Medical science has advanced enormously over the past 20 years but there is still so much that we do not know or understand. Children are more complex than adults as we have to understand growth and development as well as disease processes. They are complicated individuals but great fun to be involved with and we are very grateful to parents and children over the years who have taken part in our research studies and helped us to understand a little more and (we hope ) be better doctors as a result.

We find that patient problems often provides the inspiration for research activity. Although we are a small unit we are involved in several different areas of research.

1. Lung infection

a. An illness in infants caused by a virus (respiratory syncytial virus ) is a major problem each winter. Dr Jeremy Hull leads a research initiative which is trying to determine whether there are genetic differences which influence why one infant becomes severely ill and the next has little more than a cold when exposed to the same virus. These studies continue but already we have found that

• Disease severity following RSV infection appears to be determined by a genetic factor close to the IL-8 gene Thorax. 2000 Dec;55(12):1023-7.
• genetic factors play an important role in susceptibility to severe viral respiratory infections in early life, and that this effect may be independent of subsequent childhood asthma Pediatr Pulmonol. 2004 Oct;38(4):321-8.
• preliminary results suggest that there is a genetic predisposition to wheeze following severe RSV bronchiolitis. Clin Exp Allergy. 2004 May;34(5):801-3

b. Two years ago we published a multicentre randomized controlled trial of treatment of empyema. Thorax. 2002 Apr;57(4):343-7.Empyema is a condition where in association with pneumonia pus collects between the lung and the chest wall. The results of the trial influenced the way in which children are managed in the UK. We have just completed a review of 100 children with this condition in Oxford which confirms that the results from that trial can be used in practice. Pediatr Pulmonol (in press)

2. Cystic fibrosis

For several years we have been collecting data looking at insulin and other growth parameters in children with cystic fibrosis.who often have difficulty in maintaining good weight. We have been able to show that.

• progressive insulin deficiency may result in reduced IGF-I levels and IGF-bioactivity and may determine weight gain and statural growth in cystic fibrosis Clin Endocrinol 1999 Nov;51(5):659-65
• despite improvements in management, contemporary children with CF still gain less body fat and fat-free mass and are shorter than controls. Leptin levels by age and by fat mass were higher in CF children compared to controls.Acta Paediatr. 2004 Sep;93(9):1185-91

3. Sleep and breathing problems

Children can have breathing disorders that occur only or predominately during sleep. In order to make the diagnosis an overnight recording of data such as heart rate, breathing movements and oxygen levels is needed. Traditionally paediatric sleep studies have been conducted in hospital: an expensive place where beds are scarce, and which is very different to the patients normal sleeping environment. Instead we have established home monitoring. The intention is to keep to a minimum, the need for children to attend hospital, patient waiting times and study costs, while ensuring good quality data. We have just analysed our results. The success rate was high for home studies (89%).Hospital 99%. Sleep efficiency was significantly higher at home, especially in younger children (<6yr). We plan to continue our research into how to make studies at home more efficient.

Research is an important part of improving care for children. Each year we learn something new and try to apply it to improve the welfare of the children we look after.

Dr Anne Thomson MD FRCP FRCPCH
Consultant in paediatric medicine ,Oxford Radcliffe Hospital and Hon Senior lecturer at University of Oxford.

Illustrations on this page:
Top: The research team at John Radcliffe. Dr Anne Thomson (centre) with Dr Hull and co workers.
Bottom: Cathy the Cystic fibrosis nurse.