The neonatal Intensive Care Unit at Apollo Hospitals is specialized in the care of sick newborns including premature and tiny babies. The advent of newer therapeutic modalities, artificial life-support techniques, and infection control mechanisms has tremendously decreased mortality in newborns. Apollo’s pride, one of the most advanced neonatal units in the world, has ushered in a new era in neonatal medicine.
A tertiary care unit with advanced equipment including high frequency ventilators caters to premature babies with special needs and those born after high-risk pregnancies such as following in vitro fertilization. The unit provides pre and postoperative management of neonatal emergencies.
The staff consists of 4 Consultant Neonatologists, 2 Registrars, 2 Fellows and specially trained Neonatal Nursing and Para-medical staff. They provide round the clock cover and function as a team. A transport incubator with monitoring facilities and a transport ventilator allows safe transport over long-distances. Mobile ventilation, a comprehensive network available at Apollo has improved survival. These advances, backed by conventional neonate management technology (incubators, computerized monitoring including blood pressure, oxygen levels in the blood, blood gas analysis etc.) would be of no use unless a skilled, dedicated professional team utilizes them. The ICU team is highly qualified with experience abroad and is capable of dealing with complicated surgical cases.
It is important that every baby be managed professionally in the first month of life and especially the first hour. Improved imaging even before birth (fetal echo and ultrasound) well-baby clinics and parent support networks have come a long way in changing the face of long term follow up results of surgery and neonatal intensive care on sick premature newborns with low birth weight.
Parents of babies admitted to the unit are allowed unlimited access to visit the baby. They are encouraged to actively participate in the day-to-day care of their baby. Mothers are encouraged to room in with the baby. The neonatal and obstetric units work closely together. Difficult pregnancies are discussed and the delivery is planned in such a manner as to benefit both mother and baby. The unit conducts regular antenatal classes for expectant mothers. This increases awareness of the process of labor and birthing and prepares them for the time of delivery. Fathers are also encouraged to be present at the time of delivery.
Pediatric Intensive Care Unit :
Pediatric Intensive Care unit at Indraprastha Apollo Hospital is a nine-bedded state-of-the-art unit with all modern facilities.
The unit cares for the very sick children from the age of 28 days to 16 years and gets referrals from all over India and abroad.
The unit has the capacity to ventilate up to seven patients at a time and has the most modern ventilators and monitoring systems available. It cares for critically ill children with a wide range of conditions including septicemia, shock, respiratory, gastrointestinal, renal and cardiac conditions.
The unit is well staffed keeping the needs of small children in mind. Two well-experienced full-time intensive care consultants staff it. The unit has a trained pediatrician, experienced in intensive care on the floors at all times.
Many critically ill children require a multi-disciplinary effort and the unit is well backed by 24-hour support of all pediatric and pediatric surgery subspecialties including Neurology, Gastroenterology, Nephrology, Pulmonology, Cardiology, Endocrinology, Rheumatology and Hemato-oncology.
The nurses are well trained and handpicked with special interest in caring for the children. The unit has a 1:1 staffing for all critically ill children for optimal monitoring and management.
The unit has an open-door policy and allows free access to the parents at all times in accordance with current international practices. We put great emphasis on infection control at all levels including adhering to strict hand-washing protocols for the visitors. These measures have stood us well and we have been able to keep infections well under control. Pediatric critical care transport services are available round the clock from all referral areas by ground transport or air ambulances.
Some state-of-the-art facilities available in the unit are:
Cardiac Output monitoring
High Frequency Oscillatory Ventilation (HFOV).
Continuous Renal Replacement Therapy (Dialysis) for infants and children
Molecular Adsorbent Recycling System (MARS) therapy for liver failure
Flexible bronchoscopy for all ages
Liver Transplantation :
The multi organ transplant unit offers facilities for liver transplantation. Pediatric liver transplantation (LT) is now an established and a successful modality of treatment worldwide for children with acute and chronic end stage liver disease. The advent of new surgical techniques, immunosuppressive drugs, sophisticated pre and postoperative care has tremendously improved the survival rates in pediatric patients over the last four decades. In the current era, pediatric LT has one and ten-year survival rates of 90 and 80 % respectively. Till a few years back, in the absence of LT facilities in India, a patient with liver failure had only two options, certain death or travel abroad for a transplant. The first successful pediatric liver transplant in India was performed in this unit in November 1998. The youngest baby in India was successfully transplanted in August 2008 at the age of 6 months. Our results are comparable with the best centers in the west. The surgical experience gained over the last few years combined with the lessons learnt in the medical management have contributed considerably to this achievement.
Pediatric Nephrology and Kidney Transplantation :
The department provides efficient and effective treatment for the full range of pediatric renal diseases. Facilities are available for both hemodialysis and peritoneal dialysis. The service is backed by diagnostic services from the biochemistry, radiology, Nuclear medicine and pathology. Allied Nephrology Service is available in CAPD (continuous ambulatory peritoneal dialysis) and hemodialysis. Services for kidney biopsies, dialysis and transplantation are also available under one roof. Pursuit of excellence in patient care through the improvement of the understanding of disease processes and the development of new strategies in the treatment of individuals with kidney disease is our primary goal. The neonatal renal diseases are effectively managed in association with neonatologists. Facilities for their diagnostic work up and dialysis etc. are available.
Kidney transplant operations involve taking out one kidney from the body of a person and transplanting it surgically in the body of another patient whose both kidneys have failed. The transplanted kidney functions as the patient’s own kidney. Patient with end stage kidney failure has two choices, either life long dialysis or kidney transplantation. Transplantation offers better quality of life, better ling term rehabilitation and is more cost effective than lifelong dialysis. Now a day’s donor can get the kidney removed by keyhole surgery where there is minimal pain and morbidity. The 6 cm scar is just above the pubic bone, which is not visible. The donor can go home 3-4 days after surgery and can resume his work 2-3 weeks later, keyhole donor nephrectomy has become popular all over the world.
Life after Kidney transplantation – Anti rejection treatment is essential and regular blood tests are also necessary. There is freedom from dialysis. The recipient needs to be a little careful about hygiene and especially should avoid over crowed places.
Neonatal and Pediatric Surgery & Pediatric Urology :
Expertise is available for correction of major congenital malformations in the neonate. Highly specialized facilities exist for the management of emergencies and complex surgical problems in infants and children. Pediatric bronchoscopy, cystoscopy, laparoscopy and thoracoscopy, both diagnostic and therapeutic are available.
The unit has extensive experience of dealing with all kinds of major congenital anomalies and has consistently produced excellent results. The hospital has a separate day care facility for babies to have surgery and return home the same day. More than 1000 cases have been done without a single baby having to stay beyond the stipulated time or return with any morbidity. One day stay allows baby to recover from surgery at home.
We have a team of neonatal surgeons backed by four neonatal intensivists. All have had significant exposure, training and experience overseas prior to joining Apollo hospitals. The team has been working together for the last 10 years, steadily improving service & curtailing costs while providing corporate quality healthcare.
2-3 % of new borns are born with congenital anomalies (birth defects). The vast majority of them are correctable. However it is important to appreciate that the first chance is the only chance in new borns.
Pediatric urology is a recently launched specialty of the department. We are regularly performing endourological procedures like ablation of posterior urethral valves, endoscopic treatment of vesicoureteric reflux, endoscopic treatment of ureterocoeles, treatment for obstructive uropathy and laproscopic surgery for impalpable testis and kidney disorders. The division has performed over 1000 endoscopic and open procedures without any morbidity in the last one year. There is free and easy access to urodynamics, lithotripter, endoscopic theatre supported by well-trained staff.
Pediatric and Neonatal Cardiology & Cardiac Surgery :
The Apollo Hospital features a unique neonatal and pediatric congenital heart disease program that provides expertise in every area of pediatric and congenital heart care. Our team members are in tune with the special needs of the tiniest of heart patients.
Services offered include non-invasive diagnostics services with digitized Echo machine; cardiac catheterization suites for diagnostic and interventional cardiac catheterizations including neonatal interventions, balloon angioplasty, device closure of ASD, PDA, VSD, cardiac biopsy, balloon septostomy, stenting of blood vessels including neonates and electrical problems (arrhythmias) of the heart of newborn and children.
Children and babies need a certain level of care in handling, specially when they have cardiac problems. This becomes even more critical in neonatal cases. They need special infrastructure, treatment and doctors. That is why Indraprastha Apollo Hospitals, New Delhi, has set up a very specialized Pediatric Cardiac Care Department. Manned by dedicated pediatric cardiac surgeons, cardiologists, anesthetists, intensivists and other support staff who have specialized in pediatric cardiac care and offer treatment and handling of children and babies with cardiac problems that are at par with the best anywhere in the world.
Smallest baby to have heart surgery – 700 grams weight (PDA ligation)
Smallest baby to have angioplasty – 1.6 kg (Coarctation)
Youngest baby to have angioplasty – 17 hours old (Pulmonary Stenosis)
Pioneered use of Bosantan for Pulmonary Hypertension in children
First child with HIV to have open heart surgery
Youngest child to have coronary angioplasty – 3 years and 6 months
Apollo is the first private sector hospital in India to get the capability of a state-of-the-art echocardiography technique called Intra- Cardiac Echo (ICE), which is particularly useful for closing holes in the heart without surgery. Apollo has a neonatal interventional program and a device closure programme for repairing certain heart defects without surgery.
The specialized services provided :
Pediatric Cardiac surgery
Open Heart Surgery
Neonatal and infant cardiac surgery: Arterial switch operation, Truncus Repair TAPVR Repair, AV Canal
Pediatric Hemato-oncology and Bone Marrow Transplant :
The Pediatric Hematology and Oncology division is an integral part of ACAP. Childhood cancers though rare are eminently curable. Treatment is available for both hematological cancers and solid tumors as per protocols currently giving the best outcomes anywhere in the world. A team of pathologists, surgeons, and radiation oncologists backs this service, as optimal treatment requires multi disciplinary involvement. State of the art treatment is given in a patient friendly setting with efforts to minimize the pain involved in the treatment as much as possible.
There is a dedicated thalassemia unit for patients with thalassemia major and a day care ward.The Blood & Marrow Transplant Department is offering allogeneic and autologous transplant to children with malignant and non-malignant conditions. The diseases treated are leukemias, lymphomas, neuroblastoma, thalassemia, aplastic anemia and other immune deficiency and storage disorders.
A six bedded HEPA-filtered laminar air flow unit and state of the art stem cell processing unit backed up by excellent laboratory services compares with the best standard of care internationally.
Pediatric Neurology :
Apollo Hospitals Delhi is known for best Pediatric neurology in Delhi. The centre has two dedicated full time pediatric neurologists. We provide comprehensive care for children with developmental delay and facilities to manage the children with complex neurological problems, chronic epilepsy and those having headaches.
The pediatric neurology department provides a specialist service for the diagnosis and treatment of children with neurological disorders, who are already under the care of a pediatrician or other pediatric subspecialist. There is a dedicated neurophysiology department to compliment existing services for patients who have neuromuscular disorders.
We provide investigations and treatments, which are usually not provided at other places. The service is provided for children with the following disorders:
CNS infections (Meningitis, Encephalitis)
Traumatic brain Injuries
Complex neuro-developmental disorders
Peripheral nerve diseases
Malformations of the central nervous system
Neurodegenerative and neuro-metabolic disorders
Tumours of the central nervous system
Neuropsychiatric & Neurovascular Diseases
Pediatric Orthopedic Surgery :
Children are not just small adults. They cannot always say what is bothering them, or answer medical questions, or be patient and cooperative during a medical examination. Pediatric Orthopedic Surgeon knows how to examine and treat children in a way to help them be relaxed and cooperative. He/she also appreciates the worry that goes with having a child with a musculoskeletal problem, and has experience in communicating with anxious family members. A child’s musculoskeletal problems are different from those of an adult. Because children are still growing, the body’s response to injuries, infections, and deformities may be quite different than what would be seen in a full-grown person. Sometimes, what is thought to be a problem in a child is just a variation of growth that will resolve with time. A good example of this is ‘in toeing’ in a toddler. Some of the problems children have with their bones and joints that are due to growth do not even occur in adults. Moreover, the evaluation and treatment of a child is usually quite different than for an adult, even for the same problem.
Our centre has a dedicated pediatric orthopedic surgeon who diagnoses, treats, and manages children’s musculoskeletal problems, such as:
Gait abnormalities (limping)
Limb and spine noted at birth or later in life
Scoliosis and limb length difference
Hip anomalies like DDH (Developmental Dysplasia of Hip) or Perthes
Bone or joint infections and tumors
Cerebral palsy, Arthrogryphosis, Osteogenesis imperfecta (to list a few)
Pediatric Nephrology :
ACAP provides a full range of services for children suffering from kidney problems. Complicated urinary tract infections, Nephrotic syndrome and Nephritis are assessed fully. Dedicated real time ultrasound guided renal biopsy is available to give accurate diagnosis of various renal problems. Acute renal failure in newborns to all age groups of childhood is dealt with by providing dialysis modalities of all types including continuous renal replacement therapy(CRRT). Complete work-up and treatment modalities are also available for hypertension and chronic renal failure in children.
Developmental Pediatrics and Rehabilitation
Expert evaluation and assessment of developmental disorders in children such as developmental delay, mental retardation, cerebral palsy, autism and learning disabilities backed by a comprehensive rehabilitation programme for the physical and mental handicaps arising from these conditions is available.
An ongoing high-risk infant follow-up program coordinated between neonatology and developmental pediatrics helps to identify infants showing developmental compromise and provides early intervention therapy by a multidisciplinary team from as early as the first six months of life.
Psychological and Behavior Counseling : Psychological and behavioral counseling services address emotional, behavioral and scholastic problems of children. Delayed developmental milestones learning difficulties, poor concentration, conduct disorders, interpersonal relationship problems, coping with stress are handled by experienced staff in a supportive environment.
Serving the emotional needs of children, adolescents and their families Children, adolescents, and infants have many ways to communicate emotional distress.
Sometimes children and adolescents
Feel very unhappy, worried, or frightened for reasons they cannot explain.
Cling to their parents because they are fearful
Cannot channel their energy and creativity in ways that develop their potential.
Do not know how to make friends or get along with others at school or in the family
Act meanly or aggressively
Can’t learn in school
Are restless or cannot concentrate.
Have negative attitudes toward themselves
Such behaviors and feelings often interfere with a child’s sense of well-being and capacity for emotional, social and intellectual development. If these problems do not resolve with time and support from parents, teachers, or friends, professional assistance can be effective.
ACAP offers a range of services to help children, adolescents and their families when emotional problems hinder emotional growth and development.
Assessment : Every inquiry begins with an evaluation that includes parents and child and information from other sources as needed. The goal is to determine the nature of the problem and develop an individualized treatment plan based on the child’s needs Certain psychological test are also conducted if desired.
Psychotherapy : is designed to help with immediate crises as well as ongoing or behavioral problems. Therapy sessions may be once or twice a week, in addition to collaborative work with parents.
Play Therapy : Play therapy focuses on a child’s need to express themselves through the use of play and toys. In play therapy children have access to a variety of things like art supplies, sand and sand toys, storytelling aids, and toys for dramatic and fantasy play through which they recreate the emotional experiences they are struggling with internally.
Children need an outlet to share their feelings and experiences, a safe place. We create that place for them.
Nutrition Support :
The pediatric dietitians are experienced in managing a variety of clinical conditions such as celiac disease, cow’s milk allergy that require skilled dietetic input. They have expertise in the dietary management of various inborn errors of metabolism, pre & post surgery/ transplant rehabilitation pertaining to congenital multi-organ abnormalities. Specialized diets are planned to treat conditions like Chylothorax, Nephrotic syndrome, various degrees of malnutrition and failure to thrive in childhood.
The department has prepared an indigenous gluten free diet book. Comprehensive enteral and parenteral nutrition support is routinely provided to all patients.
Adolescent Medicine :
This branch of Pediatrics addresses teenage concerns involving physical and physiological needs and various ailments. Services provided include psychological testing and counseling, assessment and management of behavioral, sexual and various other problems including enuresis, obesity and feeding fads.
Vaccinations work by exposing our body to an infection so that we develop immunity to it. Some vaccinations are given orally, others by injection. The advantage of a vaccine is that instead of getting the full-blown disease, we can get immunized by taking in a weak version of the infection. So we get immune to a disease without first having to be sick.
If your child is immunized against an illness, the chances of getting that illness are reduced to a great extent since your child’s body has already made antibodies against it. Immunization is the most effective method of protecting your child from certain serious infections.
Apollo Centre for Advanced Pediatrics has been established to ensure that the benefits of rapidly advancing knowledge and expertise in various medical and surgical fields are not denied to children. Quality tertiary care for neonates, infants, children and adolescents can only be provided through the concerted efforts of a team of pediatric specialists backed by modern equipment and other supportive services.