Antibiotics in Early Life: What Are We Changing for the Future? w Prof Wayne Cutfield

Antibiotics in Early Life: What Are We Changing for the Future? w Prof Wayne Cutfield

We’re joined by Wayne Cutfield, a paediatric endocrinologist at Starship Children’s Hospital and Professor at the Liggins Institute. Co leader of gut bugs research team. We explore antibiotic use in children, the impact of antibiotics on the developing microbiome, and practical strategies for clinicians to prescribe appropriately while supporting long-term child health. Antibiotics are one of medicine’s most important discoveries, dramatically reducing deaths from infectious diseases. However, widespread and sometimes unnecessary use, particularly in children has raised concerns. Emerging evidence suggests antibiotic exposure may be contributing to shifts in the epidemiology of chronic and autoimmune diseases that cannot be explained by population changes alone. Practical clinical pearls: 1. Antibiotics continue to be overused in infants and young children in New Zealand, although prescribing trends are improving. When antibiotics are needed, choose the narrowest-spectrum antibiotic for the shortest effective duration. 2. Early antibiotic exposure alters the gut microbiome. Observational studies have linked this with higher rates of childhood obesity, allergic disease including asthma and eczema, type 1 diabetes, and even later mental health conditions such as depression and anorexia nervosa. 3. Breastfeeding remains the gold standard for healthy microbiome development. Encourage exclusive breastfeeding for around six months where possible, as this supports immune development and microbial diversity. 4. When infants require formula feeding, consider formulas containing human milk oligosaccharides (HMOs), which may help support a healthier gut microbiome more similar to that seen in breastfed infants. 5. Diet matters once solids are introduced. Encouraging a “rainbow” of fruits and vegetables, alongside lean meats and high-fibre foods, helps promote microbiome diversity. For families in Auckland whose child requires antibiotics, consider referral to Professor Wayne Cutfield’s ongoing clinical trial investigating HMOs versus placebo following antibiotic exposure in early life. See the study link in the podcast bio. Bio: Wayne Cutfield is Professor of Paediatric Endocrinology and co-director of the highly successful Gut Bugs Research Programme. He was previously Director of the Liggins Institute and previously Director of a Better Start National Science Challenge. He single handedly established paediatric endocrinology in Auckland which has grown in to a national referral service. His research achievements and leadership in paediatric endocrinology have been widely recognised with the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes Norman Wetenhall Medal for research innovation, the University of Auckland’s Gluckman Medal for outstanding research contribution, the Royal Australasian College of Physicians Child Health Division Howard William’s Medal for clinical leadership and the RACP pinnacle award the College Medal for outstanding impact and leadership in medicine and research. He has published >350 articles in journals that include the New Journal of Medicine, Lancet, BMJ and Nature and has an H Index of 85. Resources: Hindson J. Post-antibiotics microbiome restoration driven by diet. Nat Rev Gastroenterol Hepatol. 2025;22:462. doi:10.1038/s41575-025-01090-8. Lizumi T, Battaglia T, Ruiz V, Perez-Perez GI. Gut microbiome and antibiotics. Arch Med Res. 2017;48(8):727–734. doi:10.1016/j.arcmed.2017.11.004. Professor Cutfeilds antibiotic study. https://www.auckland.ac.nz/en/liggins/in-the-community/clinical-studies/clinical-studies-babies-children/oak-study.html [https://kor01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.auckland.ac.nz%2Fen%2Fliggins%2Fin-the-community%2Fclinical-studies%2Fclinical-studies-babies-children%2Foak-study.html&data=05%7C02%7C%7C242722a6953c4a5d4d4008dec10281d0%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C639160415689644654%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=9Ny86WXmY9qgzDA7xE%2BjwlfBXfkdYrRzww73njAhiQs%3D&reserved=0] Listen here:

Sun, Stores, and Supplementation: Vitamin D in Pregnancy and Early Life w Prof Ben Wheeler

Who should receive vitamin D in pregnancy and infancy? We focus on risk identification, prevention strategies, and the clinical recognition of deficiency, including nutritional rickets. Vitamin D deficiency remains an important and preventable issue, particularly in at-risk populations. To explore this topic, we are joined by Professor Ben Wheeler, a Paediatric Endocrinologist and Paediatrician. Practical clinical pearls: · Universal infant supplementation works best Provide vitamin D supplementation to all infants up to 12 months, regardless of feeding method, ethnicity, or perceived sun exposure, as risk-based approaches miss vulnerable babies. · Maternal vitamin D status shapes infant health Maternal deficiency during pregnancy directly affects neonatal vitamin D stores and future bone health, making antenatal supplementation an important prevention strategy. · Sun exposure is not a reliable strategy in infancy In New Zealand’s high-latitude environment, sun exposure alone is inconsistent and carries skin cancer risks, so daily supplementation is preferred for infants. · Test selectively, supplement proactively Routine vitamin D testing is usually unnecessary in asymptomatic women and infants; focus instead on guideline-based supplementation and prevention in at-risk populations. · Recognise rickets early and act urgently Consider vitamin D deficiency and nutritional rickets in infants with poor growth, delayed milestones, hypotonia, bone pain, or irritability. Hypocalcaemia and raised ALP are important clues, and suspected rickets requires urgent same-day paediatric discussion and possible hospital admission. Bio: Professor Ben Wheeler is a Paediatric Endocrinologist and Paediatrician working for the University of Otago and the Southern District Health Board. His research focuses on access to and use of new technologies for children and young people affected by diabetes, as well as factors that impact on glycaemic control in diabetes. He also has a research interest in vitamin D and bone health during pregnancy, lactation, and infancy. He has a number of collaborations ongoing in these areas, and usually multiple clinical trials or studies running in these areas at any one time. Resources: https://static.info.content.health.nz/docs/health-pros/topics/maternity/national/companion-statement-vitamin-d-sun-exposure-pregnancy-infancy-nz.pdf [https://static.info.content.health.nz/docs/health-pros/topics/maternity/national/companion-statement-vitamin-d-sun-exposure-pregnancy-infancy-nz.pdf] https://www.starship.org.nz/guidelines/vitamin-d-deficiency-investigation-and-management/ [https://www.starship.org.nz/guidelines/vitamin-d-deficiency-investigation-and-management/] https://bpac.org.nz/2025/vitamind.aspx [https://bpac.org.nz/2025/vitamind.aspx] Wheeler, Benjamin J et al. “A Brief History of Nutritional Rickets.” [Wheeler, Benjamin J et al. “A Brief History of Nutritional Rickets.” Frontiers in endocrinology (Lausanne) 10 (2019): 795. Web.]Frontiers in endocrinology (Lausanne) [Wheeler, Benjamin J et al. “A Brief History of Nutritional Rickets.” Frontiers in endocrinology (Lausanne) 10 (2019): 795. Web.] 10 (2019): 795. Web. [Wheeler, Benjamin J et al. “A Brief History of Nutritional Rickets.” Frontiers in endocrinology (Lausanne) 10 (2019): 795. Web.] Simm, Peter J et al. “Editorial: Childhood Rickets—New Developments in Epidemiology, Prevention, and Treatment.” [Simm, Peter J et al. “Editorial: Childhood Rickets—New Developments in Epidemiology, Prevention, and Treatment.” Frontiers in endocrinology (Lausanne) 11 (2020): 621734. Web.]Frontiers in endocrinology (Lausanne) [Simm, Peter J et al. “Editorial: Childhood Rickets—New Developments in Epidemiology, Prevention, and Treatment.” Frontiers in endocrinology (Lausanne) 11 (2020): 621734. Web.] 11 (2020): 621734. Web. [Simm, Peter J et al. “Editorial: Childhood Rickets—New Developments in Epidemiology, Prevention, and Treatment.” Frontiers in endocrinology (Lausanne) 11 (2020): 621734. Web.] Listen Here: https://podcasts.apple.com/nz/podcast/sun-stores-and-supplementation-vitamin-d-in-pregnancy/id1845748299?i=1000769448088 https://open.spotify.com/episode/6UiuK9TgKYFg8A3xXNIwN3?si=8f5ae56c48f9434a

Eyelid lesions w Dr Sid Ogra.

Dr Louise Kuegler and Dr Sid Ogra explore the assessment and management of eyelid lesions in primary care. They discuss a clinical case of a 67y female with a non healing lesion on the eyelid. Unpacking how to distinguish benign from malignant lesions, highlight key red flags such as non-healing or changing lesions, and emphasise the importance of early recognition and timely referral. The conversation covers common conditions including actinic keratosis, basal cell carcinoma and melanoma, along with practical strategies such as thorough history-taking, clinical intuition, and the use of photography for monitoring. Preventive approaches, including sun protection and awareness of risk factors, are also discussed to support better patient outcomes. Practical clinical pearls: * Most eyelid lesions are benign (however as they are in a functional place, if large may still need to be removed) * Malignant lesions are usually treatable if caught early * Red flags to watch for: Loss of eyelashes (Number one by far). Non-healing areas of skin or styes that after 3/12 have not resolved as expected- this could be sebaceous cell carcinoma. Bleeding and ulceration. * If uncertain of diagnosis→ refer early Speaker Bio: Dr Sid Ogra, MBChB, FRANZCO Specialist in Oculoplastics (eyelid and tear duct disorders) – adults and children Specialist in cataract surgery, including premium lenses and refractive correction Dr Sid Ogra is a well-established ophthalmologist with subspecialty expertise in oculoplastics and a busy cataract surgery practice. He provides care across Auckland and Queenstown, seeing both adult and paediatric patients. Sid graduated with distinction from the University of Auckland and completed his ophthalmology training across Auckland, Rotorua and Wellington. He then undertook an Oculoplastic Fellowship in Hereford, UK (2019), further refining his surgical skills in eyelid and tear duct disorders. He has also completed observerships at the Byers Eye Institute at Stanford (USA) and Samsung Medical Centre in Seoul (South Korea), gaining additional international experience in advanced ophthalmic care. Sid is committed to a collaborative approach, working closely with patients to ensure they are well informed about their condition and treatment options, and supporting shared decision-making to achieve the best possible outcomes. Resources: Bernardini, Francesco P. Management of malignant and benign eyelid lesions. Current Opinion in Ophthalmology 17(5):p 480-484, October 2006. | DOI: 10.1097/01.icu.0000243022.20499.90 Sun, M. T., Huang, S., Huilgol, S. C., & Selva, D. (2019). Eyelid lesions in general practice. Australian Journal of General Practice, 48(8), 509–514. https://search.informit.org/doi/10.3316/informit.554448397575586 Listen Here:

GLP- 1 RA and Eye Health w A Prof Racheal Niederer.

Are GLP-1 receptor agonists putting your patients’ eye health at risk? Here’s what you need to know. GLP-1 receptor agonists are revolutionising diabetes management, offering significant weight loss and cardiovascular benefits. However, there is a potential link to eye disease, particularly in those with pre-existing conditions. Recent studies suggest that while these medications improve overall health, they may cause a temporary worsening of diabetic retinopathy due to rapid improvements in blood glucose levels. This is important for primary care, as patients need appropriate assessment and counselling before starting treatment. Before prescribing, ensure a recent retinal screening has been completed, especially for higher-risk patients. Close monitoring in the first few months is essential to detect any early complications. Practical clinical pearls: Rapid weight loss can worsen diabetic retinopathy. Start low, go slow, and monitor the retina in diabetic patients. Ensure retinal screening has been completed within the last 12 months before starting treatment. If retinopathy is present, initiate cautiously and arrange closer ophthalmology follow-up. Advise all patients to seek urgent review if they develop any visual symptoms. Ocular complications are rare in non diabetics, but important to recognise early. Report any suspected adverse events to Medsafe to support ongoing safety monitoring. Guest bio: Assoc Prof Rachael Niederer PhD, MBChB, FRANZCO Ophthalmologist | Uveitis and Medical Retina Specialist Rachael attended Auckland University Medical School from 1997–2002 and won the highly prized Sir William McKenzie Award for Early Excellence in Eye Research. She completed her PhD on corneal nerves and keratoconus in 2008 and was awarded the Vice Chancellor’s Best Doctoral Thesis award. Rachael completed her ophthalmology vocational training in both Auckland and Hamilton and, in the RANZCO final examination, achieved a gold Howsam Medal for the highest marks in Australia and New Zealand. She completed her fellowship at Moorfields Eye Hospital in London, specialising in uveitis and medical retina. In 2016, she was appointed Senior Medical Ophthalmologist at Greenlane Hospital and, in the same year, was the RANZCO college representative for Auckland ophthalmology trainees. In 2019, Rachael was appointed Senior Lecturer at the University of Auckland, Department of Ophthalmology. In late 2025, she was promoted to Associate Professor at the University of Auckland, recognising her ongoing contributions to ophthalmology, education, and research. Rachael’s research interests are extensive and include more than 140 publications in international journals and over 60 presentations at New Zealand and international conferences. She is an investigator in the Zoster Eye Disease Study and has a particular interest in uveitis and the epidemiology of eye disease. She is also committed to reducing inequalities in access to eye care within the community. Resources: MedSafe NZ Pharmacovigilance - https://medsafe.govt.nz/ [https://medsafe.govt.nz/] American Diabetes Association Screening Guidelines - https://diabetes.org/diabetes/medication-management/retinal-screening [https://diabetes.org/diabetes/medication-management/retinal-screening] Green Lane Eye Clinic - https://aucklandeye.co.nz/ [https://aucklandeye.co.nz/] Rachael Niederer - Auckland Eye - https://www.aucklandeye.co.nz/specialist/assoc-prof-rachael-niederer/ [https://www.aucklandeye.co.nz/specialist/assoc-prof-rachael-niederer/] GLP-1 Receptor Agonists Overview - NICE - https://www.nice.org.uk/guidance/ta543 [https://www.nice.org.uk/guidance/ta543] Listen Here: #GLP1 #EyeHealth #DiabetesCare

Mastitis spectrum in the lactating indivdual w Dr Yvonne Le Fort.

What if that red, painful breast isn’t an infection — and antibiotics aren’t needed? Mastitis is now seen as a spectrum, often inflammatory rather than infective. Treating it as routine infection risks overprescribing and missing early, effective care. Talking to Lactation medicine physician Dr Yvonne Le Fort we unpack the case of Kim, a well 26-year-old female, three months postpartum with a tender, erythematous breast, we cover: When mastitis is inflammatory vs infective What early management should prioritise When antibiotics are actually needed Red flags and when to escalate Practical clinical pearls: * Mastitis is a spectrum — it may be inflammatory and is not always due to infection. * Initial management of lactational mastitis- includes pain relief, reducing breast oedema, and addressing hyperlactation. * Milk culture – consider if symptoms persist despite antibiotics, or if mastitis is recurrent or prolonged. * Antibiotics – not all cases need them. Use only for systemic symptoms or if no improvement after 24–48 hours. First-line: Flucloxacillin. If penicillin allergy: Clindamycin * Breast abscess or mass – refer urgently for imaging ± surgical drainage. * Non-lactational mastitis – usually infective; requires antibiotics and close follow-up. Refer early if cancer suspected. * Inflammatory breast cancer can mimic mastitis — maintain a high index of suspicion. Guest bio: Dr Yvonne LeFort, a family medicine doctor trained in Canada, has practised breastfeeding medicine for over 20 years and runs a private breastfeeding clinic on Auckland’s North Shore. She is a dual Fellow of RNZCGP and CCFP (Canada), an IBCLC, and a Fellow of the Academy of Breastfeeding Medicine (ABM). She serves on the board of the New Zealand Breastfeeding Alliance (NZBAA), supporting evidence-based breastfeeding education for all medical and health care colleagues. Currently, she is a professional advisor to La Leche League New Zealand, a member of NZLCA, and the founder of a Breastfeeding Medicine RNZCGP Peer Review Group. Yvonne has recently completed a Post Graduate Diploma in Digital Health from Otago University. She has provided both formal and informal education for IBCLCs and medical colleagues, helping to upskill healthcare workers with the knowledge needed to provide best-practice care when consulting with breastfeeding dyads. She has presented nationally and internationally on a wide variety of topics. Yvonne is the first author of the ABM’s Position Statement on Ankyloglossia and Breastfeeding Dyads (2021), a contributor to New Zealand Aotearoa National Guidance for the Assessment, Diagnosis and Surgical Treatment of Tongue-Tie in Breastfeeding Neonates, and a co-author of Complications and Misdiagnoses Associated with Infant Frenotomy: Results of a Healthcare Professional Survey (International Breastfeeding Journal, 2022), along with several other clinical protocols. Resources: https://www.redwhale.co.uk/content/the-mastitis-spectrum [https://www.redwhale.co.uk/content/the-mastitis-spectrum] https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf [https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf] https://www.tewhatuora.govt.nz/for-the-health-sector/specific-life-stage-health-information/maternal-health/breastfeeding/breastfeeding-problems/mastitis-and-breast-abscesses/ [https://www.tewhatuora.govt.nz/for-the-health-sector/specific-life-stage-health-information/maternal-health/breastfeeding/breastfeeding-problems/mastitis-and-breast-abscesses/] https://tewhatakura.nz/guidelines [https://tewhatakura.nz/guidelines]