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Thiruvananthapuram and Hridyam: A Model for Managing Children with CHD

Learn about the unique experience of setting up a dedicated Paediatric Cardiology facility in Thiruvananthapuram, Kerala. Discover the strategies used to reduce infant deaths from congenital heart disease and the importance of early diagnosis and intervention.

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Thiruvananthapuram and Hridyam: A Model for Managing Children with CHD

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  1. Welcome to Thiruvananthapuram and

  2. Hridyam for Little Hearts: A model for Managing children with CHD Kerala macro- micro strategy Setting up of Paediatric Cardiology Facility A Unique Experience Dr.Lakshmi.S HOD, Paediatric Cardiology SATH

  3. Why a unique experience ? • A dedicated Paediatric CATH lab is first of its kind in the state. • Setting up of a dedicated Paediatric Cardiac Surgical facility- First of its kind in a state medical college.

  4. Health Statistics IMR- 34 NMR-29 U5MR-52 IMR - 10 NMR-7 U5MR-13 Type to enter a caption.

  5. To achieve single digit IMR • Reduction of infant death from congenital heart disease

  6. Prevalence of CHD 6-8 /1000 live births • 2-3/1000 Live births are critical CHD • 60% with critical CHD die in infancy unless intervened

  7. Kerala • 4000 new CHD /year • 1300 critical CHD/year • 780 infant CHD deaths /year • 25% of infant deaths in Kerala are due to CHD

  8. Reduction of CHD deaths

  9. Clinical Pulse oxymetry Echocardiography Early diagnosis Clinical Echocardiography Infancy Foetal Echocardiography Foetus Newborn • How early

  10. Foetal diagnosis Planned delivery Parental counselling • Assess risk of intrauterine demise • Assess risk of immediate neonatal compromise • Intra uterine interventions • Screen for extra cardiac and chromosomal anomalies • Medical Termination of Pregnancy

  11. Prevention of infant CHD deaths Palliative Corrective • Surgery • Catheter interventions • Medical management

  12. Why early intervention is needed ?

  13. Multidisciplinary Approach Pediatric cardiologist Neonatologist Paediatrician Nephrologist Neurologist Dedicated nurses Cardiac Anaesthetist Pediatric Cardiac surgeon Intensivist Care of infant with CHD

  14. S A T HOSPITAL

  15. In born nursery

  16. Out born

  17. Admissions – PICU

  18. Cardiac Cases

  19. ACHD admissions

  20. CCHD admissions

  21. Primary causes of infant death (%)

  22. How to tackle this ? 3 prong approach • Early detection by foetal echocardiography • Critical heart disease pick up in newborn and definitive management/palliation • Correcting simple heart diseases which contribute to infant mortality

  23. Till recently we had 2 major centres • One in central government sector • One in private sector

  24. Two way approach • Empowering private sector and incorporating them into CHD management {Empanelling} • To strengthen government Medical colleges

  25. Pediatric cardiology unit started in 1998 • Became separate department in 2007 with Dr.Zulfikar Ahamad as HOD • Involved in diagnosis and treatment of neonates, infants and children with congenital and acquired heart diseases.

  26. Educating Paediatricians

  27. Patients requiring interventions or surgery were referred to SCTIMST • With establishment of Hridyam programme patients are also going to empanelled hospitals from 2017 onwards. • 193 cases were registered from SAT IN last 4 months

  28. Genuine enhancement of facilities started 3 years back • Because of strong political will and a committed administration

  29. FETAL ECHO 2017

  30. FETAL ECHO 2018

  31. PEDIATRIC ECHO 2018

  32. Very important milestone • Unique experiment and experience by state government • Setting up of a dedicated high end Paediatric Cath lab

  33. Cath Lab • Dedicated Pediatric cath Lab was sanctioned

  34. Recently 13 new posts were created in the Pediatric cardiology department. At present the department has posts of • Professor • Associate professor • Two Assistant professors • Six staff nurses • Two Cath lab technicians • One office attendant • Two Grade 2 cleaning staffs • Two nursing assistant • One clerk cum typist

  35. Thanks to National Health Mission • Training our staff nurses • Posting and training anaesthetist

  36. Our plans in near future • Neonatal structural interventions • Surgical correction of CHD

  37. Dedicated Pediatric Cardiac surgery • Offering a dedicated Paediatric Cardiac Surgical service to the state will become a reality in near future National Health Mission State Government

  38. Pediatric cardiac surgery • Cardiac surgeon got trained at SCTIMST • Equipments sanctioned • Planning to start in near future

  39. Our Dream • Full fledged paediatric Cardiac surgery unit • Dedicated paediatric Cardiac ICU • Dedicated neonatal cardiac ICU

  40. Thankyou….

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