In paediatrics these days, super-specialised care is in. With new advances in technology, medicine and surgery, doctors are now able to sub-classify children on the basis of their age and medical conditions to give them super-specialised care. So, there is no longer just a paediatrician. There is a neonatologist, gastroenterologist, neurologist, nephrologist and dermatologist - super-specialist doctors to deal with the myriad health issues relating to children. “There is a realisation that there is a huge difference between how a disease manifests and responds to the treatment when it comes to children and adults. Even side-effects of the medicine differ,” says Dr Anupam Sibal, director and paediatric gastroenterologist at Apollo Hospitals. “We have to take into consideration long-term side-effects that a medicine could have on children as they are at a growing stage. Super-specialisation in branches of paediatrics helps us study each disease and its therapy in detail.”
Super-specialisation, say doctors, also helps in spreading awareness about the treatments available in different specialities. Take, for example, bone marrow transplant. Of 5,000 bone marrow transplants done in India every year, more than half are on children. There are many medical conditions-thalassemia, aplastic anaemia, leukaemia-among children that are now being treated with bone marrow transplant. Earlier, these conditions were treated through blood transfusion, which reduces life-expectancy. Bone marrow transplant has also been effective in treating children with primary immunodeficiency syndrome. “These children generally die within the first year of birth because of infections, but now specialists can perform bone marrow transplants in babies as young as two or three months old,” says Dr Satya Prakash Yadav, senior consultant, paediatric hematology at Fortis Memorial Research Institute (FMRI) in Gurgaon.
Neonatology, too, has seen great advances in the past few years, and doctors are now equipped to handle babies as small as 450gm. The quality of neonatal care has also improved. “Now we ventilate premature babies non-invasively with CPAP [continuous positive airway pressure] machines, where we attach prongs to their nostrils and encourage natural lung breathing instead of inserting a plastic tube into their lungs. It prevents infection as well as trauma caused by the tube,” says Dr T.J. Antony of FMRI. Likewise, babies are given full feed through mouth instead of intravenous feed, which again prevents infection. In case of birth asphyxia, brain hypothermia therapy-cooling the newborn's brain at 34°C-is now practised, which protects the brain against any damage caused by the condition. And if a baby passes stool in the womb, inhaled nitric oxide is administered.
Paediatric cardiology also includes foetal cardiology-diagnosing and treating cardiac problems in the womb itself. “Foetal heart navigator is an equipment that enables doctors to take up such complicated cases,” says Dr. Vikas Kohli, Paediatric Cardiologist at BLK Super Speciality Hospital, New Delhi. “We can move it 180 degrees to the left and right and 180 degrees in anterior and posterior direction and get a three-dimensional view of the heart. We got this machine just two months back and we now screen 5 to 10 babies every day with it.”
Apart from treatments, early detection techniques help in the prevention of many diseases in children. These days, doctors across the country are seeing many cases of lifestyle diseases in youngsters. “I recently got a 24-year-old patient with 100 per cent blockage in the main artery. Now we are educating schoolchildren with the help of a new test called IMT [Intimal Medial Thickness] test,” says Kohli. “We take the coronary artery that goes to the brain and study the thickness of the artery with a special machine. We can see the thickness of the wall and the percentage of fat. With this test, we can predict the cholesterol level in children. It is an effective way to counsel children about the importance of physical activity and healthy diet.”
Link: The Week - Cover Story - Expert Surplus