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    An exploration of body composition in healthy early and full term infants using air displacement plethysmography shortly after birth : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
    (Massey University, 2018) Beauchamp, Annaliese Helena
    Background: The Developmental Origin of Health and Disease theory suggests environmental factors during gestation are important early predictors of later disease. There is a wealth of evidence identifying an association between low and extreme birth weights and an increased risk of adverse health outcomes in later life. The importance of growth in early life led to standardised monitoring of body weight, length and head circumference at birth and throughout infancy. Evidence now suggests body composition, specifically adiposity, in early life to be a better marker of poor health outcomes in later life. Gestation is a continuum and during each week of gestation the foetus continues to accrue fat mass (FM) and fat free mass (FFM), which are not routinely measured at birth. Development of air displacement plethysmography (ADP) presents a valid and reliable technique to measure FM and FFM of infants at birth. Majority of infants are born at term gestation (37 to <42 weeks). Early term infants (37 to <39 weeks) have a higher risk of developing adverse clinical outcomes and later health issues compared to full term infants (39 to <42 weeks). It is currently unknown whether there are differences in FM and FFM between infants born early versus full term. Aim: To investigate the FM and FFM of healthy early and full term New Zealand (NZ) infants within three days of birth. Methods: Healthy term infants were recruited from Auckland City Hospital (ACH), NZ as part of this cross-sectional observation study. Weight, length and waist circumference were measured using standardised techniques. ADP was used to measure FM and FFM of infants. Infants were grouped into early or full term categories. Waist circumference was divided by length to give the waist to length ratio (WLR). Two indices of length-normalised body composition were calculated: a FM index (FMI) and FFM index (FFMI) derived by dividing FM and FFM values (kg) by length2 (m2). Independent 2-tailed t-tests were used to compare the body composition measurements between early and full term infants and between genders. Results: 255 healthy term infants were recruited. There were no differences in the percentage of FM and FFM between early term and full term infants (10.2±4.0% vs 11.1±4.1%, P=0.109 and 90.0±4.0% vs 89.0±4.1%, P=0.110). Full term infants had significantly higher FMI and FFMI compared to early term infants (1.44±0.6 vs 1.26±0.06, P=0.02 and 11.3±1.0 vs 10.8±0.96, P<0.001). Early term males had significantly heavier body weights (P=0.04), FFM (2793.1±332.9g vs 2619.7±315.4g, P=0.003), FFM % (90.8±3.8% vs 88.7±4.0%, P=0.009), FMI (1.15±0.55 vs 1.38±0.56, P=0.039) and lower FM % (9.2±3.8% vs 11.3±4.0%, P=0.009) than female early term infants. No gender differences within full term infants were noted in FM (g), FFM (g), FM %, FFM %, FMI or FFMI. Conclusion: The results of this study suggest full term infants continue to gain FM and FFM along the same trajectories as that at early term gestation although they have greater FMI and FFMI than early term infants. While there were gender differences in body composition noted between early term infants, they were no longer apparent within the full term infants. This study identified the need to investigate the body composition changes of healthy early and full term infants at different time periods following birth. This will allow observation of factors which influence body composition in early life.
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    Neonatal nursing in Fiji : exploring workforce strategies to help Fiji achieve Sustainable Development Goal 3, Target 3.2 : a thesis presented in partial fulfilment of the requirements for the degree of Master in International Development at Massey University, Palmerston North, New Zealand
    (Massey University, 2019) Manuel, Ireen
    In Fiji 124 neonates lost their lives in 2017. While rates have improved in the Pacific, Fiji’s neonatal mortality rate has remained stagnant. The neonatal workforce struggles to meet the demands of this vulnerable population. Neonatal mortality is a global health challenge which is reflected in Sustainable Development Goal 3, target 3.2. This target aims to end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030. My research set out to explore and provide some understanding of the development needs of neonatal care globally and review the workforce challenges for nurses in this speciality area in Fiji. Improving the continuum of care for neonates will be critical if Fiji is to achieve Sustainable Development Goal 3, target 3.2. To answer these research questions, I adopted a qualitative methodology. I conducted four semi-structured interviews in Fiji and interpreted qualitative primary and secondary data. In doing so, I came across challenges that were present within programmes, service designs and national policies. Some of these challenges were easily fixed and did not need policy interventions, but rather individual willingness to change. Others required state interventions and long-term commitment and willingness. When applying the rights-based approach to health framework, my findings showed that the hardworking workforce in Fiji is still trying to change an organisational culture to a point where the workforce can feel fully inclusive and able to make evidence-based decisions as a team. The profound effects of not being able to do this is detrimental to the positive outcome for the neonates in their care. It was evident that health has many determinants and the problem relating to neonatal mortality is complex. My research showed that the neonatal nursing workforce were committed to reform and an effective health care service with adequate capacity and consumables is needed to run a well-functioning neonatal service. The key conclusions of my research are that there needs to be better collaboration between all sectors, evidence-based research practice and empowerment of the neonatal nursing workforce in Fiji. This is necessary if the government of Fiji is to achieve a neonatal workforce that can support it to achieve the critical Sustainable Development Goals target of reducing neonatal mortality.
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    Exploring the fat mass and fat free mass of term and moderate to late preterm infants : an observational study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
    (Massey University, 2015) Van Dorp, Louise Mary
    Background: Moderate to late preterm infants (32-36+6 weeks’ gestation) make up 83% of preterm births in New Zealand. Preterm birth is associated with having a higher risk of obesity, diabetes and cardiovascular disease in later life. Preterm infants demonstrate postnatal growth restriction followed by a period of accelerated growth. When compared to term infants at equivalent ages, preterm infants have been found to have a higher % fat mass. Nutrition is a modifiable factor contributing to the growth of preterm infants. While the goal is for these infants to be breast-fed, this is often not possible in early postnatal life due to delayed maternal milk supply and immaturity of the infant. Evidence is limited for the optimal feeding strategy for these infants until full breast-feeds can be established and there is great variability in practice. Aims: To measure the % fat mass and fat free mass of moderate to late preterm infants and term infants after birth at Auckland City Hospital; to explore the relationship between feeding strategies currently used within Auckland City Hospital and the acquisition of fat and fat free mass in moderate to late preterm infants after birth. Methods: Moderate to late preterm infants and term infants were recruited from Auckland City Hospital. Air displacement plethysmography (ADP) was used to measure the fat mass and fat free mass of the infants. Preterm infants were measured once they were medically stable and term infants were measured within 72 hr of birth. Eleven preterm infants were measured a second time prior to discharge from hospital. Information regarding what the preterm infants were fed within the first five days after birth was collected from their medical notes and the infants were prospectively grouped according to which feeding strategy they predominantly received, either: breast-milk, infant formula, 10% dextrose, or parenteral nutrition. Statistical analysis was performed using independent t-tests, Pearson’s Chi square tests, Mann-Whitney tests, paired sample t-tests, one-way ANOVA, and Kruskal-Wallis tests. Results: Forty seven preterm moderate to late preterm infants and sixty nine term infants were recruited. Term infants had a mean ± SD % FM of 10.9 ± 4.2%, when broken down by sex males had 9.4 ± 3.5% and females had 12.2 ± 4.8% (P = 0.018). Preterm infants measured within the first week of birth (n = 25) had a mean ± SD % FM of 8.7 ± 4.4% and those measured within the second week of birth (n = 19) had a mean ± SD % FM of 8.1 ± 2.9% (P = 0.6). Twenty two preterm infants were measured at ≥ 36 weeks’ postmenstrual age and had a mean ± SD % FM of 10.9 ± 5.0%, which did not differ from the % FM of term infants measured after birth (P = 0.98). Eleven preterm infants were measured twice during their hospital admission and their mean ± SD % FM increased from 8.5 ± 3.5% to 15.0 ± 4.2% (P <0.001). The median [25th-75th quartiles] % increase in FM for infants with two measurements was 98.9 [70.1, 114.9] %. One-way ANOVA revealed significant differences in FFM (P = 0.004), weight (P = 0.013), and length (P = 0.036) between the feeding groups. Post hoc analysis showed that infants in the parenteral nutrition group had significantly less FFM than infants in the formula group (P = 0.008) and were lighter and shorter than the breast-milk group (P = 0.013, P = 0.036). Conclusions: Moderate to late preterm infants experience a rapid increase in FM during hospital admission and reach the % FM of a term infant before term corrected age. Moderate to late preterm infants in the parenteral nutrition group were the lightest, shortest and had the least FFM. This study also highlights considerations to be made for future research using ADP in the Newborn Intensive Care Unit at Auckland City Hospital.