If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergent medical advice if in a remote region.

Paediatric surgery registrars at Queensland Children's Hospital (QCH) and 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:

• QCH: 07 3068 1111
• GCUH: 1300 744 284

Burns

All major burns require emergency management and referral

The Paediatric Burns Centre (PBC), Qld Children’s Hospital offers a 24/7 referral service. For a referral coming from regional QLD, an email 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.

• For those burns located in the Mackay region and above, please refer to Townsville Hospital first (07) 4433 1111
• For those burns located in the Gold Coast region and below to Grafton NSW, please refer to Gold Coast University Hospital first. Paediatric surgical registrar or on call surgical cover 1300 744 284

If these hospitals are unable to care for the patient, then please follow the information below to refer to PBC

To refer a patient to the Paediatric Burns Centre (Qld Children’s Hospital);

• Contact the Burns Register on call via switch (07) 3068 1111
• Complete Category 1 Referral to Burns Outpatients (QH staff only)
• Submit referral form by clicking ‘submit at the end of the form or by emailing through to burns-opd@health.qld.gov.au
• Attach any photos to this email if possible
• If advised that the patient can be treated locally, continue to contact the burns Registrar at each dressing change to update progress and send through photos to above email address

All paediatric patients should be referred to the PBC however they may not physically be required to attend the Queensland Children’s hospital. If treatment can be managed in the local area, then this is the preferred treatment

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

Enlarged lymph nodes/midline neck swelling

• 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

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

Constipation and encopresis

• Acute neonatal bowel obstruction

Vomiting

• Bile stained vomiting is a surgical emergency - phone the on-call paediatric surgical registrar
• Suspected pyloric stenosis - phone the on-call paediatric surgical registrar

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 and neonatal bilateral undescended testes are urgent referrals to service

Renal and bladder congenital lesions

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

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

Skin and soft tissue masses

• Acute breast infection requiring admission or drainage
• 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 anomlaies/haemangioma

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