team provides clinical service in Paediatric Intensive Care, Neonatal
Intensive Care and high-risk neonatal care. It is also responsible for
the care of all neonates born in Queen Mary Hospital.
The PICU is a tertiary centre admitting patients up to 18 years of age.
Referrals are mainly from General Paediatrics, Haematology, Oncology,
Neurology, Paediatric surgery, Neurosurgery, Trauma, ENT, Liver transplant,
Bone marrow transplant, Orthopaedics and Oral Maxillofacial units. Highly
specialized services such as liver transplantation, epileptic surgery,
and Laser therapy for airway obstruction are territory-wide as they
are only performed in Queen Mary Hospital.
NICU is also a tertiary centre accepting referrals from public and private
institutions. Admissions include low birth weight neonates, multiple
pregnancy and severe congenital malformations especially those requiring
urgent medical or surgical interventions after birth. The team also
provides and coordinates long-term follow up and rehabilitation programmes
for those high-risk neonates discharged from the unit.
The PNICU is located on the 10th floor of K-block at Queen Mary Hospital.
It was just renovated in 2001 to improve the capacity and facilities
for the relocation of Tsan Yuk neonatal service. It has 7 PICU, 15 NICU,
1 HDU and 35 SCBU beds. A multidisciplinary team provides comprehensive
and quality care with expertise in neonatology, critical care, respiratory
medicine, acute nephrology, nursing, nutrition, pharmacology, rehabilitation
and psychosocial services. All the ICU beds are fully equipped with
state of the art patient monitors and ventilators. Modern treatment
modalities including high frequency oscillatory ventilation, inhaled
nitric oxide, haemodialysis, peritoneal dialysis and plasmapheresis
are developed for critically ill patients. All patient documentations
are now computerized. Isolation facilities capable of handling highly
infectious disease such as SARS are also available.
The neonatal intensive care service continues to implement evidence
based modern intensive care treatment including early surfactant replacement
therapy, prevention of nosocomial infection, optimal nutrition management
and the judicious use of non-invasive ventilatory support. Much focus
has been put on improving total patient care including minimum handling
and clustering of nursing care, breast feeding promotion, developmental
care programme, antenatal parental counselling with NICU visitation
for expectant parents of preterm delivery, pre-discharge programme and
parents support group. A designated neonatal transport team is also
available for transfer of critically ill neonates.
The annual PICU admission was around 300, of which 30% are from General
Paediatrics, 10% from Haematology/ Oncology, 25% from Paediatric surgery
and 20% from Neurosurgery. For Neonatal Service, the annual delivery
rate in QMH is about 3500, most of which are high-risk obstetrics cases.
The NICU admission is around 300 each year of which approximately 70%
are inborn babies and 30% are outborn babies. The annual SCBU admission
is around 2800.
of Tsan Yuk Neonatal Service
Department started the neonatal service more than 30 years ago in Tsan
Yuk Hospital. It is the teaching hospital of The University of Hong
Kong and the only maternity hospital in Hong Kong. With the devoted
staff and neonatal expertise, the quality of service was highly respected
in the territory. With advances in neonatal intensive care and declining
birth rate in the territory, it is considered more cost effective to
combine the neonatal and obstetric service with Queen Mary Hospital,
where there are fully equipped on-site supporting facilities including
imaging studies such as CT and MRI scans, paediatric surgery or neurosurgery
specialties consultations. The neonatal and obstetrical services were
thus relocated to Queen Mary Hospital in October 2001.
This relocation provided a chance to improve the existing service in
Queen Mary Hospital. Major alteration of ward K10S was carried out for
better PICU operation and provision of standard isolation facilities.
Ward K10N was modified for NICU and SCBU purpose. The patient monitor
system was upgraded and computerized patient documentation (Clinical
Information System) for ICU patients was installed. This renovation
opportunity also allowed the relocation of the delivery suite from a
separated main building of QMH to ward K9, which was in close proximity
to the neonatal unit. The integration enhanced quality and cost effectiveness
of the neonatal clinical services and further consolidated the role
of Queen Mary Hospital as a high-risk tertiary perinatal centre.
High-Risk Perinatal Programme
advancement in prenatal diagnosis and obstetrical service, more and
more high-risk pregnancies are detected early. These include premature
labour, multiple pregnancies, severe intrauterine growth retardation
and congenital malformations such as chromosomal disorders, congenital
diaphragmatic hernia or hydrocephalus. Participation of the neonatal
team in the antenatal period is essential in quality perinatal service.
The Joint High-Risk Perinatal Programme was further consolidated after
the establishment of Perinatal Centre. The neonatal and obstetrics team
have regular weekly meetings to review the high-risk cases and arrive
at a management consensus. Paediatrician and obstetricians provide joint
antenatal counseling for expectant parents complicated by preterm deliveries
or babies with congenital malformation. For cases that required ICU
support, the parents were further counseled by our nurse specialist
during NICU visitations to make them better prepared for the stressful
neonatal course. This programme provides a high standard and quality
The monthly perinatal audit meeting provides an important channel for
discussion on patient outcomes and improvement in patient management.
It also provides an opportunity to share updated scientific knowledge
The first successful paediatric liver transplant in Hong Kong was performed
at Queen Mary Hospital in 1995. QMH is now the only centre designated
for liver transplantation in Hong Kong. The PICU team participates in
the pre-operative and post-operative support. On average, 6-8 patients
are transplanted each year.
Cadaveric donors are not readily available in Hong Kong, and most organs
for transplantation were from living donors, mainly parents or close
relatives. It is, therefore, more important for every discipline involved
to provide a very high standard of care to achieve the greatest success.
Of the 45 liver transplants performed, only 11 patients received cadaveric
liver. The indications for liver transplantation include biliary atresia
(30 cases), acute or chronic hepatic failure of other causes (11 cases)
and liver tumour and metabolic disease (2 cases). Two patients required
a second transplant. We have achieved the best long-term survival of
more than 90%.
Clinical Information System
renovation in K10 allowed an opportunity to install the Clinical Information
System (CIS) for better documentation. A total of 28 bedside and 4 wireless
mobile stations were installed. Since November 2002, all ICU patient
documentations were done electronically. The interface with patient
monitors, medical devices and hospital Clinical Management System (CMS)
allows more convenience in patient data charting. Errors related to
poor documentation or illegible handwriting is now kept to the minimum.
With the increasing complexity of ICU care, implementation of CIS is
necessary to maintain the standard and quality. Another benefit of the
CIS is that the electronic information can be easily retrieved for clinical
audit and research purpose. Currently, data from the CIS is used for
studies on neonatal infection, drug utilization and oro-gastric tube
Since 2001, a parenteral nutritional support team was established to
minimize the complications related to parenteral nutrition. The members
consist of paediatricians, paediatric surgeons, nurse specialist and
pharmacist. They provide a consultative, supervisory and educational
role. Complications, especially on TPN cholestasis and line infections,
were much decreased. The team's service is now expanded to other nutritional
support issues such as home parenteral nutrition, mucus fistula refeeding
in ileostomy patients, and special formulations for patients with short
PNICU team is also responsible for ensuring the quality of paediatric
and neonatal resuscitation in Queen Mary Hospital. Guidelines were developed
and updated regularly, according to the best available evidence. Regular
training courses were conducted for trainees, nurses and midwives in
the labour room. To ensure competent and efficient teamwork during resuscitation,
regular CPR drills were conducted in various paediatric and neonatal
Through years of development, with support from the hospital and The
University of Hong Kong, the PNICU service is well established. The
team is well organized with active participation from nursing and allied
health services. It facilitates the operation and development of tertiary/
quaternary services in Queen Mary Hospital. The combined Paediatric
and Neonatal Intensive Care service allow better utilization of the
very limited resources. The sharing of expertise within team members
on neonatology, paediatric intensive care, respirology, nephrology and
gastroenterology help to provide better development in the two sub-specialties.
Indeed, we are able to maintain a leadership role and a distinct identity
for the two sub-specialties in the territory.
PICU, we will continue to support the development of tertiary/ quaternary
services especially in oncology and transplantation. We will also support
the integration of paediatric cardiology service from Grantham Hospital
to Queen Mary Hospital in order to provide a better comprehensive multidisciplinary
care for the cardiac patients. At the same time, this allows the PICU
service in Queen Mary Hospital to reach international standard by having
the full spectrum of patients. There will be more collaboration with
other sub-specialties on quality improvement and research. We will try
to improve the network with other PICU centres, especially PYNEH, to
provide a high quality cost effective service to the critically ill
children in Hong Kong.
For Neonatology, the partnership with the Obstetric service and the
Pre-natal Diagnostic Centre in Tsan Yuk Hospital on high-risk pregnancy
should be further strengthened, both on clinical service and research.
The plan is to have the service accredited for Neonatology sub-specialty
training by the Hong Kong College of Paediatricians upon formal establishment
of the sub-specialty programme.
Grant & Awards
of research interest:
Newborn hearing screening.
Studies on universal hearing screening and high-risk screening are
performed in collaboration with other paediatric units. We are currently
conducting a study on the implementation and cost effectiveness of
a universal newborn hearing screening programme by Two-stage Automated
Auditory Brainstem Evoked Response for all babies before hospital
discharge. This project was collaborated with the Paediatric Department
of PYNEH and was supported by the SK Yee Foundation.
Changing pattern of congenital malformations in
A pilot study on the pattern of congenital malformations in a regional
perinatal centre was conducted, with emphasis on the impact of prenatal
diagnosis. A joint programme with the Department of Health is planned
to provide a more accurate territory-wide congenital malformation
reporting system. The study is collaborated with the Department of
Obstetrics and Prenatal Diagnostic Centre.
Postnatal growth and neuro-developmental outcome
of severe small for gestational age neonates including twin babies
with severe growth discrepancies.
Survey on infection control, hand hygiene and nosocomial
infection in NICU.
MR imaging study on birth asphyxia infants and
other neonatal encephalopathy. It is collaborated with the Department
of Diagnostic Radiology.
Surgical management of necrotizing enterocolitis.
Application of the Clinical Information System
Ventilation strategies for critically ill patients.
The NICU has been subscribing to the Vermont Oxford Network since 1998.
It is an international collaboration to collect data on high-risk neonates
from major neonatal centres in order to improve the quality and safety
of medical care. Queen Mary Hospital is the only centre from Hong Kong
and is one of the three studied centres in Asia among a total of 408
centres in US and other countries. The compiled vital statistics is
very useful for peer review and individual centre's quality improvement.
The PNICU team works closely with other service partners, in particular
with paediatric surgery for better patient care, and the ventilator
care centre in the Duchess of Kent Children's Hospital for pre-admission
evaluation and emergency support.
With the increasing complexity of care, treatment options, alternative
medical treatment and end-of-life decisions faced in the ICU, the collaboration
with the medical ethics service became much closer. Premature babies
parents support group was also established to provide better support
and counseling. The team also provides PNICU support for critically
ill neonates and paediatric patients under the care of the cardiac team
at Grantham Hospital.