BCG is the only vaccine currently available for protection against TB and with nearly half of all UK case of TB occurring in London. Dr Dionysios Alexandrou, Consultant Paediatrician at The Portland Hospital, shares his insights into the importance of the BCG vaccination.

How common is Tuberculosis in the UK?

Over 8,000 people a year get TB in the UK, and 400 die as a result of it. More than 300 children under the age of 15 diagnosed with the Tuberculosis disease every year and nearly half of all the cases of TB in the UK occur in London.

How does the BCG vaccination protect against TB?

BCG is the only vaccine currently available for protection against TB. It contains a weakened form of the bacterium, Mycobacterim tuberculosis, and once administered will stimulate the immune system the body protect against TB.

Why is the BCG not a routine vaccination in the UK?

The BCG vaccine is currently given to about three quarters of infants worldwide, but many developed countries that have a low burden of TB have opted to refrain from giving this vaccination routinely.

Whilst BCG is currently not recommended for routine immunisation in the UK, it is recommended for infants living in areas with more than 40 cases of TB per 100,000 population per year, as well as those whose parents or grandparents are from countries with at least that incidence.

How is the BCG vaccine Administered?

Infants less than 6 months of age do not need to be tested with a tuberculin skin test (the Mantoux test), before administration of BCG, but those over 6 months of age do.

Should this test prove negative, the BCG vaccination is then administered as a single injection into the skin.

At what age should a child have the BCG vaccination?

Newborn babies can get the BCG vaccine soon after birth. Clinical trials have shown that BCG is about 80% effective in preventing the disease when given to newborn babies who have never encountered Mycobacterim tuberculosis.

What should I expect after the vaccine?

The BCG vaccine is given as an injection just beneath the surface of the skin and a small lump appears on the skin as the injection is being given.

Approximately 3-6 weeks later, a small red pimple usually appears at the site of the injection. The pimple will remain for a number of weeks and there may be a slight discharge. A scab may form over the injection site and may leave a small scar when it heals.

Are there any side effects from the BCG vaccination?

Allergic reactions to BCG vaccination are rare but a small number of people may get swollen glands under the arm. More severe reactions can include ulcers or abscess formations.

Some useful tips for caring for caring for your child’s BCG injection

Your child can be bathed as normal, and there is no need to protect the area of the injection with a plaster. However, if you find that the pimple begins to ooze, cover it with a dry dressing and change it regularly.

You may also wish to dress you child in clothing that is lose around the area that the vaccination was given but do not use cream, oils or ointments on the pimple even there is a discharge.

Where can I go for further help and advice?

If you are worried about immunisations or whether your child might be showing symptoms of something more serious, then leading paediatricians like Dr Dion Alexandrou at The Portland Hospital are available to help. Call us on 020 7580 4400.

Are you worried about gestational diabetes? We asked Dr Joseph Iskaros, Consultant Obstetrician and Gynaecologist at The Portland Hospital, what he knows about the condition:

What is gestational diabetes?

Gestational diabetes is a form of diabetes that develops during pregnancy. It is caused by resistance to insulin (a hormone that controls blood glucose) due to hormones secreted by the placenta.

How will I know if I have gestational diabetes?

A glucose tolerance test is used to detect gestational diabetes. During this test your blood sugar levels will be recorded after a period of fasting and then again 2 hours after you have consumed 75gm glucose drink.

This glucose tolerance test is not offered to everyone but if you have any of the following risk factors it will be offered between 24 and 28 weeks of your pregnancy:

1. If you are overweight or have a body mass index greater than 30kg per square metre of your height
2. If you have had previously had a baby weighing more than 4.5kg
3. If your origin of ethnicity is from South East Asia or the Middle East
4. If you have a parent or sibling with Type 2 Diabetes
5. If your baby’s ultrasound scan shows that they will have a large birth weight and have more fluid around them

How will having gestational diabetes affect me?

Women who have gestational diabetes may complain of tiredness, thirst or repeated urinary tract infections.

How will having gestational diabetes affect the baby?

If your blood sugar is high it can increase insulin production in the baby. This could cause the baby to have a larger birth weight and to be more prone to jaundice.

Increased insulin production in the baby can also cause your child to have a condition called hypoglycaemia. This is when the baby has low blood sugar levels after their delivery. If this is the case, early and frequent feeds are advised to help stabilise the blood sugar levels.

How can I reduce my risk of gestational diabetes?

Gradually reducing your sugar consumption and eating a balanced diet can help your body manage your glucose levels.

Gentle physical activity can also help to lower blood glucose levels and may further help to reduce your risk of developing gestational diabetes.

How will gestational diabetes be managed during labour and delivery?

Women with gestational diabetes are at greater risk of having a baby with a higher birth weight and for this reason it might be advisable to start labour by 39-40 weeks to minimise the risk of labour complications.

During the course of your labour your blood sugars will be checked regularly and if you are on insulin you might be given an insulin, glucose or potassium drip during labour to help control your blood sugars.

How will gestational diabetes be managed after labour and delivery?

After the delivery of the baby all treatment is stopped. However, due to your increased risk of developing Type 2 diabetes, you are encouraged to maintain a healthy lifestyle and are advised to check your fasting blood sugar with your GP 6 weeks after delivery and, if normal, every year thereafter.

Where can I go for further help and advice?

If you are worried about gestational diabetes, then leading Consultant Obstetricians and Gynaecologists like Dr Joseph Iskaros at The Portland Hospital are available to help. Call us on 020 7580 4400.

The hospital, which opened its doors 30 years ago in June 1983, was the brainchild of the late Barry Lewis, a paediatrician who encouraged a group of around 50 obstetricians and paediatricians practicing privately alongside their NHS work to support his idea of a purpose-built independent hospital solely for the care of women and children. It was then, and still is, the only private hospital of its kind in the UK.

In the late 1970s, there were no private maternity or paediatric units in London. Although many large NHS hospitals had private maternity beds, these could only be accessed by doctors from that hospital. Mr Setchell was a consultant at St Bartholomew’s Hospital which had no private beds. The only choice for him and many others was to deliver babies at the now defunct Welbeck and Avenue Clinics; both converted nursing homes which doctors felt were far from safe or satisfactory.

It was the same for paediatrics. Children’s wards were confined to the NHS and private patients had to be treated in adult units.

Mr Setchell was on the Portland’s original planning committee which, together with a team of hospital architects, designers and construction engineers, met once a month to plan what facilities were needed and find a suitable site. Each of the doctors invested £2000 in the project. Two or three years after the Portland opened, the General Medical Council ruled that doctors could not refer to a facility in the private sector in which they had a financial interest unless they declared it to the patient. Most, including Mr Setchell, decided to withdraw their investment, receiving £8 interest!

“The hospital has been reconfigured several times over the years but the quality of the staff and the safety of the patients have always been paramount. It is the excellence of the staff that has made it the success it remains.”

As the only dedicated private women and children’s hospital in the country, The Portland has thrived since those early days attracting royalty and celebrities.

“When we were designing the Portland the most important thing was good, modern, safe facilities with well trained staff. We didn’t want glitzy décor,” says Mr Setchell.

“It was brilliant to have a hospital where you could assure your patients they would be safe and well looked after in a clean and comfortable environment and the Portland has maintained that ethos. That is why I have continued to deliver there.

“The hospital has been reconfigured several times over the years but the quality of the staff and the safety of patients have always been paramount. It is the excellence of the staff that has made it the success it remains.”

Q. “I’m 20 weeks pregnant and have noticed that I get short of breath very easily. Is this normal?”

A.“Yes this feeling is entirely normal and many women feel this sensation.

You need more oxygen in pregnancy and your body adapts to this need in several ways.

An increase in hormones particularly progesterone directly affects your lungs and stimulates the respiratory centre in your brain although the number of breaths you take each minute actually changes very little, the amount of air you inhale and exhale increases significantly.

Often in early pregnancy there is a heightened awareness of the need to breathe deeply.

The feeling is normal and harmless. Sit up straight and keep your shoulders back when sitting to allow your lungs to expand as much as possible and when in bed prop yourself up with some extra pillows. Some women feel more comfortable lying on their left side.

Talk to your midwife or doctor at your antenatal visit and they will reassure you that all is well.”

                                                                                                                                                                                                                                                                                         Q. My child has just started school and I’m concerned about him picking up infections from other pupils, particularly as the weather is likely to change. How do I know when to give him medicine and which ones should I choose?

A. Almost every child under 3 years of age will pick up several infections in the course of a year, especially in the winter months and particularly if there is a sibling at home who attends school, a playgroup, a nursery or a child-minder.  Most of these infections cause a runny nose, a sore throat, cough and can cause fever. A child is considered to have a fever if his or her temperature is 39°C or higher.

If you have a thermometer at home, it may be helpful to take the child’s temperature. If the temperature is greater than 39°C and the child appears to be distressed or unwell then consider using paracetamol or ibuprofen. Do not alternate or combine paracetamol with ibuprofen at this stage.

If the temperature remains greater than 39°C despite using paracetamol or ibuprofen, then switch one for the other (e.g. if you have been giving paracetamol, stop and switch to ibuprofen).

If it remains greater than 39°C despite switching paracetamol and ibuprofen, consider alternating paracetamol and ibuprofen. Add in a dose of the second drug after two hours. Paracetamol is normally given every 6 hours and ibuprofen every 8 hours. Take care not to exceed the maximum stated dose of each drug in a 24-hour period.

If, at any stage, you are concerned, do not hesitate to seek medical help. The Portland Hospital offer a Children’s Doc Around the Clock service which is an urgent medical appointment service for babies and children up to the age of 16 and is available 24 hours a day, 7 days a week, 365 days a year.  Call 020 7390 8022 to book an appointment if required.

We ask Miss R. Jane Leitch, Consultant Ophthalmic Surgeon at The Portland Hospital, to explain what these eye tests on children should involve, when they should be carried out and by whom.

When should my child have their first eye test?

A baby’s first eye examination should be carried out in the immediate neonatal period. This will usually be carried out by a member of the obstetric or paediatric team who will look for any obvious abnormality in a child’s eyes and eyelids, and make sure that anything unusual is referred to an ophthalmologist (eye doctor).

Will my child need an additional eye examination before their first birthday?

Your baby should also have their eye health tested when they are eight weeks old. The eight week eye health check is usually carried out by your GP or possibly your health visitor.

If there is a strong family history of early glasses wear or having a squint (where the eyes deviate) it may be advisable to have a check with a paediatric ophthalmologist for a more detailed visual assessment.

What does the eight week eye health test check for?

The purpose of this eye test is to make sure that your baby has developed their ability to ‘fix and follow’.

It is usually the mother’s face that the baby will first start to fix on, particularly when feeding, and this tends to happen when they are six weeks old. If your baby has been born prematurely, then fixing on should be established six weeks post term, rather than from birth. 

How is the eight week eye health test conducted?

The eight week vision test involves observing the baby’s visual behaviour to make sure that they are fixing and following.

During this test an ophthalmoscope will also be shone into your baby’s eyes which will allow the tester to see if there are any abnormalities at the back of your child’s eyes.

Are there any symptoms I should monitor my child’s eye health for?

Before your child is three months old your baby’s eyes may cross or drift intermittently but after three months of age your baby’s eyes should look straight ahead. If you have any concerns that your baby’s eyes are deviating excessively, then it is a good idea to have this checked by a GP or Paediatric Ophthalmologist

When should children have their first formal eye test?

The first formal test for vision is recommended between four and five years of age. At this age children, if they do not know their letters, will happily perform a letter matching test. This test will usually be carried out by an orthoptist and may automatically occur within the school or community setting. 

The purpose of this vision test is to detect a lazy eye.  A lazy eye is an eye that does not see well, but is otherwise healthy.  This is treatable at the age of four to five years, but if it is picked up later treatment may have limited success.

Where can I go for more information?

For further information, or if you have any specific queries about your child’s eye health or eye tests for children, please contact the Portland Hospital Eye Clinic on 020 7387 4072.

You want an honest relationship that works both ways and you want to be sure that your child is receiving the very best care available.

Here we introduce you to Kate Cross, a Consultant Paediatric and Neonatal Surgeon at The Portland Hospital, to provide you with an insight into her own life as a busy wife, mum and consultant. Kate explains her reasons behind choosing to be a Paediatric Consultant and why her career is very close to her heart.

“I always knew I wanted to be a doctor from a very young age. My brother was very ill with severe asthma as a child- so much so, we nearly lost him – he was continually hospitalised. I saw the medical staff looking after him, keeping him alive, and I know that this was something that I wanted to do”, says Kate.

“I love the fact that being a surgeon actively makes a difference. If you can fix a problem as the start of a child’s life, you’ve enabled them to have a better quality of life for the next 70 or 80 years.

There’s no doubt that being a mother myself has made me more empathetic with parents. Once you’ve been in A&E holding your own child’s distressed child in the middle of the night, you understand what is needed in that situation from a professional perspective”.

Thankfully I have an understanding and supportive husband who works from home in a different industry. Our set up has meant that I could balance the requirements of working with two small children.

It can be hard to find the right balance and energy to give your family when you are working long hours on call. When I’m not at work I try to give 100% to my family.  Sleep deprivation with a young baby wasn’t that much of a shock when your job requires you to get up in the middle of the night. It was more of a shock for my husband,“ Kate explains.

“Mothers carry so much guilt and worry that they aren’t doing the right thing. In my working life I try to make them see that there isn’t a right or wrong way.”

Kate has worked at The Portland as a Paediatric Consultant for 8 months so far and she forms part of The London Children’s Surgery Group. This group of General Paediatric Surgeons provide complex surgical treatment for newborn babies (neonatal surgery) and children to the age of 16 with major acquired or congenital conditions. The surgeons also perform minor surgery for conditions such as appendicitis, hernia, undescended testes and reflux.

Click here to find out more about Kate’s experience and specialists areas of interest, or email tracy.jones@hcaconsultant.co.uk or call 020 7182 7709 to arrange a consultation.

Recent news reports suggest that due to a decline in uptake of the MMR vaccine in the last decade, cases of measles in the UK are rising steadily. It is now thought that a measles outbreak in London could be imminent as almost half of the capital’s children have not had the MMR. Are you vaccinated against measles? Dr Andrew Raffles, Consultant Paediatrician at The Portland Hospital, shares his view on the importance of this vaccination.

How common is measles in the UK?

Measles was once a very common illness in the UK and thousands of children died every year from the condition in the last century. The development of an effective routine vaccination, the MMR vaccine, ensured that cases declined to as few as 1 per cent of people in some countries but in recent weeks there has been a return of this old world disease and an epidemic has been declared in Swansea.

What causes a measles epidemic?

The majority of measles epidemics are caused by ineffective vaccine programmes. It is thought that large numbers of unimmunised children can heighten the risk of an outbreak of this disease, which is highly contagious and can be spread through airborne droplets such as those stimulated by coughing and sneezing. To prevent an outbreak from happening it is estimated that 95 per cent of the population should be immunised.

How does the MMR vaccine protect against measles?

The MMR vaccination is the only vaccine currently licensed for use and readily available for protection against measles. Unlike many routine childhood vaccinations they contain a live, weakened form of the measles virus which, once administered, stimulates the immune system to provide protection against the disease.

How is the MMR administered and at what age should a child have this vaccination?

The MMR is a voluntary vaccination in the United Kingdom that is administered to children at the age of 12 months and then again at 3 to 4 years of age via an injection.

Should you live in an area with a high risk of measles infection, the MMR vaccination can be given at an earlier age, as young as 6 months or at a later age if your child was not vaccinated as an infant.

Why are two doses of the MMR vaccine given?

Two doses of the MMR are given because only 85 per cent of people will gain full immunisation from measles with a single dose injection. The second dose ensures 90 per cent of people who receive the vaccine will be fully protected against this disease.

It is not possible to determine if you have full immunisation from the first dose alone, however, it is important to note that there are no harmful effects of offering additional doses to children who are already immune to this disease as the body will naturally neutralise any additional vaccine.

Are there any side effects of the MMR vaccine?

During the late 1990s the MMR vaccine was widely linked to autism but this has since been disproven and worldwide, high quality medical research has confirmed that the MMR does not appear to cause autistic illness. Some children may experience symptoms such as  pain and swelling at the site of the injection which usually goes by 24 hours. Other children get a mild measles like illness some ten days or so after the vaccination.

Does my child need additional measles vaccines?

Generally no, unless you have been in very close (kissing!) contact with a relative with confirmed measles. If this happens and your child is 6-12 months of age, then a dose of measles vaccine within 72 hours of contact can help prevent contracting and spreading measles. Your baby will then also receive the measles vaccines at the normal time. In the same situation with an older child, aged over 12 months, if he or she has had both doses at 12-13 months and again at 3.5-4 years, then there is no need for additional doses. If he or she has only received a single dose, then a second dose will be recommended.

Where can I go for further help and advice?

If you are worried about immunisations or whether your child might be showing symptoms of measles, then leading Paediatricians like Dr Andrew Raffles at The Portland Hospital are available to help. Call us on 020 7390 8020.

The Portland is the first hospital in the world to offer this revolutionary ‘Sense My Baby’ technology exclusively to anyone who has had an ultrasound scan at the Portland. Parents-to-be can see their existing ultrasound image enhanced with breathtaking clarity to that of an actual photograph, giving them a ‘real’ feel of what their baby will actually look like*.

Over sixty hours of analysis and re-engineering is required to produce one ‘Life Changing’ image. Sense My Baby provides an amazing window to your unborn baby’s world and the closest thing to seeing your baby before birth.

How Sense My Baby works

Sense My Baby uses ‘structural’ information from the original image, analysing data characteristics that enable the system to differentiate between the degraded image and that of a higher resolution – the latter being the area that is isolated and then captured. These images are then individually enhanced using CEIP technology (Corrective Enhancement Imagery Programme).

 
How to book Sense my Baby?

The following is a step-by-step guide to purchasing Sense My Baby’s Life Changing Images:

1. You will first need to book your 3/4D ultrasound baby scan with The Portland Hospital. No additional scans are required, as Sense My Baby conduct their procedure on the video information contained within the scan recording (DVD).

2. The Portland will then send the scanned information to Sense My Baby electronically via a dedicated secure encrypted channel. This goes direct to the Sense My Baby Laboratory, where the image analysis will take place.

3. Sense My Baby will contact you directly to discuss the scan, once we have received and reviewed the imagery. Payment is only taken by Sense by Baby, once confirmation is given that you are happy to proceed.

4. Once finalisation of the image has taken place, it will be returned electronically to The Portland Hospital via the same dedicated secure channel and Sense My Baby will inform you upon the dispatch of your image. Expected delivery time is between 5-7 days.

Image Privacy 

The Portland Hospital and Sense My Baby are committed to protecting your privacy at all times. We maintain physical, electronic and procedural safeguards that comply with applicable legal standards to store and secure client information from unauthorised access and use, alteration and destruction. These safeguards also play a key role in the protection of our technology / R&D, as they remain paramount to maintaining the company’s pioneering success. We can therefore give you our assurance that your information will only ever be used to facilitate the purchase of our products.

*Admission is given on the basis that the quality of the structural information contained within the initial 3/4D scan meets our minimum standard.

For further information about Sense My Baby’s Life Changing Images please visit www.sensemybaby.com or call 020 3070 3377. If you would like to book a 3/4D scan at The Portland Hospital please contact the Ultrasound and Fetal Medicine Department on 020 7390 6081.