Author Archives: pamela

Traumatic brain injury prediction rules in children: Getting the evidence right, translating into practice, and shared decision making

Blunt head trauma is a common presentation in the pediatric ED. Although some children have overt signs of traumatic brain injuries (TBIs), many have minor head trauma with no or subtle signs of TBI. Among children with apparently minor blunt head trauma, identifying those who indeed have TBI is challenging. Over the past decade there has been increasing use of computed tomography (CT) to avoid missing children with TBI.

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“This is the first time I have felt like I fit in and not different than everyone else.” 70 years of diabetes camps at RCH – an odyssey in 4 parts

The RCH diabetes camps program is 70 years old this year and one of the oldest such programs in the world. Diabetes camp experiences are profound and are seen internationally as an integral part of paediatric diabetes clinical care. This program speaks to and of what is the soul of the RCH: a holistic patient and family centred approach that goes beyond clinical therapy within the walls of the hospital.

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“The times they are a-changin” Paediatrics in Geelong and reflections on the role of RCH in children’s health in Victoria

This Grand Round will present the evolution of Paediatrics in Geelong and the Barwon Region, as well as discussing the evolution of General Paediatrics as a specialty. We will discuss the importance of the relationship between The Royal Children’s Hospital and Barwon Health and its role in helping to deliver high quality medical and health care to children of our region. We will also discuss ways in which the relationship will continue to be important as Paediatrics in Geelong develops further in the years ahead. This relationship is a good case study of the role that RCH can take throughout Victoria.

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Biologics: the good, the bad and the oh so expensive

Biologics are therapeutics that target specific components of the immune system. They are characterised by unpronounceable generic names (alemtuzumab, eculizumab, blinotumomab, pembrolizumab). These medications have revolutionised the treatment of several immune-mediated disorders: including rheumatoid arthritis, inflammatory bowel diseases, psoriasis, lymphoma, lung, breast, ovarian and other cancers, and macular degeneration, and are widely used in a range of clinical disciplines.

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Is it ethical to sterilise an adolescent with an intellectual disability?

In a recent case in the US, a mother requested a vasectomy for her 13 year old son. He has autism and intellectual disability, and functions at the level of 4-5 year old. He had starting talking about getting married and having children, and she was concerned to make sure that he could never father a child. We will discuss this case, in the context of the wider ethical debate about sterilisation of children and young people, mostly young women, with intellectual disability. Concepts of bodily integrity, dignity and human rights meet with the practicalities of life for a young person with ID and their parents and carers.

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New blood management guidelines for neonatal and paediatric patients

The decision on whether to transfuse a neonate or child can be complex. You need to carefully consider specific patient circumstances, clinical condition, response to previous transfusion and the full range of other available treatments, balancing the evidence for efficacy and improved clinical outcome against the potential risk. There are new guidelines for blood transfusions.

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Genetics of intellectual disability and autism: past, present and future

It is now recognized that genetic factors are the major cause of intellectual disability and autism. This presentation will provide an overview of recent advances in our understanding of these genetic factors and the application of new genetic testing technologies to provide an answers for individual families.

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The early life origins of everything

The modern environment is associated with an increasing burden of non-communicable diseases (NCDs). Mounting evidence implicates environmental exposures, experienced early in life (including in utero), in the aetiology of many NCDs, though the cellular/molecular mechanism(s) underlying this elevated risk across the life course remain unclear. The Barwon Infant Study (BIS) is a population-derived birth cohort study (n = 1,074 infants) with antenatal recruitment, designed to facilitate a detailed mechanistic investigation of development within an epidemiological framework.

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Chronic wet cough and bronchiectasis in children: a clinical spectrum

Chronic wet cough (>4 weeks) is common in children and often considered benign and self-limiting. However, there is increasing evidence to suggest that it may have greater significance, particularly if left untreated. Chronic wet cough, protracted bacterial bronchitis and bronchiectasis share many clinical and pathological features and are postulated to represent a clinical spectrum. With increased access to CT scans, non-cystic fibrosis bronchiectasis diagnoses are rising.

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