Twenty-day-old Sayyed Mohammed looks fragile as he lies on the hospital bed with an IV drip and breathing tubes attached to him. There is a nurse constantly monitoring his vitals, besides his anxious mother. But considering what he has been through, Sayyed is catching up quite well, say his doctors.
Moments after birth, Sayyed turned blue. He was detected with transposition of the great arteries or TGA, which causes the impure and pure blood to mix. The baby could not be treated at the hospital where he was born and had to be transferred in a cardiac ambulance to Fortis Hospital, Mumbai, which has a paediatric cardiac unit that performs the arterial switch operation.
“It is one of the most complicated procedures to be done on newborns. To make matters worse, we feared that he may be suffering from brain injury, too,” says Dr Vijay Agarwal, chief paediatric cardiac surgeon at Fortis Hospital, who conducted the eight-hour-long surgery on Sayyed.
Thanks to the availability of trained doctors and improved life support systems, babies like Sayyed are getting a new lease of life. “We can perform complex open heart operations within hours of birth with great improvement in results. Operations which carried a risk of 5 per cent to life five years ago have a risk of only 1 per cent today,” says Agarwal.
Medical technology has come a long way, but the lack of awareness poses a problem. Congenital heart ailments remain the most common birth defects, yet doctors do not prescribe the 3D echo at 16 weeks of pregnancy that can diagnose the problem early and lead to better results in surgery, says Dr Swati Garekar, paediatric cardiologist at Fortis Hospital.
This is why foetal medicine holds potential. It is a branch which specialises in diagnosis and treatment of conditions detected in the foetus, sometimes through intrauterine surgery done in the womb. Says Dr Anita Kaul, head of foetal medicine in Indraprastha Apollo Hospitals, Delhi: “A lot of babies today are dying prematurely and we can prevent them by diagnosing the problems early on.”
Dr Jesal Sheth, neonatal and paediatric interventionist at Fortis Hospital, Mumbai says there has been a spate of procedures to help treat critical newborns. The defibrillators that resuscitate hearts can now be used on babies, too. Be it the blue light that prevents jaundice or the nitric oxide that can help babies with breathing difficulties, these improvements mean much to these patients.
Another advancement is the development of endoscopic and laparoscopic surgeries for children. “Now we are using telescopes that are just 3.3mm [wide] and can handle more complex diseases at younger ages,” says Dr Rasik Shah, paediatric surgeon, P.D. Hinduja Hospital, Mumbai. A laparoscopic surgery not only reduces the scar for the child but also fastens the recovery process, prevents infection, reduces pain, he says. Also, 30 to 40 per cent of paediatric surgeries are done in day care.
From cardiology, endocrinology to neurology, super specialists are bringing with them specialised knowledge and skills. Be it bone marrow treatment or cancer therapy, children have access to the best treatments. Today, liver transplant in children has become widespread with better outcome. “The outcomes of selective centres in the country are comparable to those in the world,” says Dr Anupam Sibal, medical director and senior paediatric gastroenterologist, Indraprastha Apollo Hospitals, Delhi. “The survival rate of our patients is over 90 per cent in our liver transplant programme.”
Medical science has taken strides in preventive medicine, too. Pneumococcal vaccine and rotavirus are helping prevent pneumonia and diarrhoea, two common diseases that affect six million children annually. Drugs and investigation tests are also getting better. “There was about a 30 per cent risk of HIV transmitting from mother to her child. Now due to newer drug regimes, the risk has fallen to 1 per cent. This has encouraged many HIV+ mothers to go ahead and have children. Also drug resistant TB, which took two months for the results to come in, can be diagnosed in two days,” says Dr Tanu Singhal, paediatrician, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
A major roadblock for paediatric surgery is that parents do not have insurance cover for the children. Even for those who do, policies do not cover children younger than three months. In such scenarios, even if treatments are available, many are left deprived. “Today I saw a 23-day-old girl detected with severe heart defect,” says Garekar, “but her parents can't afford the surgery and we are now waiting for donors.” It is clear we have better treatment now. What we need now are better policies.
From surfactant therapy, drugs for treating apnoea of prematurity, advances in neonatal surgery, haemodialysis units, bronchoscopes for infants, child-centric resuscitation, medication safety and anaesthesia guidelines to paediatric psycho-pharmacology, the list of advancements in the field of paediatrics is enormous. The last millennium also saw vast progress in paediatric oncology, with significant improvements in the outcomes of haematological cancers and solid tumours.
Dr Anup Marar, paediatrician and director, Orange City Hospital & Research Institute, Nagpur
* Scientists at the Medical College of Wisconsin are working on a dual immunotherapy approach to treat children with high-risk malignant solid tumours. They are using natural killer cells and allogeneic haematopoietic stem cells.
* The American Academy of Pediatrics has made significant progress in human embryonic stem cell research. This has possible implications on childhood diseases including bone marrow failure syndrome, congenital heart disease and leukaemia. These stem cells are extracted from embryos created through in-vitro fertilisation and donated for research.
* Two million infants die of hypothermia every year. Embrace Nest Infant Warmer developed by Embrace, a San Francisco-and Bangalore-based company, is a cheap alternative to incubators. It is warmed for 30 minutes using a heater and keeps the baby warm for six hours.
* Doctors in Chandigarh recently transplanted stem cells in a 3-year-old boy suffering from neuroblastoma—a malignant tumour of the nerve tissue. It is difficult to collect stem cells from a child this young because there is risk of serious infection, but the doctors successfully performed the procedure.