- How would you say your typical day begins as a Neonatologist at the Lourdes Hospital?
(Laughs) That’s a tough question to answer for a Neonatologist. Most of the days, we neither see the sun rise nor the sun set. The Neonatal Intensive Care Unit (NICU) is one of those departments that require round-the-clock monitoring because we take care of the youngest, tiniest, most adorable patients – newborn babies who need intensive medical care till they are healthy enough to move on. Of course, we have advanced technology and a team of trained healthcare professionals who ensure nothing goes out of place. But a key responsible person needs to be around to extend timely guidance. No one can predict when a baby might fall sick. If the need arises – which is almost every day – our day might start at 2 in the morning and by the time we call it a day, the clock may have struck 12 at midnight
Of course, if there are no emergency calls, I start off by 7:30 a.m. Once I reach the hospital, I head straight to the NICU for my usual rounds. Clinical examination is time consuming, so it takes around 3 hours for the rounds to get over. We spent ample time with each baby monitoring them, checking their general well-being and also making a note of their medicine dosage. Every step of the way, we have one-to-one discussions with the babies’ parents sharing vital information with them on any new treatment plans, health condition or developments. Once the rounds are over with, I head to the Post Neonatal Ward where we have babies who have been shifted from the Intensive Care Unit (ICU). We provide counselling on lactation as well as the benefits of breast-feeding because I firmly believe mothers should breast feed their babies for the first 6 months. As my boss rightly mentioned, “If you can make a mother breastfeed exclusively for 6 months, the job of a pediatrician is almost done.” After lunch, I have another set of rounds. I stay very close to the hospital so you will often find me running to the hospital at odd hours of the day, especially when an emergency call comes in.
- As a medical student, what drew you to neonatal medicine?
After my MBBS, I got into Ophthalmology initially at the All India Institute of Medical Sciences (AIIMS) in Delhi. Later I decided to leave Delhi and joined Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) to take up my super specialty and that was a major turning point in my life. Under the guidance of my seniors and Head of Department, my passion grew for neonatology. The critical care involved in this department drew me into the world of babies. I knew being a neonatologist would be a very demanding role, but it is an equally interesting one as well. For one thing, babies are the only patients who never complain. It is our duty to figure out what complaints they may have and offer effective treatment. That’ s what I found most challenging and interesting.
- How do you view the Indian neonatal scenario?
People always think that the best treatments are available abroad. Trust me, we have the best doctors, health care professionals and state-of-the-art treatment facilities available right here in India. At Lourdes, we are fully equipped to take care of the tiniest of tiny babies in any emergency scenario. Last year, we delivered the smallest baby ever born in Kerala and the second smallest baby born in India, weighing just 380 grams. Baby Kaashvi was born premature in 23 weeks to a mother who had multiple episodes of infertility treatment and abortion. Our multi-disciplinary team at Lourdes made best use of advanced technology to save the little one’s life. We nursed Baby Kaashvi back to a normal weight by providing nutritional therapy, development supportive care as well as Kangaroo mother care.
This is a great example that India and Kerala, for that matter, is exceptionally equipped to take care of patients, especially in the neonatology wing. Of course, even the Government is doing a great job to fully equip neonatology wards in District hospitals as well as Taluk hospitals. Evidently, our Infant Mortality Rate has reduced over the years and is comparable to that of Canada. Lourdes is also a major Referral Centre for babies from various Primary and Secondary maternity homes and
hospitals.
- What are the essential facilities offered here at Lourdes?
Our NICU is a level 4 set up that ensures the best care for infants, covering a complete range of services from conception advice, antenatal care, safe delivery and care post birth. Talking about facilities, we will have to start from the Antenatal period itself to ensure the mother-to-be gets proper delivery care. Our Gynaecology and Obstetrics department makes sure this is taken care of.
The next most important care is given in the Delivery Room where the new-born infants are given first point of care. We have an efficient team of neonatologists and well-trained nurses to take care of every need of newborn infants or premature babies. Another vital aspect is the transportation of a newborn infant to the NICU. Often, we find that the infant is delivered at one centre and the NICU is located at another centre, making transportation extremely critical. Infants are fragile and lack sufficient fat in their bodies. As a result, their body temperature can go down without a moment’s notice. Our state-of-the-art incubators offer just the right support to transfer babies to the NICU. Here, their airway, circulation and nutritional needs are taken care of. We also offer Kangaroo Mother Care where the mother nurses her infant against her bare chest. This is an integral part of infant care as it stabilizes the baby, decreases stress, reduces infections and enhances mother-child bonding. Like all of us, babies also do feel pain, so the Kangaroo Mother Care is the best pain and stress reliever for babies.
- How challenging is it to provide excellent care for neonates and support for their family members?
It is very challenging, I must say. We do our best to provide regular antenatal counselling for the parents and discuss in detail about the possibilities of different outcomes as well as the measures they can take to prevent complications. Despite the efforts, we have parents asking us, “Doctor, can you give me 100% guarantee that my baby will be perfectly okay?” Well, what can I say! The only person who can give cent percent guarantee is the Almighty above. We will do our best for babies and their parents. The rest is in His hands.
- Do you advise that a mother-to-be should choose a hospital equipped with an NICU so as to benefit from the combined efforts of Obstetrics and NICU extended to both mother and child at the Lourdes?
No mother-to-be would want their newborn to end up in the NICU. But, should a complication arise during pregnancy or after delivery, it is always better to be prepared. Newborn babies would need essential care at the NICU in case of premature birth, difficulties in delivery, birth defects or illness.
While doing my DM, the first question I was asked during an interview was: “What is a high-risk pregnancy?” I answered, “For me, every pregnancy is at high risk. You can never guarantee that the baby will be fine when it is born. So, if there is no facility at the hospital to take care of a newborn infant with complications, the little one will have to be transported to a tertiary care centre thereby adding to the risks and inevitable complications. No matter how state-of-the-art a transport incubator may be, the best incubator is always the mother’s womb.
We should also understand that the process of birth could be stressful for the baby as well. If there is a variation in the baby’s body temperature, hypothermia can result. There could also be blockages in the baby’s airway. The list of complications could go on. So, it’s better to be safe than sorry and choose a tertiary care centre with an NICU set up for delivery. The Obstetrics wing and the NICU work hand-in-hand to ensure both mother and baby are well looked after.
- As a Referral Centre, how do you transport babies born at other nursing centres where there may not be a full-fledged NICU?
We have a specialized emergency transport system for retrieving newborn babies from nearby hospitals in case life-saving intensive care is required. Our ambulances are equipped with world-class transport incubators – the smallest possible version of a mobile NICU – to maintain the infant’s temperature. Ventilator support and advanced heart monitoring systems are made available with the transport system to monitor the baby during the
transportation.
High performance shock absorbers ensure infants are transported in absolute safety and our ambulance drivers make sure they never rush through traffic at breakneck speed. What’s more! Our transportation staff are highly trained to handle infants during the retrieval process. Awareness seminars are regularly conducted to ensure our staff receive up-to-date knowledge on the checklists to be followed before, during and after transporting a newborn.
One cannot just walk into a hospital, take the baby and transport the little one to a tertiary care centre. If the baby is not stable, our trained professionals will first take the steps to stabilize the baby’s airway, temperature, breathing and circulation before transportation. The process may be time-consuming, but it ensures the baby’s safety. As the Secretary of the National Neonatology Form (NNF), Ernakulam, I am doing my best, along with my team, to reduce infant mortality rate with better neonatal care. We are in the process of making a transport App available called the Neo Transport Cochin that lets you check the status of ventilator beds available at all tertiary care centres in Kochi. This information is vital before transporting a newborn to another hospital with an NICU. The app is linked to Google Maps to help gauge the time required for transporting from one hospital to another. Another advantage of the App is that both hospitals will be well prepared beforehand.
- Finally, when do you call it a day and head home?
Usually, I wind up by around 7:30 or 8:00 p.m. Sometimes it may extend to 9.30 p.m. But if there is an emergency in the middle of the night, I make sure I’m at the hospital and not at home. There are times when parents just want to meet a consultant at Lourdes to feel their baby is in the right hands. So, I make sure to reach the hospital to talk to the parents about their baby’s condition or treatment plans.
At Lourdes, our job does not end after a baby is discharged from the NICU. The care continues till the infant grows to become a healthy toddler and a stronger adult. Finally, without prayer and God’s abundant blessings nothing is going to work. I think being a Neonatologist has increased my total trust in God. Every birth is a Miracle and I always see angels in babies. That’s life at the NICU and I’m totally loving every bit of it.