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KING EDWARD MEMORIAL HOSPITAL SETH GORDHANDAS SUNDERDAS MEDICAL COLLEGE

बृहन्मुंबई महानगरपालिका रुग्णालय

Introduction:

The Department of Neonatology, established in 1992, the fit of its kind in Western India, is one of the major institutions in India offering comprehensive neonatal care. The department of neonatology of this institution has 42 bedded tertiary care neonatal care Unit. The department caters to over 7000 deliveries and 1500 neonatal intensive care admissions per year. It is a major referral centre for municipal as well as private hospitals. The department is well equipped with state of art equipment. The department of Neonatology has progressively grown over the years and it excels in patient care and in teaching.

History of the Department:

History of the department goes back to year 1958 when sick neonates was taken care by pediatric department. In year 1970 separate neonatal unit was established next to post-natal ward. In year 1978 high risk newborn OPD services were started for follow up for NICU graduates. In year 1985 Dr S F Irani who was the head of pediatrics at that time took charge of the neonatology division.

Establishment of level II and III NICU:

In the year 1990 Level II Neonatal Care Unit established on the 10th floor of New M. S. Building where it is located currently. It was upgraded to level III NICU two years later in 1992. Division of Neonatology was separated from parent Department of Paediatrics and started functioning as full – fledged Neonatology department in year 1994.

DM Neonatology:

In the same year department was recognized for DM (Neonatology) degree course by University of Mumbai. In year 1995 Dr. R. H. Udani, Prof. of Neonatology took charge of the Dept. of Neonatology.

Development in 21st Century:

With the arrival of Next millennium many new development happened in the department in various forms. In year 2000, mothers were allowed to enter into NICU and Human Neonatal Care approach was initiated. In year 2001 Creation of a place for mothers to rest was inaugurated and named as ‘Vatsalya’ (Donation received from Bidada Sarvodaya Trust, Mumbai). Kangaroo Mother Care for LBW infants was also started in the department in the same year. Creation of Seminar room ‘Gyandeep’ (Donation received from Matushri Jekuvarba Doshi Trust, Rajkot) was done in yaer 2002. In year 2004, Dr. Ruchi N. Nanavati, Prof of Neonatology took charge of the Dept. of Neonatology.

Establishment of Milk Bank:

Human Milk Bank was established in NICU premises in year 2005 through Donation from Inner Wheel Club of Bombay. It was a boon to those mothers who were sick to express milk for their babies.

Kangaroo Mother Care Center (Shishughar):

Ambulatory Kangaroo Mother Care Center was established through Donation from ‘Saving Newborn Lives’, an initiative led by ‘Save The Children- (USA)’ with support of the Bill & Melinda Gates Foundation near orthopaedics building of KEM Hospital.

In house Neurosensory Screening Facility:

In house Hearing & Ophthalmic Screening was started in year 2008. Initiation of Newborn Metabolic Screening for Congenital Hypothyroidism & Congenital Adrenal Hyperplasia was started in the same year. DM Neonatology degree was recognized by Medical Council of India in year 2009. Maharashtra University of Health Sciences (MUHS) Fellowship in Neonatology was also started in the same year.

Centre for Facility Based Newborn Care Training:

Department recognized as Collaborative Centre for Facility Based Newborn Care in 2010 under National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India under Norway India Partnership Initiative (NIPI) supported by UNICEF which was upgraded to Regional Collaborative Centre for Western India next year.

Renovation of NICU and upgradation with up-to-date technology in Newborn Care:

NICU was renovated to its current facility under CSR project of MCGM by Mazagon Dock Ltd in year 2014-15. Initiation of Total Body Cooling therapy & Nitric Oxide therapy were also added in facilities available in NICU by 2015. Dr. Ruchi Nanavati awarded as “Officer of the Month” in January 2017 by Honorable Municipal Commissioner of Mumbai for the excellent patient care in Neonatology and for renovation to the state of art NICU in KEM Hospital under CSR project with Mazagon Dock Shipbuilders Ltd. Increase in seats from 1 to 4 in DM Neonatology by MCI in 2018. Kangaroo Mother care Centre was renovated and inaugurated in November 2021 under the guidance of Dr Ruchi Nanavati.

Pain and Palliative Care in Newborn Care:

Inpatient pain and palliative care project was started in collaboration with TATA hospital, funded by Cipla foundation since December 2021. Dr Anitha Haribalakrishna took charge of the department since December 2021. Since june 2022, Bayley Scale of Infant development (BSID IV) started to be practiced for assessing developmental milestones of NICU graduates.

Recent Achievements:

• Approval of the department’s Human milk bank as Comprehensive Lactation Management Centre and provision of funds under National Health Mission.
• Establishment of inpatient Neonatal Palliative Care project in collaboration with Tata Memorial Hospital, under aegis of Cipla Foundation since January 2022 with approval from BMC.
• Establishment of OPD services for mothers with antenatal diagnosed major congenital anomalies under Neonatal Palliative care project in collaboration with Tata Memorial Hospital, under aegis of Cipla Foundation since January 2022 with approval from BMC.
• Department of Neonatology recognized as the regional “Regional Collaborative Centre for Facility Based Newborn Care” under National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India.  First Capacity building program for training doctors and nurses from all over India was conducted for a batch of 25 participants under FBNC program. Organization of 10 SNCU Observership Training Programs (14 days each) for paediatricians & nurses from various districts of Maharashtra, under NUHM, National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India. Organization of 10 Facility Based Newborn Care Observership Training programs of 14 days each for pediatricians & nurses from all over Maharashtra.
• International Board Certified Lactation Consultant course was conducted in KEM Hospital for the first time by Department of Neonatology in collaboration with BPNI Maharashtra in August 2022.
• Bayley Scale of Infant Development (BSID IV) workshop was conducted in the department in September 2022.
• Dr. Ruchi Nanavati published the first edition of Neonatal Practice Guidelines, Evidence based management in December 2022.
• Pain and palliative care services to sick newborns.
• End of life care in NICU.
• Prenatal counselling for mothers with babies with congenital birth defects and parental counselling services by psychologist and social worker
• International: Collaboration with World Science Foundation in the project titled Phonocardiogram in screening for critical congenital heart diseases in newborn infants: a test accuracy study.

Future Outlook:

• Establishment of Neonatal Cardiac Program
• Fetal Medicine OPD (Restructuring Birth Defects OPD)
• National Nodal Centre for training in Neonatology
• Increase in seats for DM Neonatology
• Rotation of residents to Paediatric surgery, Radiology & Cardiology
• Rotation of students in other units in India as well as exchange programs in Australia & Canada where ex-students from KEM are program heads
• Publication of neonatal books: protocols, atlas
• Dedicated faculty for research
• Sabbatical leave for dedicated research development
• Renovation of Human Milk Bank
• Neonatal Screening before discharge
• Computerization of all NICU data & KMC OPD
• Point of care Lung ultrasound in newborns
• Increasing the number of NICU beds
• Increasing the staff nurse strength in NICU

FACILITIES:

Nicu complex.

NICU, Department of Neonatology has bed strength of 42 and total area of 6275.50 sq. feet.

Location: Ward 38, 10th Floor, MSB Building, KEM Hospital, Parel, Mumbai.

Neonatal Care

The department of Neonatology caters to over 7500 deliveries per year including high risk referrals, approximately 35% being LBW babies requiring special care. Neonatal Intensive Care services: Level III Neonatal Intensive Care Unit manages over 1800 – 2000 neonatal intensive care admissions per year. NICU is the major referral centre for babies from various municipal as well as private hospitals and maternity homes. The facilities for providing advanced neonatal care are available in the unit. We ventilate approximately 225 – 250 babies annually. We have 2 High frequency ventilators, 12 class 1 ventilators, 2 Variable flow CPAP machines, & 8 Bubble CPAP machines. We practice patient triggered ventilation as well as High Frequency Ventilation. The sick neonates are closely monitored with multiparameter monitors, capnometers, transcutaneous monitors, and online airway graphics. These babies also receive total parenteral nutrition which is prepared under the laminar flow housed in the NICU. We have a facility for in house ultrasonography. We provide Total body cooling therapy & Nitric oxide therapy. We have facility to monitor cerebral function.

Services Offered

• Care of Preterm babies upto 25 weeks gestation
• Care of Micropremie babies with weight less than 700 gms
• High frequency ventilation
• Conventional ventilation
• Bubble CPAP and HHHFNC facility
• Whole body therapeutic hypothermia for asphyxia babies
• Cerebral function monitoring
• Pre and post-operative Neonatal surgery care
• Pre and post of neonatal cardiac surgery care
• Inhaled nitric oxide facility
• Capnography
• In house 2 D echocardiography
• Point of care ultrasonography
• Total parenteral nutrition with in house laminar flow facility
• In house retinopathy of prematurity screening
• Palliative care treatment
• Counselling of mothers along with in house counsellor
• In house Point of care CRP,INR, Procalcitonin, Bilirubin and routine blood tests
• In house ABG analysis

Humane Neonatal Care :

The doors of NICU were opened for mothers of critically ill babies to get them actively involved and participate in the care of their babies. Humane Neonatal Intensive Care approach was established by observing an ideal NICU protocol for protection of babies from over stimulation and by observing the minimal handling protocol to reduce the NICU environmental stress related complications for optimal recovery and positive health of sick neonates.

INBORN UNIT

INBORN AND OUTBORN CARE UNIT

TRANSITIONAL CARE UNIT

ADVANCE VENTILATION UNIT

Human Milk Bank (HMB):

HMB is an institution established for the purpose of collecting, screening, processing, storing & distributing donated human milk that is dispensed to recipients who are not the biological offsprings of the donor mother. For better survival of preterm and low birth weight babies, it is very important that we guarantee a constant and adequate supply of human milk. Today a more controlled system of to ensure the availability of bacteriologically safe milk exists in form of HMB. HMB is possible as there are mothers whose lactation exceeds the requirements of their infants.

Mothers’ Resting Area:

Vatsalya is resting area for mothers whose babies are admitted in NICU.

Palliative Care Unit:

Very sick babies who are nursed in any of the above sections are given supportive care, psychological counselling and social support.

Kangaroo Mother Care Center (Shishughar)

The department is selected as the center of excellence for initiating KMC for Low Birth Weight babies in India. We are the first in the country to start Ambulatory KMC Center inaugurated on 15th August 2005. LBW infants discharged from NICU are regularly followed up for growth, neurodevelopmental status & early intervention therapy is instituted when required.

BSID Center

Follow up care program: We believe in well organized and multidisciplinary follow up care program for better neurodevelopmental outcome of high risk NICU graduates. We run a BSID centre twice weekly at Kangaroo Mother Care Centre where these babies are followed up longitudinally for a period of 5 years. Hearing and visual assessment is done in the centre itself by the experts for all high risk babies and early intervention therapy is instituted when indicated.

Speciality Clinics

High risk clinic.

Every Wednesday Timing: 1:30 pm to 3:30 pm Location: First Floor, MSB Building, KEM Hospital, Parel, Mumbai.

Monday to Saturday Timing: 10:00 am to 1:00 pm Location: KMC Center, Behind KEM Orthoperidics Building, Parel, Mumbai

Bayley Scale of Infant Development Clinic

Every Wednesday and Friday in KMC clinic Timing: 10:00 am to 1:00 pm Attended by Assistant Professor trained in BSID.

Hearing Screening Clinic

Every Saturday Timing: 10:00 am to 1:00 pm Location: KMC Center, Behind KEM Orthoperidics Building, Parel, Mumbai

Well Baby Clinic

Birth defect clinic.

Every Thursday (OPD No. 10) Timing: 1:30 pm to 3:30 pm Attended by various specialties (Paediatric surgery, Obstetrics, Plastic surgery and neonatology combined)

• Recognized by M.U.H.S. for DM degree 3 years course. It is also a centre for conducting DM Neonatology examinations.
• No. of seats: DM degree: 4 per year
• The unit consists of 2 RECOGNISED TEACHERS.
• Residents: 4 in each of the three batches, Senior Resident post– 4, SSMO – 4
• Lectures are delivered for UG, PG students.
• Teaching program from Monday – Friday. (12:00PM – 1:00PM)
• Topics for teaching program are distributed. On Monday- pathophysiology discussion by DM Residents, Tuesday- seminar by paediatric residents, Wednesday – Case analysis by DM resident, Thursday -Journal Club discussion by DM Residents, Friday – Faculty lecture.
• Residents are encouraged to attend various workshops and present papers and posters in conferences in rotation.
• Residents are encouraged to present cases / seminars in the All India DM Resident program every once in two months.

Apart from central library, the department houses books on various subjects of Neonatology for ready reference - 24 X 7. We have books pertaining to the field of paediatrics, neonatology and Obstetrics. Journals are available in our library. All research work done in the department in form of thesis are also catalogued in our library. KEM internet library facilities: for online journals & books.

Teaching Schedule

Suggested books for reading:

• Avery’s Diseases of the Newborn
• Cloherty and Stark’s Manual of Neonatal care
• Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the fetus and Infant.
• Goldsmith’s Assisted Ventilation of the Neonate: An Evidence-Based Approach to newborn Respiratory care.
• Volpe’s Neurology of Newborn.
• Textbook of Neonatal Resuscitation (9th Edition)
• Physical Diagnosis in Neonatology by Mary Ann Fletcher
• Fetal and Neonatal Physiology by Richard A. Polin MD
• Neonatal Practice Guidelines-Evidence based Management by Ruchi Nimish Nanavati.
• IAP textbook of clinical Neonatology
• Atlas of neonatal Functional Echocardiography by Pradeep Suryawanshi
• Atlas of Point of Care Neonatal Cranial Ultrasound by Pradeep Suryawanshi

Schedule for Academic activity

Patient Feedback:

We take counselling sessions of our patients on periodic basis about their baby’s clinical condition and take feedback on how they feel about the management and the care providers. We try to look into the social aspect of the patient’s care by involving the pscychologist and social worker. We believe that our patients are our true assessors and their feedback will help us improve our care.

Patient Education:

We educate our patients about various aspects of newborn care including breastfeeding, milk expression, importance of MOM (Mothers’ Own Milk) , milk donation, kangaroo mother care, identification of danger signs. Our team carries out awareness sessions weekly on various aspects of neonatal care among the parents of the newborns admitted in our NICU. We educate them about the post discharge care. We teach our patients to be self-confident and impart knowledge on post discharge newborn care. Parents are counselled on the need of regular follow ups and developmental assessments of their child as and when called upon.

We are currently a single unit department, headed by Dr. Anitha Haribalakrishna

PUBLICATIONS

• Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Antimicrobial Resistance Collaborators. Lancet. 2022 Feb 12;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0. Epub 2022 Jan 19. PMID: 35065702
• Mascarenhas D, Goyal M, Nanavati R. Neonatal palliative care practices: an Indian perspective. Paediatr Int Child Health. 2022 Feb;42(1):22-28. doi: 10.1080/20469047.2022.2089821. Epub 2022 Jun 21
• Kulkarni T, Majarikar S, Deshmukh M, Ananthan A, Balasubramanian H, Keil A, Patole S Probiotic sepsis in preterm neonates-a systematic review. Eur J Pediatr. 2022 Jun;181(6):2249-2262. doi: 10.1007/s00431-022-04452-5. Epub 2022 Mar 29
• Ananthan A, Balasubramanian H, Mohan D, Rao S, Patole S. Early erythropoietin for preventing necrotizing enterocolitis in preterm neonates - an updated meta-analysis. Eur J Pediatr. 2022 May;181(5):1821-1833. doi: 10.1007/s00431-022-04394-y. Epub 2022 Feb 5. PMID: 35122138
• Jeevan A, Ananthan A, Bhuwan M, Balasubramanian H, Rao S, Kabra NS. Umbilical cord milking versus delayed cord clamping in term and late-preterm infants: a systematic review and meta-analysis.  J Matern Fetal Neonatal Med. 2022 Dec; 35(25):5478-5488. doi: 10.1080/14767058.2021.1884676. Epub 2021 Feb 10.
• Singh S, Ananthan A, Nanavati R. Post-INSURE Administration of Heated Humidified High-Flow Therapy Versus Nasal Continuous Positive Airway Pressure in Preterm Infants More Than 28 Weeks Gestation with Respiratory Distress Syndrome: A Randomized Non-Inferiority Trial. J Trop Pediatr. 2022 Jun 6; 68(4):fmac062. doi: 10.1093/tropej/fmac062.
• Nanavati RN, Mogra G, Mascarenhas D. (Eds.) Neonatal Practice Guidelines – Evidence – based Management. 1st Edn. December 2022.
• Nanavati RN, Suman Rao PN. Neonatal adaptation to extrauterine life. In: Gandhi A, Tank P, Purandare A. (Eds), FOGSI’s Textbook of Postgraduate Obstetrics, New Delhi, Jaypee Brothers, 2022; pp 682-87.
• Nanavati RN, Kirthana SB. Kangaroo Mother Care. In: Tiwari S, Bharadwa K. bang A. (Eds), IAP-IYCF Essentials of Maternal, Infant, Young Child and Adolescent Nutrition,; 2022; pp 166-71.
• Nanavati RN, Chauhan A. Toxoplasmosis – Perinatal Perspective. NNF Clinical protocols in Perinatology, 2022.
• Nanavati RN. Low Birth Weight: Aetiology and Classification. IAP PG Textbook of Pediatrics, 2022.
• Nanavati RN, Bajaj S. Approach to Neonatal Encephalopathy. India Point of Care. September 2022.
• Vamsi Krishna Vaddi , Medha Goyal , Dwayne Mascarenhas , Anitha Haribalakrishna . Successful management of a cutaneous abscess caused by Candida albicans in a very low birth weight neonate. J Clin Neonatol. 2022 Oct 4, 11 (4).
• Nanavati R, Mogra G, Masarenhas D. Neonatal Practice Guidelines. Evidence based management 1st Edn. Dec 2022.
• Mascarenhas D, Goyal M, Nanavati R. Favourable outcome of a severe bradyarrhythmia in a neonate: a case report. Cardiology in the Young. 2022 Aug 8:1-3.
• Goyal M, Mascarenhas D, Shah J, Ranadive A, Nanavati R, Mayadeo N. Perinatal COVID-19 Infection and Outcomes: A Retrospective Observational Study from a Low–Middle Income Setting. Journal of South Asian Federation of Obstetrics and Gynaecology. 2022 Aug 22;14(4):374-80.
• Goyal M, Mascarenhas D, Nanavati R. Antenatal Betamethasone dosing schedule: an ongoing conundrum!. Pediatr Oncall J. 2022 Nov 09. doi: 10.7199/ped.oncall.2023.10
• Prashanth RR. Effect of Kangaroo Mother Care on Cerebral Hemodynamics in Preterm Infants. Indian Pediatr. 2023 Jan 15; 60(1):13-14. PMID: 36639969.
• RR P, Haribalakrishna A, Mhatre S. An unusual case of spontaneous staphylococcal scalp abscess in a newborn: A case report. Pediatr Oncall J. 2023 Mar 29. doi: 10.7199/ped.oncall.2025.29.
• Raghavendra PR, Nair S, Haribalakrishna A, Tekwani RV. Isolated macrostomia with bilateral facial cleft in a preterm neonate. J Clin Neonatol 2023; 12:120‐2.
• A case of neonatal I-cell disease with multiple intrauterine fractures Sri Lanka Journal of Child Health, 2023 ( In Press)
• How early is too early: Diagnosis of tuberous sclerosis complex in a neonate. 2023 Journal of Postgraduate Medicine | Published by Wolters Kluwer - Medknow (In press)

ONGOING PROJECTS:

• Amplitude-Integrated EEG in Preterm Infants: Correlation between Amplitude-Integrated EEG and severity of intraventricular haemorrhage- A prospective observational study. 
• Blood transfusion in very low birth weight infants: A prospective observational study".
• Correlation of lung ultrasound score & NICHD Neonatal Bronchopulmonary Dysplasia (BPD) outcome estimator score for predicting the risk of BPD in preterm neonates: A prospective observational study from Western India.
• Development, optimization, and validation of LC-MS/MS-based laboratory tests for new-born screening 
• Diagnostic accuracy of Neutrophil Lymphocyte ratio in neonatal sepsis in comparison to body fluid culture- A Retrospective Observational Study.
• Diagnostic accuracy of point-of-care testing for C-reactive protein, Interleukin-6 and Procalcitonin in neonates with suspect sepsis. a prospective observational study
• Use of point-of-care testing for C-reactive protein in reducing the duration of antibiotic therapy- A randomized control trial from Western India”
• Diagnostic accuracy of point-of-care testing for International normalized ratio in neonates with coagulopathy - A prospective observational study. 
• Perinatal Palliative Care (PPC) and Parental satisfaction scores: A prospective observational study from a tertiary care neonatal intensive care unit in Western India
• Risk factors and ocular outcomes of treatment in preterm infants with treated retinopathy of prematurity : A retrospective observational study from Western India
• Rapid vs slow advancement of early enteral nutrition in neonates with perinatal asphyxia on therapeutic hypothermia: a randomized controlled trial.
• Paper-based diagnostic device for detecting neonatal sepsis
• Neonatal palliative care in a tertiary level NICU: A prospective and retrospective observational study from Western India
• Development, optimization, and validation of LC-MS/MS-based laboratory test for newborn screening

EXTRA CURRICULAR ACTIVITIES

• Newspaper / Magazine report / TV program :

World Breastfeeding week celebration: Dr. Omkar Nerurkar won the first prize in Breastfeeding slogan competition during world breastfeeding week celebration organized by Mumbai Breastfeeding Promotion Committee in 2022.

• Inaugural function of world breastfeeding week was jointly hosted by Seth GS Medical College & KEM Hospital, Department of Neonatology and MBPC on 2nd august 2023.
• Breastfeeding week celebration was conducted in the Neonatology department with emphasis on improving the Knowledge, Attitude and Practice in nursing mothers.
• World prematurity day was celebrated in the department of Neonatology.
• A symposium was organized by the department of Neonatology on preterm nutrition. Dr. Sanjay Patole, a renowned Neonatologist based in Perth, Australia was the guest faculty.
• Department of Neonatology recognized as the regional “Regional Collaborative Center for Facility Based Newborn Care” under National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India. 
• First Capacity building program for training doctors and nurses from all over India was conducted for a batch of 50 participants under FBNC program.
• Dr. Ruchi Nanavati: Faculty in IAP NEOCON 2022, The International Neonatology  Summit & XIIIth Conference of  Neonatology Chapter of the Indian Academy of Pediatrics, May 2022
• Dr. Anitha Haribalakrishna: Faculty in NEOCON 2022-41st Annual Convention of National Neonatology Forum in December 2022.
• Dr. Anitha Haribalakrishna: National Faculty in MAHANEOCON 2023 in July 2023
• Dr. Anitha Haribalakrishna: National Faculty & In charge Regional Collaborative Centre of Facility Based Newborn Care Program under National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India.
• Organization of 10 SNCU Observership Training Programs (14 days each)  and two capacity building for pediatricians & nurses from various districts of Maharashtra, under NUHM, National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India
• Dr. Ruchi Nanavati published the first edition of neonatal Practice Guidelines, Evidence based management in December 2022
• Dr. Omkar Nerurkar won the first prize in Breastfeeding week slogan competition during world breastfeeding week celebration organized by Mumbai Breastfeeding Promotion committee.
• DR Medha Goyal was awarded Dr sanjay Oak best superspeciality resident for the year 2021.
• Dr Swati Dubey won the third prize in E slogan competition during the world breastfeeding week 2023
• IAP NEOCON 2022, The International Neonatology  Summit & XIIIth Conference of  Neonatology Chapter of the Indian Academy of Pediatrics, May 2022- Oral presentation-Post Insure administration of Heated Humidified High Flow therapy versus nasal continuous positive airway pressure in preterm infants >28 weeks gestation with respiratory distress syndrome: A randomized non-inferiority trial by Dr. Srijan Singh.
• VI national Conference of Kangaroo Mother Care in India KMCCON April 2022-Poster presentation- Kangaroo mother care in neonates with birth weight 2-2.5 Kg: a quality improvement study by Kirthana S. B.

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