It was an honour for me to be awarded the Diana, Princess of Wales, Tushinskaya Memorial Scholarship for an observership programme in London. As a neonatologist in a Russian unit, I was particularly interested in seeing how UK hospitals manage preterm babies, infants with congenital malformations (including heart defects) before and after surgery, conditions associated with prematurity (eg necrotising enterocolitis, chronic lung disease, anaemia of prematurity), parental involvement in neonatal care and prevention of nosocomial infections.

Great Ormond Street Hospital (GOSH)

I spent most of my time in the UK in the NICU at GOSH. The unit has many surgical patients with complicated congenital malformations, which the multidisciplinary team manage pre- and post-operatively. I saw a huge variety of pathologies including prenatally diagnosed malformations, bowel atresia, tracheo-esophageal fistula, necrotising enterocolitis (medical and surgical stages), congenital diaphragmatic hernia, exomphalos major and gastroschisis, intraventricular haemorrhage admitted for subgaleal shunting, suspected VACTERL association, hypernatraemic dehydration, congenital heart defects and conjoined twins.

GOSH is famous for being the largest specialist hospital within the UK treating the rare condition known as Vein of Galen malformation (VGM). VGM affects about one in a million children. I had never encountered a baby with this pathology before but during my time in London I saw eight cases with completely different backgrounds and post-operative outcomes. VGM results in abnormal connections between the blood vessels within the brain and can lead to heart failure, hydrocephalus and other complications. It requires input from a multidisciplinary team that is involved in investigations, planning treatment and post-operative monitoring.

At GOSH I observed several ex-premature patients with chronic lung disease complicated by pulmonary hypertension requiring high frequency ventilation and drug administration – typical of the treatment that we use in Bashlyaeva Hospital. I know about the theory of inhaled nitric oxide therapy but it is off-label for children in Russia and we don’t use it in my hospital. I saw several infants at GOSH who received iNO therapy leading to good outcomes and rapid recovery from persistent pulmonary hypertension of the newborn. Similarly, it was interesting to see the widespread use of non-invasive respiratory support for preterm infants, particularly high flow therapy, and the use of high flow nasal cannulae.

In Russia we use IgM-enriched intravenous immunoglobulin (IVIG) for viral infections and neonatal sepsis. At GOSH I discovered that IVIG is not used as it has been shown that there is no reduction in mortality during hospital stay, or death or major disability at two years of age in infants with suspected or proven infection.

It was unusual for me to see such a large variety of staff roles in a unit – as well as the traditional doctors and nurses there were clinical nurse specialists, neonatal nurse practitioners, nurses in charge, family liaison sisters and other specialists such as pharmacists, dietitians, psychologists etc. The staff on the unit were always happy to explain things to me and share their own experiences. I was surprised by the deep knowledge of anatomy/physiology/pharmacology etc that UK nurses have.

We do have teaching sessions at Bashlyaeva Hospital but at GOSH there were teaching sessions on the unit almost every day – usually related to the pathologies seen during morning ward round. These help the doctors to brush up on the disease signs, pathophysiology, required investigations and treatment and, moreover, new trials and studies regarding that pathology. At journal club the staff gather to discuss and critically evaluate recent medical articles; I had never attended such meetings before and found them extremely valuable.

Other important sessions included simulations, equipment teachings, case-based discussions, morbidity and mortality meetings, psychosocial meetings and reflective practice. I attended the Keep Calm And Carry On course – a one-day training session to build emotional resilience to manage difficult conversations, challenging situations and emotional responses such as anger and disappointment.

University College London Hospital (UCLH)

I spent two weeks at UCLH where I had the chance to meet several members of the large neonatal team. In the transitional care unit I learnt about the main principles of transitional care (eg phototherapy pathways, jaundice charts, sepsis pathways and establishing breastfeeding within the hospital). I also attended a discussion with an infection control nurse about hand hygiene for doctors and nurses – one of the major concerns for hospital infection control.

I became familiar with the neonatal journey planner, which is used in the unit as a tool for parents and the medical team to define the moment when a baby is ready to be discharged home. The planner consists of:

• charts about the infant’s medical history
• important health information (such as birth details, newborn blood spot screening, vitamin K administration and immunisation)
• parent education (hand hygiene, reducing the risk of sudden infant death syndrome, the importance of breastfeeding and car seats, recognising signs of illness, etc)
• a discharge checklist with follow-up appointments.

I became acquainted with neurodevelopmental care, including the basics of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), skin-to-skin contact, and different types of neurodevelopmental assessments such as the Bayley scale, general movement investigation and the Hammersmith infant neurological examination.

I was incredibly fortunate to attend a follow-up clinic where I met one of the first patients to undergo fetal surgery for spina bifida at UCLH the previous year.

London Neonatal Transfer Service (NTS)

In the Moscow neonatal transfer service it is possible to perform conventional ventilation, IV fluid infusions, and ECG, oxygen saturation and blood pressure monitoring. The London NTS team has equipment for almost any therapy that commences in hospital, eg cooling for babies with hypoxic-ischaemic encephalopathy, conventional and high frequency ventilation (even with iNO), phototherapy etc.

As well as driving the vehicle, the ambulance crew can operate all of the equipment in the vehicle and they attend debriefing sessions and teachings. Consequently, they have basic knowledge in paediatrics and neonatology and can assist a doctor or a nurse if required and talk to the parents while the medics are busy with their baby.

Back in Moscow

When I got back to Moscow and shared all that I had learnt we immediately reorganised the unit and prepared new checklists for staff and leaflets for parents. My colleagues and I have lots of ideas to put in place to improve our unit’s work in line with the high standards that I was privileged to experience in London including:

• evaluation of a comfort score and adjusting painkillers, sedation and ventilator settings according to that score
• parental involvement in feeding, comfort care and decision-making
• post-surgical antibiotics
• hand hygiene training for hospital staff to improve infection control.

I highly recommend that all medical students and junior doctors seek out a clinical observership opportunity to give deeper appreciation and reflection of their own medical practice. Observing others go about their tasks with such skill and dedication is an unforgettable and precious experience that I will cherish and remember for years to come.

Acknowledgements

My thanks are extended to the Tushinskaya Trust Founders, Dr Harald Lipman and Nahid Lipman, for this great opportunity and for their hospitality, precious support, attention and kindness.

I am grateful to all staff in the neonatal units of GOSH and UCLH. My special thanks are extended to Drs Simon Hannam, Christine Pierce, Quen Mok, Angela Huertas, Cally Tann, Nandiran Ratnavel, Lee Collier and physiotherapist Sarah Hines.

I would like also to thank Professor Ismail Osmanov and my colleagues in Bashlyaeva Hospital in Moscow.