My Newborn (Neonatal) & Paediatric Experience
Quick Intro to a Busy Page
For those of you who want to know MUCH more about me I have laid out fairly extensive information about my experience below. It splits into two distinct topics:
- Newborn (Neonatal) Experience
- Paediatric Experience
In Cayman, the two distinct aspects of care are normally all clustered under the role of a paediatrician (pediatrician) but the care of a newborn, especially a preterm one, and the care of a child require distinctly different knowledge and expertise. Cayman is not that big and this limits what it can support. However, I came to Cayman specifically to bring an enhanced level of neonatal care to the islands, whilst also offering the full range of paediatric care.
I am the only neonatologist with full admitting rights to George Town Hospital (HSA) – which has a really excellent neonatal unit and one we should be proud of on an island this size.
Newborn (Neonatal) Experience
I have extensive experience as a Consultant Neonatologist in 2 large regional level 3 (tertiary) NICUs. I was employed at Nottingham City Hospital from December 1994 until April 2006, some 11½ years including a significant number as Chief of Service) and at University College London Hospital as a locum from 2009-10 and as a permanent consultant from December 2010 until July 2016 (with 5 years as Chief of Service here too), at which point I took up post as the primary neonatal specialist for the island of Grand Cayman.
Nottingham City Hospital had 6,000 births and delivered over 3,000 neonatal intensive care and high dependency care days per year. Out of hours, I was on call for both hospitals in Nottingham (10,000 births and 6,000 IC and HD days) and managed both complex neonatal medical and surgical cases.
University College London Hospital is one of the UK leading specialist centres. It has 6,400 deliveries per year with over 1,000 admissions to the Neonatal Unit of extremely sick complex babies requiring in total nearly 6,000 neonatal intensive care and high dependency care days. UCLH has the highest inborn admission rate in the UK for babies born at less than 29 weeks gestation. UCLH has a renowned fetal medicine unit and is the delivery unit for babies who will need future care at Great Ormond Street Hospital. This means we took and cared for sick newborns from across the UK with complex problems especially cardiac problems, neurosurgical problems and general surgical problems including diaphragmatic hernias. UCLH is also a designated centre for brain cooling for birth-related newborn brain injury & has a significant number of referral of infants with complex neurological problems.
That probably all sounds rather over-scientific. Yes, it does mean that I have lots of experience in newborn care, including the most complex forms too. The majority of births don’t need that depth but when they do demand it, it’s obviously reassuring to have!
WHAT ELSE CAN I TELL YOU?
I have been the clinical lead for early care and ventilation in my 2 permanent UK consultant roles. I have considerable experience in all modes of ventilation and non-invasive respiratory support including conventional ventilation, volume guarantee, SIPAP, CPAP & HHF (if you want to know what these are, I will happily expand). I am highly competent in all neonatal procedures and perform on a regular basis neonatal resuscitation, intubation, line insertion including UAC & UVC & chest drain insertion, and cranial ultrasound.
At UCLH I ran the neonatal chronic lung disease clinic and at NCH I was involved in the follow-up of all preterm babies <30 weeks gestation until the age of 2 years. This included many infants with complex problems or family situations but also included monitoring of the developmental progress of all infants to ensure they thrived after their early experiences and challenges.
I have a vast experience in the management of the long-term neonate including severe chronic lung disease, feeding difficulties, complex congenital abnormalities and syndromes with a reduced life span. You’ll find I have excellent counselling and communication skills and extensive experience in involving teams and families in end-of-life decisions, obviously a scenario no parent wishes to face, or is adequately prepared for.
In Nottingham I developed additional special interests in the management of babies born to HIV positive mothers and babies born to drug using mothers. Fortunately, these are both comparatively rare on Cayman, although rather more common throughout the Caribbean. For each of my areas of special interest I was lead clinician and responsible for clinical improvement, evidence based guideline development, audit and teaching. In my interests in babies born to HIV positive mothers I worked closely with the Obstetricians and Consultants in GU Medicine and Infectious Diseases.
Lastly, I am also a co-author of Pocket Neonatology, a well-regarded neonatal handbook used all over the World as the ‘go to’ practical guide for neonatal care.
I have kept this deliberately much shorter here, as I am developing a more comprehensive site on my paediatric care at http://childrensdoctor.ky/ (it’s a bit empty at the moment but it’s coming!)
In my general paediatric role in Grand Cayman, I see up to 20 children a day in the outpatient setting. These children range from newborn to 16 years and have the full spectrum of childhood complaints from very minor to complex health and developmental problems. Besides the more everyday care needs, the more complex conditions managed include respiratory disease, failure to thrive, short stature, diabetes, duchennes muscular dystrophy, complex cardiac disease and immune deficiency.
I have full paediatric admitting rights to George Town Hospital and also care for children requiring urgent admission to the paediatric wards. My acute paediatric skills include line insertion and lumber puncture.
I have a broad education in both general and tertiary paediatrics including 10 months training at Great Ormond Street Hospital, as well as Nottingham City Hospital. I covered general paediatrics as registrar in Derby, Nottingham City Hospital and Stoke and as senior registrar in Queen’s Medical Centre in Nottingham. In Stoke I did a general paediatric clinic each week and at QMC I had 2 general paediatric clinics each week, as well as a neonatal follow-up clinic.
In my infant feeding and growth clinic at UCLH, I was referred many patients from the local GPs for advice including children with cow’s milk protein intolerance and food aversion. Following children up for many years until 2 years of age means that I have extensive experience in dealing with problems in this age group, as well as developmental assessment. However, my experience in paediatric care extends right through to adulthood.
Between 2006 and 2010 I undertook frequent paediatric assignments from single weekends to much longer in duration, at both Consultant and Registrar level, in a range of paediatric settings but predominantly in 3 hospitals; Chesterfield Royal Hospital, Horton Hospital and Ysbyty Gwynedd Hospital in Wales. Good paediatrics in somewhere like Cayman is partly about being up-to-date and partly about the right approach when you find yourself sometimes with limited support or back, a challenge facing all smaller islands. Consequently, my experience is not only up-to-date in both acute and general paediatrics but also covers a range of organisational types, from tertiary through to isolated local hospitals and now on our small but lovely Grand Cayman, with its obvious facilities, infrastructure and logistical constraints.