British Paediatric Neurology Association

Auckland urban area now has one million people of which about 22% are under the age of 15 years. We also take children with paediatric neurological problems from the upper half of the North Island (population approximately 2 million total) , with a few children coming from further south than that and one or two from the Pacific Islands from time to time. The service is mainly an Outpatient one with some Day Stay. Currently we visit for whole day clinics Whangarei, Rotorua, Gisborne, Hastings, New Plymouth., Palmerston North somewhere between two and three times a year. This will extend to Tauranga shortly. We fly in on an early morning plane and out on an evening plane. Telephone advice is given to Paediatricians and other specialists and occasionally general practitioners from throughout the North Island. We have inpatients in a ward we share with the Paediatric Neurosurgeons and there are about 200 admissions a year of Neurology / Developmental Paediatric patients. In Auckland the service sees 300 new patient referrals a year and 1000 follow up patients.

Organisationally we are linked with the Developmental Paediatric Service. This tends to see children who have mental retardation syndromes including Down syndrome and who are often severely multiply handicapped. Those children requiring inpatient admission for seizure control etc are admitted into a Paediatric Neurology bed. Dr Rosie Marks who works virtually full time in this area of practice with some clinic time being provided by Professor Ed Mitchell, and an English Paediatrician trained in Developmental Paediatrics Dr Phillipa Clark. These clinicians assist in the call roster for inpatients.We share on a roughly 50/50 basis a General Paediatric Trainee Registrar. On the Neurological side I am full time, along with the vacant position which consists of 6/10 service time and 4/10 University teaching / research time (negotiable).

The two Paediatric Neurologists share a 1:2 call roster for telephone and other referral advice, with a week on and a week off service. During the on service week we attend to inpatients. Within about 12 months we expect a third Paediatric Neurologist on the roster bringing it down to a 1:3.

I spend one day a week seeing neurological patients at Wilson Centre clinics on the North Shore, and Rosie Marks spends one day a fortnight there seeing developmental paediatric patients, again sharing the Neurology Registrar there.

For Neurophysiology, EEGs, and sensory evoked potentials, nerve conduction studies are provided by the Neurophysiology Department based in Auckland Hospital where they have two full time Neurophysiologists (Dr Elizabeth Walker and Dr Peter Bergin) both adult Neurologists, Mayo Clinic trained. VideoEEG monitoring is carried out in the Starship neuroservices ward. MRI is readily available with Children’s Hospital anaesthetists being available as necessary.

There is a surgical epilepsy programme with the simpler things being done in Auckland and anything requiring PET scanning etc or subpial electrodes going across to the Austin Hospital in Melbourne. Lab services largely come through the laboratory on the Auckland Hospital / Medical School site of which Starship is a part, with specimens going to Australia and elsewhere for gene DNA probes if they are not available locally, or for respiratory enzyme analysis etc.

Starship Hospital (Auckland Children’s Hospital) is a stand-alone building with its own Emergency Department, Intensive Care Unit, Social Work Department, Therapy Department, Radiology Department, etc and its own administration. Intensive Care facilities are good and there is a good transport team, with by and large any child in New Zealand requiring more than two days of ventilation being transferred to the Intensive Care Unit at the hospital by air ambulance or helicopter. In conjunction with the Intensive Care Unit plasmapheresis is available. Other services within the Children’s Hospital include Oncology, Gastroenterology, Immunology, Rheumatology, Cystic Fibrosis, Respiratory, Renal, Endocrine, Orthopaedic, ENT, General Paediatrics, General Surgery, Tertiary level Surgery, Neurosurgery, and Psychiatry

At the Starship site each of the Paediatric Neurologists does one new patient half day clinic (three new patients), and one half day follow up clinic (six to eight patients). We share in the general undergraduate paediatric teaching and contribute to an FRACP two week course for Registrars which is attended by Registrars from throughout New Zealand with about 50% of the attendees coming from Australia each November. A Paediatric Update session for three days held in March for the country occurs annually with about half the Paediatricians in the country coming to that and the other half going because of the difference in timing to the equivalent in Sydney. There is a weekly update session in the hospital and a weekly Grand Round.

As a unit we have a Neuroradiology Conference attended by usually three or four of the campus Neuroradiologists as well as Paediatric Radiologists along with the Paediatric Neurosurgeons and ourselves.

In the Laboratory Service there is a Paediatric morbid anatomist and Histochemist and two Paediatric Haematologists, but are weak in Paediatric biochemists. A Metabolic Paediatrician has recently returned from training in London.

Within about the next three years the clinical services at National Women’s Hospital and Green Lane Hospital are going to relocate to a site adjacent to the Children’s Hospital and so all acute medical and surgical services will be on the same campus adjacent to the Medical School. Children’s Cardiology and Cardiothoracic Surgery will be moving into Starship Hospital. Starship’s Intensive Care Unit and Emergency Department are going to be extended as part of this new building project.

Currently there are secondary General Medical Paediatric inpatient beds at Middlemore Hospital along with outpatient services for South Auckland. There are no paediatric inpatient beds at the North Shore Hospital or Waitakere Hospital but there are General Paediatric Medical Clinics being held on the North Shore and in West Auckland.

Currently Starship Hospital discharges c11000 inpatients and 6000 day patients a year. Outpatient attendances are c35000. Emergency Department attendances are about 28000 a year. The hospital is recognised for post-graduate training purposes by the various Australasian Colleges and the hospital has recently had its Accreditation with the New Zealand Council of Healthcare Standards successfully repeated for another three years.