The neonatal surgeon.

Abstract

During presentation of Denis Browne medal to Douglas Stephens reference was made to Denis Browne's definition of role of paediatric surgeon: the aim of paediatric surgeon is not to create a monopoly but to set a standard. Clearly Denis Browne was referring to current practice in Great Britain, since there are several countries in Europe in which most of surgery of childhood is concentrated in hands of paediatric surgeons, of whom there are very many. One has only to compare number of paediatric surgeons in, for example, Poland with that in this country to appreciate difference in approach. If paediatric surgeons are to set such a standard they can do so only if they have more experience of surgery of children than general surgeon; if they accept their responsi bilities for solving problems involved in work; and, in particular, if they pay attention to those aspects in which surgery of childhood differs from surgery of adults. The indications for operation in various types of hernia, management of childhood tumours, timing and type of operation for undescended testis, are all examples in which concentrated experience of paediatric surgeon is an asset to management. If we accept our duty to set a standard in care of these surgical conditions in childhood we accept without question that most of this type of surgery will in fact be undertaken by general surgeons, and rightly so. To plan otherwise would mean to increase vastly number of paediatric surgeons with no special advantage. In contrast, my plea for neonatal surgery is that there should indeed be a monopoly, or near monopoly, in hands of paediatric surgeons, most of whom will be dealing with a sufficient volume and variety of this work to justify title of neonatal surgeons. In developing this line of thought it is appropriate to review briefly number and range of neonatal surgical problems seen in neonatal surgical ward of paediatric surgical unit at Sheffield Children's Hospital. I have reviewed critically facilities available for this type of surgery in our unit to find out where we are failing and how we might improve service.