The department of Neonatology offers the highest levels of neonatal care to manage a wide range of problems that affect newborn babies. Every year ~15,000 babies are born in CMC’s Vellore Town Campus alone. Most babies have no major problems at birth and go home within a few days with their mother. Some babies are born early or small, or get sick shortly after birth for which they need special attention in the nursery. They may have difficulty in  breathing or feeding, infection, jaundice and so on for which they need to be on IV fluids, oxygen, ventilatory support, antibiotics, phototherapy, etc. Some babies with surgical problems are also admitted to the nursery and managed with the paediatric surgery department. Most babies recover and grow up to be fit and well.

After discharge, some babies are followed up in the High-Risk Infant Clinic (HRIC). These babies have a multi-disciplinary team of physicians, occupational therapists, physiotherapists and developmental paediatricians involved in their follow up. We now screen all babies born in CMC for congenital hearing impairment. Assessment and counseling for high-risk mothers and their families in the Perinatal Clinic is an important service. In some situations, they can take fluid from around the baby in the womb and look at the baby’s chromosomes to look for any major chromosomal problem.

We continue to be CMC’s largest inpatient unit. The majority of babies admitted in the nursery are those born in CMC. We also serve as a referral unit for sick newborn babies from CHAD, RUHSA, LCECU, CMC Chittoor campus and other centres in a radius of ~100 km around Vellore. Pregnant women from various parts of India with major medical and foetal problems affecting their pregnancy come to CMC to receive suitable antenatal management and good neonatal care.

Our department is constantly adding new services and personnel to enhance the quality of care we are able to offer. We network closely with other specialties in CMC and other hospitals across India to improve neonatal services and make a positive impact in the community. Our research collaborations with institutions all over the world have had far-reaching implications in the development of neonatal care.

Transforming tiny lives – Translating cutting edge research for low resource settings

Statistics	2017-2018	2018-2019	2020-2021	2021-2022
In Patient	14824	14418	11674	12189
Nursery Admissions	2736	2661	2670	2905
COVID ward Admissions			264	45
Outborn Admissions		257	261	274
Outpatient   HRIC	3949	4354	2276	3207
LRIC			574	1739
CARING CLINIC			709	1016
Nursery Bed Strength	76	76	76	76
Bed occupancy	95.04	93.51	91.26	89.79
Average Hospital Stay (days)	4.70	4.94	4.70	4.8
Perinatal Mortality Rate per 1000 live births	19.03	16.11	20.8	23.37
Neonatal Mortality Rate per 1000 live births	3.17	2.68	3.0	6.12

We offer a comprehensive OPD follow up for high risk babies. There is also short term follow up for other babies in the Low Risk Infant Clinic. The follow up team comprises doctors, a lactation nurse, occupational therapist, social worker and a psychologist. Networking is done with various specialties like paediatric surgery, medical genetics, cardiology, etc. Babies who have long term developmental needs are transitioned to the Developmental Pediatrics team for long term follow up.

This year we saw 3207 children in our follow up HRIC, 1739 babies in our LRIC OPD and 1016 babies in the CARING CLINIC.

To enable mothers to optimise breast feeding, we have trained lactation consultants who see mothers and babies in the nursery and at follow up to encourage mothers and make them more confident in exclusive breast feeding. This is in addition to bedside breast feeding support that all mothers receive. The lactation nurse is available in the High Risk and Low Risk Infant Clinics so that mothers who have queries and problems related to breast feeding get the help they need. This has helped achieve good rates of breast feeding among newborn infants.

Occupational therapy at the bedside and on follow up is part of the multi-disciplinary approach towards achieving good neurodevelopmental outcome in high risk babies. Over 577 sessions as in-patient and 1324 sessions as out-patient of occupational therapy and assessments have been done this year. In view of the increased load, a separate area for assessment and therapy of high risk neonates functions as the Centre for Assessment, Review and Intervention in NICU Graduates (CARING) Clinic. There are also family counseling sessions.

In addition, a clinical psychologist and social worker are available for clinical assessments of babies and to provide support to families as they go through stressful periods during hospital stay and at follow up. Several social engagement activities are encouraged among mothers.

NICU Graduates Reunion

Get-together of older infants and children who are NICU graduates is held periodically.

Mission Hospital networking

We continue to visit and network with various mission hospitals to strengthen their clinical services and community outreach. Our department has also been called to troubleshoot outbreaks, address logistical issues and for advice regarding equipment and protocols. 

Management of high risk Infants

Management of preterm and low birth weight babies

Management of neonatal surgical problems

Resuscitation

Incubator care

Phototherapy

Exchange transfusion

Arterial blood gas

Total parenteral nutrition

CPAP

Ventilator support (conventional, high frequency)

Surfactant therapy

Nitric oxide therapy

Whole body cooling

Bedside EEG monitoring (aEEG)

Near Infrared Spectroscopy (NIRS)

    i. Ultrasound

    ii. Echocardiography

    iii. Hearing assessment

    iv. Congenital hypothyroidism & metabolic disorders

    i. High risk infant clinic

    ii. High risk pregnancy counseling

    iii. Low risk infant clinic 

    iv. CARING Clinic

 

We admit 4 candidates annually for the DM (Neonatology) course since 2020.

All MD (Paediatrics) trainees have rotations through the Neonatology department. PG students from community medicine, obstetrics and gynaecology, transfusion medicine and paediatric surgery have neonatology postings as part of their peripheral training. Fellowship students from PICU and Paediatrics also have postings in neonatology.

We have had International Neonatology Fellows and Paediatric Trainees (from Nepal and Sri Lanka respectively) doing their training in our unit which has been recognized as a centre for these courses. We have elective students from many universities around the world who opt for a short stay in our department.

Dr.Anil Kuruvilla and Dr.Santhanam Sridhar are DM, DNB examiners for Neonatology in various universities including the TN

DrMGR Medical University, JIPMER, Delhi and Bombay Universities as well as the National Board of Examinations.

Dr.Anil Kuruvilla, Dr.Santhanam Sridhar, and Dr Manish Kumar are reviewers for various national and international journals like Indian Pediatrics, Indian Journal of Pediatrics, Journal of Tropical Pediatrics, Journal of Turkish German Gynecological Association, Pediatric Infectious Diseases Journal, Clinical Case Reports, Lancet, British Medical Journal, Archives of Childhood Diseases, Journal of Perinatology.

1.       P Kumari, M Kumar, LS David, R Vijayaselvi, B Yadav, MM Beck. A retrospective study analyzing indications and outcomes of mid-trimester emergency cervical cerclage in a tertiary care perinatal centre over half a decade. Tropical Doctor , 2022, Vol. 52(3) 391–399.

2.       Hima B John, Samuel P Oommen, TO Swathi, Manish Kumar, Ragnhild S, Lars Adde. Preterm General Movements in Prediction of Neurodevelopmental Disability and Cerebral Palsy at Two Years: A Prospective Cohort Study. Indian Pediatr 2022

3.      Snehil Kumar, Jess Elizabeth Rasalam, Velukaran Therese David, Hilda Yenuberi, Pushpanathan Amalraj, Lakshmanan Jeyaseelan, Annie Regi, Anuja Abraham, Manisha Madhai Beck, Jiji Mathews, Manish Kumar, Sridhar Santhanam, Dolly Daniel. Breast milk contains red cell isohaemagglutinins: An observational study of 176 mothers. Vox Sanguinis 2022;117:847–852.

4.       Snehil Kumar, Jess Elizabeth Rasalam, Velukaran Therese David, Hilda Yenuberi, Pushpanathan Amalraj, Lakshmanan Jeyaseelan, Annie Regi, Anuja Abraham, Manisha Madhai Beck, Jiji Mathews, Manish Kumar, Sridhar Santhanam, Dolly Daniel. Reply to Datta: Breast milk contains red cell isohaemagglutinins: Doubts and dilemmas.  Vox sanguinis, 2022.

5.       Shanu Chandran, Benjamin J Ross, Manish Kumar. The journey from blue to pink–a rare cause for self-limiting methemoglobinemia in an Indian baby. Case Reports in Perinatal Medicine, 2022; 11(1): 20210054.

6.      Hima B John, Samuel Philip Oommen, Manish Kumar. Trajectories of general movements in very preterm infants: An experience from South India, a prospective cohort study. Current Medical Issues, Volume 20 ¦ Issue 1 ¦ January‑March 2022 16-21.

7.       Bronner P Gonçalves, Simon R Procter, Proma Paul, Jaya Chandna, Alexandra Lewin, Farah Seedat, Artemis Koukounari, Ziyaad Dangor, Shannon Leahy, Sridhar Santhanam, Hima B John, et al. Group B streptococcus infection during pregnancy and infancy: estimates of regional and global burden. The Lancet Global Health 2022:10(6):e807-e819.

8.       Proma Paul, Jaya Chandna, Simon R Procter, Ziyaad Dangor, Shannon Leahy, Sridhar Santhanam, Hima B John et al. Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina. E Clinical Medicine.Part of The Lanset Discovery Science.  2022;47; 101358

9.      Jaya Chandna, Wan-Hsin Liu, Ziyaad Dangor, Shannon Leahy, Santhanam Sridhar, Hima B John et al. Emotional and Behavioral Outcomes in Childhood for Survivors of Invasive Group B Streptococcus Disease in Infancy: Findings From 5 Low- and Middle-Income Countries. Clinical Infectious Diseases, Volume 74, Issue Supplement_1, 15 January 2022, Pages S35–S43.

10.   Hima B John, Asha Arumugam, Mohana Priya, Nandhini Murugesan, Nandhini Rajendraprasad, Grace Rebekah, Proma Paul, Jaya Chandna, Joy E Lawn, Sridhar Santhanam. South Indian Children’s Neurodevelopmental Outcomes After Group B Streptococcus Invasive Disease: A Matched-Cohort Study. Clinical Infectious Diseases, Volume 74, Issue Supplement_1, 15 January 2022, Pages S24–S34.

11.   Sophy Korula, Lavanya Ravichandran, Praveen G Paul, Jabasteen Johnson, Aaron Chapla, Sridhar Santhanam, Anna Simon, Sarah Mathai. Genetic Heterogeneity and Challenges in the Management of Permanent Neonatal Diabetes Mellitus: A Single-Centre Study from South India. Indian J Endocrinol Metab. 2022 Jan-Feb; 26(1): 79–86.

12.   R GM, Pricilla RA, Kurian S, Benjamin SJ, Rathore S, Yenuberi H, Minz SD, Kumar M, Ross BJ, Vijayaselvi R, Abraham A, Prasanthi A, Mani T, Abraham SG, Ebenezer ED, George A, Mittal R, Jeyaseelan L, Mathews JE; PoNTiS Collaborative Group. Study protocol: ‘a large cohort study of postnatal events in a not-for-profit referral centre in Vellore, South India’. BMJ Open. 2022 Dec 19;12(12):e063497. doi: 10.1136/bmjopen-2022-063497. PMID: 36535722; PMCID: PMC9764659.

13.   Chandrasekaran SA, John HB, Ross BJ, et al. Torn between two worlds: parental experiences of neonatal follow-up for infants with hypoxic ischaemic encephalopathy in India–a qualitative study using interpretative phenomenological analysis. BMJ Open 2022;12:e063732. doi: 10.1136/bmjopen-2022-063732