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The Pediatric department of MGMCRI was instituted in the year 2001 with a single unit. The department has grown steadily over the years and today has 4 fully functioning units along with an established neonatology division and a Pediatric Intensive Care Unit.

Objectives
  1. To provide ethical and evidence based, family centred quality treatment to children.
  2. To create a learning atmosphere that promotes inquisitiveness and a zest for knowledge amongst students.
  3. To help students develop the skills and competencies to function as teachers to peers, patients/families and community.
  4. To provide ample opportunities to conduct research activities.
  5. To promote the well being of the community as a whole by successfully implementing National Health Programmes.

 


EMERGENCY SERVICES

Our Pediatric Emergency Department has a state of art facilities with two dedicated pediatric ventilators, to provide optimal medical care to sick children. Our function is to receive, triage, stabilize and provide emergency management. We have exclusive pediatric emergency beds and separate area with servo controlled radiant warmers to receive and stabilize newborns. Our ED is fully equipped with oxygen and suction outlets, infusion pumps, pulse oximeters, nebulizers, defibrillators etc..

Our emergency department is headed by a Pediatrician with vast experience in managing pediatric emergencies round the clock along with post graduate residents and CRRI’s who care and also get trained in pediatric emergencies. We have well trained pediatric staff nurses, who care, handle and give optimal medical care to sick children.

We commonly receive children with Road traffic accidents, Poisonings, scorpion stings, snake bites, Acute Severe Asthma, Seizure disorder, shock etc., We have supportive sub specialties like Cardiology, Neurology, Pediatric surgery, Urology, Nephrology,… to deliver better care to children. We have adequate supportive service like Laboratory, X-ray, CT/MRI and Blood Bank.

Our Pediatric Intensive Care Unit is easily accessible from emergency room to facilitate the safe transfer of sick children.

PEDIATRIC INTENSIVE CARE UNIT (PICU)

The Pediatric Intensive Care Unit is a specialized unit of the department of Pediatrics that caters to the needs of sick children requiring intensive, round the clock monitoring and care.

The PICU is a six-bedded unit that is designed to provide non-invasive and invasive monitoring and intensive care to the most critically ill children. Two state of the art ventilators are available to provide both invasive and non-invasive modes of ventilation like CPAP (continuous positive airway pressure). The ICU is replete with facilities to do continuous non invasive monitoring of vital parameters and is also equipped with infusions pumps, nebulizers, defibrillators etc. to deliver optimum care. Facilities to do bedside echocardiography and ultrasonography, ultrasound guided central line insertions are also available at all times and are utilized to effectively manage patients in select situations. The intensive care unit is headed and supervised by a Professor in Pediatrics and by an Assistant professor with ample experience in emergency pediatric medicine and pediatric critical care. The ICU is also manned by postgraduate students in pediatrics and CRRIs who are also simultaneously trained in the management of critically ill children. The supportive staffs include senior staff nurses and junior nurses who are trained to handle emergent situations and provide excellent point of care. The patient- staff ratio is maintained at 2:1 as per recommendations. There is an assistant professor, one or more postgraduate students and CRRIs available 24 hours a day to monitor the progress of patients and intervene at the earliest.

DIVISION OF NEONATOLOGY

The Division of Neonatology, MGMC & RI is a tertiary care unit equipped with state of art equipments meeting national standards and covered round the clock by doctors and nurses trained in neonatology. The unit provides routine newborn care to all babies born in this hospital as well as life saving treatment for premature, low birth weight and critically ill neonates as young as 27 weeks both inborn and outborn.

Neonatal Intensive Care Unit (NICU)

Our NICU is equipped with servo controlled radiant warmers for continuous temperature maintenance, state of art multi channel monitors and Ventilators, Bubble CPAP, Phototherapy units, digital infusion pumps and complemented by round the clock laboratory and biomedical services, bedside ultrasonography and echocardiography. Well trained nursing staff, senior postgraduate residents and junior consultants under unit chief provide 24x7 care. The unit also provides pre and post operative care for neonatal surgical emergencies.

Babies treated in our NICU includes term and preterm babies with respiratory distress syndrome, perinatal depression, congenital pneumonia, meconium aspiration syndrome, persistent pulmonary hypertension, sepsis, septic shock, inborn error of metabolism, surgical emergencies like diaphragmatic hernia/NEC etc.

Interventions like intubation and mechanical ventilation, surfactant therapy, arterial and central lines, exchange transfusions, emergency thoracocentesis,.. are being done by experienced hands.

  • All the deliveries are attended by pediatricians trained in neonatal resuscitation
  • Counselling is offered for all prospective parents by obstetricians and pediatricians before birth of the baby
  • We have a planned approach to high risk pregnancies
  • Complex neonatal surgeries are being done by experienced pediatric surgeon
  • NICU graduates with risk factors are being followed up regularly at neurodevelopmental follow up clinic held once a week with a multidisciplinary approach, including screening for Retinopathy of Prematurity and hearing impairment (BERA)
  • Well baby clinic for routine check up and immunization of all babies born here is being conducted weekly
 

Post partum unit

The hospital provides for the mother and the newly born with rooms (approximately 75 beds) ranging from general ward to semiprivate and deluxe rooms catering to the needs of people belonging to various socioeconomic strata. Babies are shifted to these post natal wards from labour room, operation theatre and from NICU (direct NICU admissions for out born babies). Here rooming-in is practiced to facilitate mother infant bonding.

Post natal care

In the postnatal ward, every newborn is examined by a team of doctors everyday to monitor signs of well being and to identify the sick one’s for intensive care. Doctors and trained nursing staff are available round the clock to address emergency issues. Breast feeding which is initiated at labour rooms is continued in postnatal wards. All problems related to breast feeding are identified and addressed personally at the earliest.

The common problems encountered during routine rounds in postnatal wards are neonatal hyperbilirubinemia, hypoglycaemia in IUGR, early and late onset sepsis, hypocalcemic seizures etc. Such infants are immediately shifted to NICU for further evaluation and management.

During the hospital stay, mothers are taught methods of keeping the newborn warm, care of the cord and recognition of early warning signs. All babies who received NICU care are followed up in postnatal ward for feeding, weight gain, completion of antibiotics etc,

At discharge a doctor takes responsibility of counselling all the mothers about exclusive breast feeding, burping, need for appropriate temperature maintenance, bathing etc, and their concerns and doubts are cleared before discharge. Specific date for follow up is given to each of them. Discharge summary which is being given to the patient contains detailed information of antenatal risk factors, intrapartum events and anthropometry at discharge. For babies who were admitted in NICU for a long time, problem based details and their specific management are provided for future reference in their discharge summary.

Immunisation and follow up

All babies in postnatal ward are vaccinated free of cost according to National Immunisation Schedule (BCG, OPV, Hepatitis B, ) before discharge. Immunisation charts with anthropometry are also given to the parents along with discharge summary.

Review dates are given at discharge and parents are contacted over phone one day prior to review to remind them about the visit and ensure well being of the neonate / infant. All high risk infants are followed up in well baby clinic conducted on Wednesday. Neurodevelopmental assessment, vision and hearing evaluation are done for such infants and therapy provided based on their needs.

Labour Ward

Our Labour ward is well equipped to conduct both normal deliveries and caesarian sections. There are two radiant warmers and two sets of resuscitation kits which are always kept ready for management of emergencies. Each delivery is attended by an AP, PG and an Intern. Details of risk factors are collected before delivery and resuscitation equipments are kept ready. After delivery is received in the radiant warmer and resuscitation is performed according to recent NRP guidelines. Labour ward is well equipped to provide advanced live support measures like endotracheal intubation, umbilical venous catheterization and administration of drugs. Stable babies are monitored in radiant warmer until the mother is ready for breastfeeding. Sick babies are stabilized in the labour ward and shifted to NICU for further care. A nurse is appointed to clear the used material after each delivery and to keep ready a new resuscitation kit.

Periodic cleaning of Labour wards and resuscitation rooms are being done according to infection disease control department.

 


The Pediatric out-patient department

The Pediatric OPD is located in the ‘D’ block, ground floor of the hospital building. Children up to 12 years of age attend the pediatric OPD which functions from 8.30 A.M to 4.30 P.M on all weekdays and from 8.30 A.M until 1.00 P.M on weekends. The OPD is run by Assistant Professors, Senior Residents, Postgraduate Students in Pediatrics and CRRIs under the supervision of the Unit Chiefs and the Head of the Department. Apart from the regular OPD services, there are five specialty units that run on specific days of the week to attend to the needs of children who require special, individualized care. The OPD has facilities to provide treatment like Nebulization, Injections and also has the necessary equipments to provide emergency care when required.

Specialty clinics

a) Cardiology

The cardiology clinic is run by a competent team comprising a cardiologist, a Pediatrician, Cardiology and Pediatric Post Graduate Students and CRRIs. Children born with congenital cardiac anomalies like VSD, ASD, Tetrology of Fallot, cardiomyopathies and children with commonly acquired heart conditions like rheumatic fever and rheumatic heart disease are managed in this clinic. Apart from the periodic evaluation of the underlying cardiac conditions, children are also assessed in the domains of growth and development to ensure wholesome care. Echocardiography is done by experienced hands and procedures like CT angiography and cardiac catheterization are planned in consultation with the CTVS unit. Treatment is closely collaborated with the surgical team in order to provide timely surgical interventions when the need arises. The treating team also makes necessary arrangements with the help of hospital social workers to help poor patients reap the benefits of the chief minister’s health scheme.

b) Well baby / Immunization /High Risk baby follow up Clinic

True to the adage that “prevention is better than cure�, the well baby clinic functions to promote healthy and safe child rearing practices. Assistant Professors, Senior Residents and Postgraduates working in the Newborn Unit run this specialty clinic to deliver continuing care and follow up. All babies attending the Immunization and Well Baby Clinic are administered vaccines, free of cost in accordance with the National Immunization Schedule. Child’s growth and development is meticulously assessed during each visit and any deviation from the normal is addressed immediately. Exclusive breast feeding until 6 months of age and age appropriate complementary feeding practices are emphasized. NICU graduates receive added attention to identify potential morbidities and receive appropriate treatment often in association with specialists of other departments like Ophthalmology, ENT, Physiotherapy and Occupational Therapy.

c) Neurology and Child Rehabilitation clinic

Children with chronic neurological problems like epilepsy, developmental delay, cerebral palsy and neurodegenerative disorders etc pose challenging problems that calls for a team of specialists to deliver the best possible care. Our Pediatricians, with the help of a neurologist with expertise in managing children with neurological problems, physiotherapists and occupational therapists strive to provide such care to these children attending the neurology clinic. Parents are educated regarding the disease conditions and are also provided support to cope with their children’s health problems. Regular follow up and compliance with treatment schedule is also emphasized.

d) Nephrology clinic

Nephrotic syndrome and urinary tract infections are among the commonly occurring renal problems in children that require regular follow up. The Nephrology unit takes care of such children in addition to the follow up of children with chronic kidney disease, acute kidney injury, congenital genitourinary disorders and rare conditions like renal tubular acidosis. Assessment of growth, blood pressure and evaluation of the underlying problem is undertaken during each visit. The child’s family is also involved in the successful management of these children wherever applicable. Consultations are also sought from the surgeons and urologists in cases where surgical intervention might be needed.

e) Child Guidance Clinic

The need for a dedicated unit of specialists with expertise in the field of child and adolescent psychology and psychiatry to address the issues of children requiring such care is being recognized these days. The child guidance clinic functions to meet that end, under the supervision of a psychiatrist, a Pediatrician in addition to Post Graduates in the Departments of Psychiatry and Pediatrics to correctly diagnose and treat problems like ADHD, autism, learning disabilities and a host of other psychiatric and psychological conditions. The team also spends quality time providing unbiased and valuable information regarding these conditions to the concerned family to allay their anxiety and improve their understanding of the condition, which is the cornerstone of the management.

 

Academic Activities

Department of Pediatrics undertakes intensive clinical training for Postgraduate and Undergraduate students in a systematic way. They are posted by rotation to all the working areas of the Department. Research work is undertaken in a scientific way and in the last five years, 22 papers have been published in the indexed journals.

 


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The undergraduate program was instituted in the year 2002 and the post graduate program was started in the year 2007. At present, yearly 4 students are admitted for the M.D course and 2 for Diploma in child health (D.Ch).

GOALS

The goals of training in Pediatrics are directed towards developing a competent pediatrician who

  • Appreciates and recognizes the health needs of neonates, infants, children and adolescents and carries out professional obligations in keeping with principles of National Health Policy and professional ethics;
  • Has acquired the clinical competencies pertaining to delivery of appropriate, cost effective, quality pediatric health care- preventive, promotive, curative and rehabilitative- activities that are required to be practiced in the community and at all levels of health care system;
  • Has acquired skills in effectively communicating with the child, family and the community;
  • Has acquired teaching and training skills in educating medical and paramedical professionals
  • Appreciates the need and keeps updating the knowledge and skills pertaining to contemporary advances and developments in medical sciences as related to child health;
  • Has developed scientific temper and is oriented to principles of research methodology and clinical epidemiology.
Objectives

At the end of the training course in Pediatrics, the Pediatric Trainee / student should be able to

  • Identify social, economic, environmental, biological and emotional determinants of child and adolescent health, and institute diagnostic, therapeutic, rehabilitative, preventive and promotive measures to provide holistic care to children;
  • Appreciate the importance of growth and development including prenatal growth and development as the very foundation of Pediatrics and help each child realize her/his optimal growth and development potential;
  • Demonstrate adequate level of proficiency and competency in basic clinical skills, e.g. taking clinical history, conducting thorough clinical physical examination including assessment of physical growth and neurodevelopmental and behavioural development and in arriving at the most likely or possible clinical diagnosis, in identifying precipitating or predisposing factors; high risk and low risk groups and good and bad prognostic factors;
  • Plan and perform relevant, cost-effective investigative and therapeutic procedures in confirming the possible diagnosis and excluding the other differential diagnosis;
  • Develop analytical skills in the interpretation of important diagnostic, imaging and laboratory results;
  • Diagnose illness in neonates and children based on the analysis of history, physical examination and investigative work up;
  • Plan and deliver comprehensive treatment for illness in neonates and children using principles of rational drug therapy and Evidence Based Medical principles;
  • Carry out resuscitation, triaging and offer appropriate medical help to affected children during disasters.
  • Demonstrate skills in accurate, meaningful and concise documentation of clinical case details, and in collection of periodical and cumulative morbidity and mortality data relevant to the assigned situation;
  • Plan and advise measures for the prevention of childhood diseases and disabilities.
  • Plan rehabilitation of children suffering from chronic illness and handicap, and those with special needs;
  • Assess, recognize, diagnose neonatal and childhood critical illness and emergency situations and plan appropriate laboratory investigations and institute appropriate management.
  • Provide comprehensive care to normal, ‘at risk’ and sick neonates;
  • Recognize the diagnostic and management limitations of the health facility and the need for appropriate and timely referral of children to higher health facilities and speciality care;
  • Recognize the need for medico-legal registration and referrals of specific cases and maintenance of appropriate documentation of case details and
  • To maintain the integrity and dignity of the chosen profession.
  • Practice Pediatric health care delivery services in keeping with the principles of professional ethics;
  • Develop sensitivity and appreciate the emotional and behavioural characteristics and needs of children, and keep these fundamental attributes in focus while dealing with them;
  • Demonstrate empathy and humane approach towards patients and their families and respect their sensibilities;
  • Demonstrate effective communication and counselling skills in explaining management options, prognosis and in providing health information and health education messages to patients, families and communities;
  • Function as an effective and productive member of a team engaged in health care, research and education;
  • Organize and supervise the desired managerial and leadership skills;
  • Appreciate and recognize the key importance of maternal and child health in the context of the health priority of the country;
  • Demonstrate competency both individually and collectively as a team member to function effectively in primary, secondary and tertiary care levels and play an effective and responsible role in the training and implementation of assigned National Health Programmes such as immunisation, IMNCI, millennium development goals and others with regard to maternal and child health;
  • To document, collect and send health related information as required by government and other health agencies and help them effectively in formulation of health policies pertaining to child health.
  • Develop self learning skills as a self-directed learner and recognize the need for updating knowledge and clinical practical and technical skills pertaining to his/her professional area of practice; in selecting appropriate and accurate learning resources, and critically analyze relevant published literature in order to practice evidence-based Paediatrics;
  • Demonstrate competencies in the application of basic concepts of research methodology and epidemiology in collection, interpretation and publication of scientific medical data;
  • Facilitate learning of medical/nursing students, practicing physicians, para-medical health workers and other providers as a teacher-trainer.
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