Paediatric Surgery

Paediatric surgery registrars at Queensland Children's Hospital/GCUH can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:

• Queensland Children's Hospital: 07 3068 1111
• Gold Coast University Hospital: 1300 744 284
• Townsville: 4433 3642 (4433 1111 Nights)

All major burns require emergency management and referral

Catchment areas:

• Mackay region and above, please refer to Townsville Hospital first (07) 4433 1111
• Gold Coast region and in Northern New South Wales down to Grafton, please refer to Gold Coast University Hospital first. Paediatric surgical registrar or on call surgical cover 1300 744 284
• The Pegg Leditschke Children’s Burn Centre (PLCBC), Qld Children's Hospital offers a 24/7 referral service. For a referral coming from regional QLD, an online referral service is available. Criteria for referring to our service is based on the Australian New Zealand Burns Association transfer guidelines for Burns Service referral.

To refer a patient to the Pegg Leditschke Children’s Burns Centre Queensland (Qld Children's Hospital:

• Contact the Burns Register on call phone via switch (07) 3068 1111
• Fill in the referral form: https://econsult.acclario.com.au/chq/telehealth/burns/
• If advised that the patient can be treated locally, continue to contact Burns on-call phone at each dressing change to update progress and send through photos to the email address: CHQ_QCHburns@health.qld.gov.au

NB: Most paediatric patients referred to any of the centre's do not require physical attendance at the facility, as treatment can be offered at local facilities.

Antenatal & neonatal surgical conditions

• Patients with congenital malformations causing bowel obstruction or respiratory compromise are emergency referrals not outpatients. Resuscitation and safe transfer to tertiary paediatric unit is a priority. Notify neonatal unit or appropriate neonatal/paediatric medical specialist of neonatal/fetal diagnosis as per local protocol.
• Acute neonatal bowel obstruction

Lymphadenitis

• Acute infective node with no improvement within 48 hours
• Nodes rapidly increasing in size, overlying skin erythema or very tender
• Acute infection not responding to treatment/antibiotics

Midline neck swelling

• Respiratory compromise, acute abscess or infection midline neck not responsive to treatment/antibiotics present to emergency

Facial Masses

• Respiratory compromise or rapidly escalating issues with swallowing

Umbilical and peri umbilical pathology

• Any painful, red, or irreducible hernia – discuss with on-call paediatric surgical registrar
• Suspected vitello-intestinal remnant or patent urachus

Abdominal pain - chronic

• Acute abdominal pain (suspected serious pathology) especially severe pain or peritonitis
• Intussusception
• Hypertrophic pyloric stenosis
• Suspected bowel obstruction with bile stained vomiting
• Suspected malignancy – discuss with on-call paediatric surgical registrar if serious pathology is suspected

Perineal conditions

• Severe pain or peritonitis

Perianal conditions

• Acute abscess causing distress or sepsis

Constipation and encopresis

• Acute neonatal bowel obstruction

Vomiting

• Phone the on-call surgical registrar for:
  • Bile-stained vomiting (a surgical emergency)
  • Suspected pyloric stenosis usually ≤ 6 weeks of age
  • Suspected intussusception approx. 3 months to 3 years age
  • Suspected strangulated inguinal hernia/gonadal torsion

Stomas and abdominal devices

• Accidental removal of gastrostomy button or ACE tubing – phone on-call paediatric surgical registrar
• Any stomal or abdominal device issues refer to treating hospital

Hernia, hydrocele and testicular conditions

• Irreducible, incarcerated or strangulated inguinal hernia
• Suspected testicular torsion
• Inguinal hernia: If under <52 weeks post conceptual age, call nearest paediatric surgical unit for urgent review
• Acute scrotal pain with or without swelling
• Ambiguous genitalia urgent referral to paediatric general medicine/Paediatric Endocrinology (depending on local resources)
• Neonatal bilateral undescended testes are urgent referrals to service

Renal and bladder congenital lesions

• Acute retention
• Poor urinary stream in neonate / suspected valves

Ovarian conditions

• Acute ovarian torsion

Urinary tract infections (UTI)

• Acute infant urinary tract infection presenting septicaemia or acutely unwell
• Hypertension > 97 percentile for age and/or height
• Presumed UTI in infant <3 months

Penile conditions

• Paraphimosis (when unable to replace foreskin)
• Disorder of sexual development (DSD) – refer to paediatric surgeon or paediatric medicine immediately

Incontinence

• If incontinence associated with new neurological signs

Breast issues

• Acute infection requiring admission or drainage

Skin and soft tissue masses

• Acute infection - if unresponsive to treatment or acutely unwell from infection
• Suspected solid paediatric tumours should be urgently referred through local paediatric medical service and/or paediatric oncology services

Vascular anomalies/haemangioma

• Obstruction of vision, airway compromise, uncontrolled bleeding, ulceration, suspected  kapsiform haemangioendothelioma (KHE) or cardiac output compromise  - contact paediatric surgical registrar on call