CardiologyPaediatric
DieticiansCommunity
PaediatricsPaediatric Intensive
Care UnitGastroenterology
& Nutrition GroupPaediatric
SurgeryGeneral
PaediatricsRadiologyNeonatal
UnitRespiratoryNeurology
New developments in 1998 included the first use of the Atrial Septal Defect Occluding Device, Dr Burch underwent training in this technique and six patients have undergone successful closure in Oxford. There are a further five patients awaiting closure to be undertaken in early 1999. Peripheral clinic activity increased with many centres in the region requesting further clinics. Dr Orla Franklin was welcomed to the department, replacing Martin Runciman who took time out from his Calman training post to go to the Texas Children’s Hospital, to train in cardiac electrophysiology.
The Community Paediatric Department undertook studies concerning behaviour problems in children with severe learning difficulties and the follow up of children admitted to hospital with a fracture in the first year of life. It has been involved, with the Department of Gastroenterology, in a study looking at the incidence of feeding difficulties in children with cerebral palsy and also with the Audit Commission in a review of the services provided for special needs children at the Hugh Ellis Paediatric Assessment Centre. In association with the Health Services Research Unit the department has made grant applications for a study to evaluate the effectiveness of a home visiting programme in the primary prevention of emotional and behavioural problems in high risk families.
The Paediatric Gastroenterology service in Oxford delivered each week three specialist clinics, a fibreoptic endoscopy session and a day-case session for programmed investigation of gastrointestinal disorders in children. The service receives over 400 new referrals per annum. Development of the paediatric gastroenterology service in Oxford has included the establishment of: i). A Nurse-led Childhood Constipation Clinic - the first of its kind in the country; ii). A Multidisciplinary Children's Allergy Clinic and iii). A Multidisciplinary Feeding Assessment Clinic for disabled children with feeding problems.
Changes in clinical practice during 1998 have largely concerned improvements in organisation of the acute service. The A and E audit (Dr.Anthony) highlighted several causes of delay in sending children up to ward 4C and improvements in communication have been introduced as a result. A rapid access clinic and a registrar follow up clinic have been established which have relieved some of the pressure on A/E and children’s day ward areas. In an attempt to reduce the number and duration of admissions for children with acute asthma a new policy of using MDIs and spacers in preference to nebulisers has been introduced. A new clinic attended by Dr. Van’t Hoff from the nephrology department at Great Ormond Street is providing valuable input for children with urological and renal problems.
The level of the Neonatal Unit’s clinical activities remained high and survived the minor disruption caused by refurbishment of the "Hot Room". The "Silver Star" high risk obstetric service and regional prenatal diagnosis service continue to provide a wide variety of high risk perinatal problems. The clinical activity was enhanced by the three advanced neonatal nurse practitioners (ANNPs) who began working successfully on the unit, with a fourth due to commence duties in early 1999. A neonatal hearing screening programme was finally implemented in the autumn of 1998. The unit began recruiting infants for the United Kingdom Oscillatory Study in the autumn of 1998. This is a multicentre study of oscillatory ventilation versus conventional ventilation in infants under 29 weeks of gestation. The Biochemistry Department with Dr NK Ives have been undertaking an evaluation of two blood glucose analyzers.
Drs Pike and McShane continued to provide a District & Regional Paediatric Neurology service. Dr McShane shares in the supra-Regional Epilepsy Surgery Service and Dr Pike supervises the Regional Paediatric Neuromuscular Service. Dr Pike has just completed, with Drs Ruggieri and Smarason, a national questionnaire study of spinal cord insults in the prenatal, perinatal and neonatal periods which has been presented at the International Child Neurology Association meeting in Slovenia in September 1998 in poster form. Dr Pike is also participating in a spectroscopy study of the heart in Duchenne Dystrophy, with Dr Crilley and colleagues from the Magnetic Resonance Spectroscopy Unit, and also in a study of immune mechanisms in brain malformations with Professor Angela Vincent in the Neurosciences Unit in the Institute of Molecular Medicine. In addition both Dr Pike and Dr McShane are participated in a multi-Centre trial of steroids and Vigabatrin in infantile spasms, and Dr Pike, with Dr Denise McDonald, and Dr Hilton-Jones in the Department of Neurology, embarked on a study of fractures in Duchenne Muscular Dystrophy. Dr Pike also supervised a review by Dr Ravi Kumar of modes of presentation in paediatric brain tumours. Dr McShane was involved in a study of subdural haematoma in non-accidental injury and has continuing involvement in a national paediatric stroke study.
There have been a number of staff changes during 1998. However, we have continued to develop the dietetic service. We have also completed ‘Guidelines for feeding the under fives in Oxfordshire’, run a postgraduate course for dieticians within the UK and completed a survey of feed preparation on level four.
The Paediatric Intensive Care Unit (PICU) in Oxford continued to provide critical care for a wide variety of patients ranging from those with acute life-threatening illness or trauma to those undergoing planned surgery for complex congenital disorders. As an integral part of the national strategy to centralise Paediatric Intensive Care, Oxford has been designated as a Lead Centre, expanding both the range and scope of clinical activities provided. The PICU has assumed a major role in the training and education of medical and nursing staff both locally and in regional referral centres with particular emphasis on the initial management and stabilisation of the critically ill child. The recent development of a rapid patient retrieval service staffed by trained PICU medical and nursing personnel has streamlined the management of patients requiring intensive care, and ongoing audit projects include a local audit of radiological practice in PICU and a national audit of the management of raised intracranial pressure in children.
1998 has been another year of change for Paediatric Surgery. Unfortunately, Mr Dudley was unwell during the year with Mr Steve Donnell acting his locum. At middle grade level we are hoping for progress with recognition for further SpR posts in 1999 and have been muddling through 1998 with one SpR and a number of locum positions. The year saw a steady increase in the number of outpatients, and elective and emergency cases. Miss Rowena Hitchcock further developed the urological side of the service we provide and Mr Hugh Grant developed the gastric intestinal side of surgery. During the year, laparoscopic surgery was introduced to the children of Oxford. Approximately thirty patients have been operated laparoscopically for both major and minor conditions. It has proved useful in diagnostic surgery, and also in major interventional surgery where laparoscopic fundoplication is now being routinely performed. The department continued to increase its links with other specialities and other centres. Miss Hitchcock worked closely with Dr Janet Craze to provide a urology/nephrology service. Mr Grant worked closely with Dr Sullivan, the Paediatric gastroenterologist to provide a unified service, nutrition service and combined approach to complicated paediatric gastroenterological disease.
Dr R Goodman was appointed in July 1998, having spent a year at the Hospital for Sick Children in Toronto, Canada. He joined Dr D Lindsell as a Consultant Radiologist with an interest in Paediatric Radiology. Over the last year, the Department of Radiology has been successful in its bid to upgrade its existing MRI unit to magnetic resonance, angiography and echoplanar capabilities, its CT unit to a spiral scanner and will be purchasing an additional third ultrasound machine. In addition, a new replacement fluoroscopy unit will be installed early in 1999. These expansions and upgrades will have exciting potential in the field of paediatric imaging and research.
Dr Hull worked with Dr Thomson in the care of children with respiratory disease. This involved in-patient and out-patient work as well as a bronchoscopy service. There was continued growth in tertiary respiratory work. The Oxford Cystic Fibrosis Centre has over 120 children under its care. There has been considerable growth in the use of non-invasive ventilation, long term for children with neurological disability and in the shorter term in children with cardiac disease. New links have been established with the cranio facial service at the Radcliffe Infirmary to manage children with obstructive sleep apnoea secondary to cranio facial abnormalities.
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