Pioneer in intensive care of newborns

NEONATAL PAEDIATRICIAN

18-3-1926 1-10-2012

WILLIAM Henry (Bill) Kitchen, who has died at the age of 86 after a brief illness, was a legendary figure in care of the newborn in Australia. He is widely acknowledged as the founding father of modern newborn-baby care in Victoria, having pioneered numerous advances in the immediate care and follow-up of prematurely born infants. In so doing, he set standards that formed the basis for the excellent level of newborn care in Australia today. His research was recognised internationally and is still widely quoted.

Kitchen was born in Darlinghurst, Sydney, to Eric and Catherine (nee Fox). His early years were in Vaucluse, from where he remembered watching the Harbour Bridge being built. His family moved to Melbourne in 1933. He was educated at Malvern Grammar School, Scotch College and the University of Melbourne. He graduated in medicine in 1949 with first-class honours in obstetrics and gynaecology (winning the Fulton scholarship) and second-class honours in medicine. After a comprehensive training in general paediatrics he entered private practice as a consulting general paediatrician.

In 1954 he married Kathleen (Kay) True, whom he met while both were resident doctors at the Royal Children's Hospital in Melbourne. They had three children, Andrew, Jane and Virginia. Tragically Kay died in 1960. Kay's sister, Maureen Barden, introduced Kitchen to Davida (Dee) Switson, and they were married in late 1961, with the subsequent birth in 1963 of twins Bill and David.

Gradually much of Kitchen's practice and interest centred on neonatal work and in 1965 he was appointed first assistant in neonatal paediatrics in Melbourne University's department of obstetrics and gynaecology, based at the Royal Women's Hospital. This appointment opened up a career with a major interest in neonatal intensive care.

A worldwide study tour of leading centres looking into new methods of newborn intensive care convinced Kitchen that controlled studies to evaluate the outcome of these new methods would be the most productive research for

his new unit.

He conducted the world's only clinical trial of the use of then new intensive-care techniques, which showed significantly improved survival rates, but a higher rate of

long-term problems in survivors. This provided a valuable lesson for those involved in caring for very tiny babies the need to look for outcomes beyond the initial stay in hospital.

Kitchen's research covered

a wide field but concentrated mainly on follow-up studies, attracting multiple research grants. Starting with the

follow-up of babies born at

The Women's, he soon realised that better data could be obtained by studying a whole region, and from this developed the Victorian Infant Collaborative Study (VICS), which studied all tiny babies born in Victoria. This was

done in collaboration with colleagues from Queen Victoria Medical Centre (later Monash Medical Centre), the Mercy Hospital for Women and the Royal Children's Hospital. VICS continues to this day as part of his legacy. It set the standard internationally for follow-up studies and its publications are quoted widely. Kitchen had close to 100 articles published in peer-reviewed journals, many of which affected the

way neonatal specialists approached their care of babies. He was an invited speaker at many national and international conferences.

When studying babies of very low birthweight (those weighing less than 1500 grams) he noted that those born outside one of the three university-affiliated maternity hospitals in Victoria (including The Women's) did not do nearly as well as those born in one of those three. He thus convened a working party to develop a special ambulance service to retrieve sick newborn babies. With much organisational work and political persuasion by Kitchen, this came to fruition

in 1976 as the Newborn Emergency Transport Service, which set the standard for neonatal transport throughout Australia and further reduced mortality and morbidity in the newborn population.

In the early days, parents were excluded from the nurseries. Together with the social worker on his follow-up team, Maggie Ryan, Kitchen introduced the concept of families being allowed close contact with their babies. In 1983 his team's accumulated wisdom of pastoral care was published in a book titled Premature Babies, A Guide for Parents. This book has been a great support for many parents, going into a second edition.

Throughout his career Kitchen mentored many trainees. Graduates of his training at The Women's are in every state, New Zealand and several other countries, some of them directors of major units. Kitchen was renowned among his colleagues and trainees for his ability to cut through the complexity of a problem, quietly and logically pointing out the nub of the issue and its solution. He never appeared ruffled and was courteous to people in all stations in life.

He was an inspiration to all

who worked with him for his humanity as well as his medical expertise.

After he retired from active clinical practice in 1991, he was appointed as secretariat to the research and ethics committee of the Royal Women's Hospital, to which he brought his meticulous and well-organised research experience. He became consultant paediatrician to

the Consultative Council on Maternal and Paediatric Mortality and Morbidity, which reports on statewide data for outcomes for mothers, babies and children. During his nearly 10 years there, he converted the collection and analysis of data to a computerised database, resulting in much improved reporting of information.

Kitchen was made a member of the Order of Australia in 1993 "for service to medicine, particularly in the field of neonatal paediatrics and research". In 1992 he was awarded fellowship ad eundem of the Royal Australian College of Obstetricians and Gynaecologists, and in 1994 received the Gold Medal of the Australian College of Paediatrics.

In retirement, Kitchen continued to participate in intellectual pursuits, undertaking several University of the Third Age courses and expanding his skills as a woodwork craftsman. He and Dee also enjoyed their holiday house at Barwon Heads, until Dee's sudden death in 2007.

Kitchen's colleagues saw him as probably Australia's most influential neonatologist, an exceptional man who made an immense contribution to the practice of newborn care everywhere. He was considered well ahead of his time in his understanding and application of the principles of evidence-based medicine. By his work he touched a large number of people who never even met him many thousands of prematurely born Australians have him to thank for their current health and indeed their lives. He leaves a huge legacy.