/100 000) and Maori (4.1/100 000).ConclusionsThe incidence of T2DM in children <15 years of age in New Zealand has increased progressively at 5%/year over the last 21 years. The risk was disproportionately associated with girls and children from high‐risk ethnic groups.

Aim: To review indications and use of angiotensin-converting enzyme-inhibitor (ACEI) therapy for the treatment of persistent microalbuminuria (MA) and/or hypertension (HTN) in adolescents with type 1 diabetes mellitus (T1DM).Methods: Retrospective chart review of adolescent patients with T1DM seen within the paediatric diabetes service in Auckland, New Zealand, from 2006 to 2016. MA, HTN, patient demographic characteristics and ACEI prescribing and monitoring indices were examined.Results: Five hundred adolescents with T1DM were included. There were 26 patients (5%) with MA and/or HTN. MA alone was present in 16, HTN alone in 3 and both HTN and MA in 7. The 5-year MA/HTN-free rate was 98%, and the 10-year MA/HTN-free rate was 93%. Longer disease duration and earlier diagnosis were predictors of MA/HTN. There was no significant difference in standard clinical indices between study patients and others. ACEI was prescribed for 17 of 26 patients for either HTN or MA. Within 6 weeks of ACEI commencement, less than half of the subjects had repeat serum creatinine and MA screens and no record of repeat blood pressure measurement. Despite this, all patients had 3-monthly reviews within outpatient clinics where adjustments of ACEI doses were made.Conclusion: In our regional adolescent population with T1DM, there were low rates of both MA and/or HTN. In those who required treatment with ACEI, clinical monitoring post-commencement of therapy was inconsistent. Local consensus guidelines for the management of persistent MA in children and adolescents with diabetes mellitus were developed in response to this study.

Infectious diseases are the leading cause of hospital admissions in young children. Hospitalisation with an infectious disease is a recurrent event for some children. Our objective was to describe risk factors for infectious disease readmission following hospital admission with an infectious disease in the first two years of life.

AIM: To determine the most accurate data source for acute rheumatic fever (ARF) epidemiology in the Auckland region. METHOD: To assess coverage of the Auckland Regional Rheumatic Fever Register (ARRFR), (1998-2010) for children < 15 years and resident in Auckland at the time of illness, register, hospitalisation and notification data were compared. A consistent definition was applied to determine definite and probable cases of ARF using clinical records. (www.heartfoundation.org.nz) RESULTS: Of 559 confirmed (definite and probable) RF cases < 15 years (median age 10 years), seven were recurrences. Of 552 first episodes, the ARRFR identified 548 (99%), hospitalisations identified 501 (91%) including four not on the register, and public health notifications identified 384 (70%). Of hospitalisation cases, 33% (245/746), and of notifications 20% (94/478) did not meet the case definition and were therefore excluded. Between 1998-2010, eight cases, initially entered as ARF on the ARRFR, were later removed once further clinical detail was available. CONCLUSION: The ARRFR produced the most accurate information surrounding new cases of ARF (for children < 15 years) for the years 1998-2010 in Auckland. This was significantly more accurate than medical officer of health notification and hospitalisation data.

Bioequivalence between Tacrolimus Prograf® and generic tacrolimus formulations has been demonstrated in adult populations, however clinical experience and safety data regarding generic tacrolimus in pediatric transplant recipients is limited. This study aimed to evaluate conversion from Tacrolimus Prograf® to Sandoz® in pediatric renal transplant recipients nationwide. The primary outcome was a change in mean trough tacrolimus concentration. Additionally, changes in tacrolimus intra-patient coefficient of variation (CoV), allograft function, requirement for dose adjustments, and episodes of biopsy-proven rejection were evaluated.

AimTo investigate the incidence and severity of anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis in children from New Zealand.MethodA retrospective case series was undertaken of all children (18y) diagnosed with anti-NMDA receptor encephalitis from January 2008 to October 2015.ResultsSixteen patients were identified with anti-NMDA receptor antibodies in the cerebrospinal fluid, three of whom had an associated teratoma. Fifteen children had maori and/or Pacific Island ancestry. The incidence of anti-NMDA receptor encephalitis in maori children was 3.4 per million children per year (95% confidence interval [CI] 1.4-7.0) and the incidence in Pacific children was 10.0 per million children per year (95% CI 4.3-19.8) compared with 0.2 per million children per year (95% CI 0.0-1.0) in children without maori or Pacific Island ancestry. Sixty-seven per cent of children had a good outcome (modified Rankin Score 2) at 2 years' follow-up. This compares unfavourably with other cohorts despite a shorter median time to first-line immunotherapy (13d; range 4-89) and a higher proportion of children being treated with second-line therapy (50%).Interpretationmaori and Pacific Island children have a higher incidence of anti-NMDA receptor encephalitis and possibly a more severe phenotype. These data suggest a genetic predisposition to anti-NMDA receptor encephalitis in these populations.What this paper addsmaori and Pacific Island children are at increased risk of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (3.4 and 10.0 per million children per year respectively). One third of maori and Pacific Island children with anti-NMDA receptor encephalitis have a poor outcome.This article is commented on by Njafang and Missa on page 673 of this issue.

Anemia is a major complication for patients on chronic dialysis. Erythropoietin is effective if iron is available, however unnecessary iron supplementation results in iron overload. Reticulocyte hemoglobin equivalent (Ret-He) may be useful for assessing iron status.

Very long chain acyl-CoA dehydrogenase deficiency (VLCADD, OMIM #201475) has been increasingly diagnosed since the advent of expanded newborn screening (NBS). Elevated levels of tetradecenoyl-L-carnitine (C14:1) in newborn screening blood spot samples are particularly common in New Zealand, however this has not translated into increased VLCADD clinical presentations. A high proportion of screen-positive cases in NZ are of Maori or Pacific ethnicity and positive for the c.1226C > T (p.Thr409Met) ACADVL gene variant. We performed a retrospective, blinded, case–control study of 255 cases, born between 2006 and 2013, with elevated NBS C14:1 levels between 0.9 and 2.4 μmol/L, below the NZ C14:1 notification cut-off of 2.5 μmol/L. Coded healthcare records were audited for cases and age- and ethnicity- matched controls. The clinical records of those with possible VLCADD-related symptoms were reviewed. The follow-up period was 6 months to 7 years. Two of 247 cases (0.8 %) had possible VLCADD-like symptoms while four of 247 controls (2 %) had VLCADD-like symptoms (p = 0.81). Maori were overrepresented (68 % of the cohort vs 15 % of population). Targeted analysis of the c.1226 locus revealed the local increase in screening C14:1 levels is associated with the c.1226C > T variant (97/152 alleles tested), found predominantly in Maori and Pacific people. There was no increase in clinically significant childhood disease, irrespective of ethnicity. The study suggests that children with elevated C14:1, between 0.9-2.4 μmol/L, on NBS are at very low risk of clinically significant childhood disease. A minimally interventional approach to managing these patients is indicated, at least in the New Zealand population.

Objectives/HypothesisTonsillectomy as a day-stay procedure remains controversial, although it is an established procedure in New Zealand. We reviewed our last 10 years' experience.MethodsA prospective audit was used to determine unplanned conversion from day-stay to overnight hospital admission rates and the incidence of postoperative complications.ResultsThere were 5,400 tonsillectomies performed over the 10-year study period (January 2004-January 2015); 71% as outpatients. The unplanned conversion rate to overnight stay was 0.4%. The median age of day-stay patients was 6.5 years (range 13 months-15 years) compared with those admitted for overnight stay (5 years; range 8 months-15 years). The primary postoperative bleed rate was 0.5% (confidence interval [CI] 0.3%-0.7%), and the combined primary and secondary posttonsillectomy bleed rate was 4.3% (CI 3.8%-5.0%). The rate of patients returning with postoperative complications within 1 month of surgery was 6.3% (CI 5.6%-7.0%).ConclusionDay-stay tonsillectomy in the pediatric population is safe when performed using the described guidelines in a facility with appropriate resources.Level of Evidence4. Laryngoscope, 126:E416-E420, 2016

AIM:To estimate hospitalisation costs for children with pertussis in New Zealand.METHOD:All children less than 16 years of age and hospitalised with pertussis between 01/01/2003 and 31/12/2013 were identified from the National Minimum Data Set and the National Paediatric Intensive Care Unit database. The cost of hospital care was estimated by multiplying the diagnosis-related group cost-weight by the national price and inflating to 2013/2014 values.RESULTS:There were 1,456 children with pertussis admitted to hospital including 65 admissions to the paediatric intensive care unit. Infants (<1 year) accounted for 78% of hospital admissions, 98% of paediatric intensive care admissions and 87% of hospitalisation costs. The total inflation-adjusted cost of the 11-year cohort was estimated at $8.3 million and the mean cost of hospital ward and paediatric intensive care was $4,242 and $42,016 respectively, per child. The 2011-2013 epidemic accounted for 39% of all hospital admissions and the cost estimated at $4.2 million. Peak annual hospitalisation costs during epidemic years increased from under $800,000 in 2004 and 2009 to over $2 million in 2012.CONCLUSION:Infants with pertussis are more likely than older children to be admitted to hospital and to the paediatric intensive care unit and generate the majority of hospitalisation costs. A revised focus on protecting vulnerable newborns and infants has the potential to both improve health outcomes for infants with pertussis and reduce medical costs.

BACKGROUNDIntravenous cannulation is a painful procedure that can provoke anxiety and stress. Injecting local anaesthetic can provide analgesia at the time of cannulation, but it is a painful procedure. Topical anaesthetic creams take between 30 and 90 minutes to produce an effect. A quicker acting analgesic allows more timely investigation and treatment. Vapocoolants have been used in this setting, but studies have reported mixed results.OBJECTIVESTo determine effects of vapocoolants on pain associated with intravenous cannulation in adults and children. To explore variables that might affect the performance of vapocoolants, including time required for application, distance from the skin when applied and time to cannulation. To look at adverse effects associated with the use of vapocoolants.SEARCH METHODSWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Latin American Caribbean Health Sciences Literature (LILACS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Institute for Scientific Information (ISI) Web of Science and the http://clinicaltrials.gov/, http://www.controlled-trials.com/ and http://www.trialscentral.org/ databases to 1 May 2015. We applied no language restrictions. We also scanned the reference lists of included papers.SELECTION CRITERIAWe included all blinded and unblinded randomized controlled trials (RTCs) comparing any vapocoolant with placebo or control to reduce pain during intravenous cannulation in adults and children.DATA COLLECTION AND ANALYSISThree review authors independently assessed trial quality and extracted data, contacted study authors for additional information and assessed included studies for risk of bias. We collected and analysed data for the primary outcome of pain during cannulation, and for the secondary outcomes of pain associated with application of the vapocoolant, first attempt success rate of intravenous cannulation, adverse events and participant satisfaction. We performed subgroup analyses for the primary outcome to examine differences based on age of participant, type of vapocoolant used, application time of vapocoolant and clinical situation (emergency vs elective). We used random-effects model meta-analysis in RevMan 5.3 and assessed heterogeneity between trial results by examining forest plots and calculating the I(2) statistic.MAIN RESULTSWe found nine suitable studies of 1070 participants and included them in the qualitative analyses. We included eight studies of 848 participants in the meta-analysis for the primary outcome (pain during intravenous cannulation). Use of vapocoolants resulted in a reduction in pain scores as measured by a linear 100 mm visual analogue scale (VAS 100) compared with controls (difference between means -12.5 mm, 95% confidence interval (CI) -18.7 to -6.4 mm; moderate-quality evidence). We could not include in the meta-analysis one study, which showed no effects of the intervention.Use of vapocoolants resulted in increased pain scores at the time of application as measured by a VAS 100 compared with controls (difference between means 6.3 mm, 95% CI 2.2 to 10.3 mm; four studies, 461 participants; high-quality evidence) and led to no difference in first attempt success compared with controls (risk ratio (RR) 1.00, 95% CI 0.94 to 1.06; six studies, 812 participants; moderate-quality evidence). We documented eight minor adverse events reported in 279 vapocoolant participants (risk difference (RD) 0.03, 95% CI 0 to 0.05; five studies, 551 participants; low quality-evidence).The overall risk of bias of individual studies ranged from low to high, with high risk of bias for performance and detection bias in four studies. Sensitivity analysis showed that exclusion of studies at high or unclear risk of bias did not materially alter the results of this review.AUTHORS' CONCLUSIONSModerate-quality evidence indicates that use of a vapocoolant immediately before intravenous cannulation reduces pain during the procedure. Use of vapocoolant does not increase the difficulty of cannulation nor cause serious adverse effects but is associated with mild discomfort during application.

AIMTo describe and evaluate a shaken baby prevention programme trialled in the Auckland District Health Board from January 2010, to December 2011.METHODDevelopment and implementation of the programme, telephone survey of a sample of caregivers and written survey of a sample of providers.RESULTSAt least 2,592 caregivers received the trial programme. 150 (6%) were surveyed by telephone a median of 6 weeks later. 128 (85%) remembered at least one key message, unprompted; most commonly "It's OK to walk away" (94/150, 63%). When asked, 92% had made a plan for what to do when frustrated and 63% had shared the information with others. Only 98/150 (65%) watched the programme DVD. Many said they already knew about the risks of shaking a baby, but still found the programme highly relevant. Thirty-one nurses were surveyed. There was a high degree of agreement that the programme was relevant. Barriers to programme delivery included time, workload and the documentation required.CONCLUSIONA shaken baby prevention programme adapted to New Zealand can be introduced in a District Health Board and is acceptable to caregivers and health professionals. Further research is needed to evaluate the content, mode of delivery and effectiveness of this programme.