The status of department of pediatrics at Hind Multispeciality Hospital has been raised to Institute of Child Health. This was done in the year 2010 as a recognition of the expanding stature of this centre that provides comprehensive health care from birth to 16 years. Today, the ICH encompasses all aspects related to children both during illness and health.The ICH has expanded its role from just therapeutic to preventive, social and educational aspects of child health.

This institue provideds best of care to children through a coordinated effort of its three departments i.e. pediatrics, neonatology and pediatric surgrey. The ICH has grown significantly over the years and is today a sought aftercent of excellence in the field of not only cutting edge comprehensive clinical care but also postgraduate education, research and social health.

Education is a major strength of this institute. The ICH has a long standing Diplomate of National Board (DNB) programme in General Pediatrics which has been expanded. Today it boasts of fellowship programmes in several specialties sucha as neonatology, hematology-oncology, critical care, rheumatology and gastroenterology.

Services

"State-of-the-art" care is provided to children with complex clinical conditions. These services are provided by a dedicated team of experienced and trained clinicians and specialists in several fields. Many specialists work together for some children to provide comprehensive care under one roof.

Services available at the ICH are:

• General Pediatrics
• Pediatric Surgery
• Neonatal intensive care
• Adolescent medicine
• Cardiology
• Comprehensive thalassemia care
• Developmental pediatrics
• Emergency medicine
• Endocrinology
• Gastroenterology and hepatology
• Hematology and oncology
• Infectious diseases & immunology
• Intensive care
• Neonatal care
• Neonatal & pediatric cardiac surgery
• Nephrology
• Neurology
• Orthopaedics
• Psychiatry
• Psychology
• Pulmonology
• Rheumatology

Specialized services added in last decade to ICH:

• Organ transplants: liver / bone marrow / kidney
• Exclusive pediatric emergency carem
• Pediatric intracranial pressure monitoring
• Pediatric and neonatal high frequency ventilation
• Point-of-care ultrasonography in pediatric intensive care unit
• Pediatric and neonatal diagnostic and interventional cardiology
• Neonatal and pediatric cardia surgery
• Neonatal and pediatric transport services
• Sedation and analgesia services
• Pediatric day care services and procedure room
• Pediatric laproscopic surgeries
• Pediatri urology
• Pediatric urodynamic studies
• Pediatric continuous renal replacement therapy (CRRT)
• Pediatric hemodialysis
• Pediatric continuous ambulatory peritoneal dialysis (CAPD)
• Plasmapheresis
• Pediatric diagnostic and interventional bronchoscopy
• Pediatric diagnostic and interventional gastrointestinal endoscopies
• Pediatric endoscopic retrograde cholangio-pancreatography
• Comprehensive care for hemophiliacs
• Long term parentral nutrition
• ROP screening of newborns
• Newborn screening of genetic and metabolic diseases
• Pediatric diagnostic and therapeutic arthrocentesis
• Use of biologic response modifiers in pediatric rheumatology
• Insulin pump therapy for pediatric diabetes mellitus

Community outreach program and advocacy on child health:

The ICH has expanded its role from just therapeutics to social pediatrics and advocacy. It conducts regular community outreach programs in various part of the country.

• Regular rural health camps
• Urban health center, Shadipur, New Delhi
• Thalassemia / Asthma / ADHD / learning disabilities detection camps
• School health checkup camps
• Pediatric & sub-specialty camps
• Pulse polio program

The ICH has been playing an important role on advocating following issues concerning children:

• Protection of child consumer
• Childhood environmental health
• Schoold health
• Issue related to street children
• Poison prevention
• Community empowerment on maternal - newborn care

Established over fifty years ago, Institute of Obstetrics & Gynacology is one of the primary centers of excellence at Hind Multispeciality Hospital (SGRH). The institute provides comprehensive services in medical and surgical care to women ensuring quality. The wide spectrum of services offered nurture every phase of a women ensuring quality. The wide spectrum of services offered nurture every phase of a woman’s life – from the nascent stage of the intrauterine life through the blossoming adolescence and child bearing age of the postmenopausal years.

The Institute pursues to excel in the following sub specialties Adolescent Gynaecology, High Risk Pregnancy Care, IVF and Reproductive Medicines, Gynaecology Endoscopy, Gynaecological Oncology, Urogynaecology and Menopausal care. Among the leading tertiary care centers of the country, the Institute is the preferred destination for patients from most of the northern states. Annually, about 25,000 out patients are attended , 5000 gynaecological surgeries are conducted and about 2200 deliveries take place, two – thirds of these being high risk pregnancies.

There is a well designed, comprehensive teaching programme for the DNB residents as well as nursing trainees. The Institute accepts observer ships to the programmes offered by the hospital and also by the federation of Obstetrics and gynaecology societies of India (FOGSI). Research work is given a special impetus and the Institute has coveted research projects in collaboration with the Institute of Biotechnology and World Health Organization. Apart from this various academic studies are planned each year to find simple and plausible solutions from scientific queries.

The faculty is actively involved with National board of examination in its far reach teaching programme teleconferencing through IGNOU. Regular CME’s and workshops are conducted on various topics . These events are especially looked forward to and heavily attended by the fraternity from Delhi and beyond.

Spectrum of Services:

• Prenatal care & counseling
• Fetal diagnostic & therapeutic procedures-(Amniocentesis, Chorionic villous sampling, Placental biopsy, Intrauterine transfusion)
• Antepartum fetal surveillance
• Continuous intrapartum fetal monitoring
• Epidural analgesia in labor
• Care & Delivery of normal & high risk pregnancies
• Adolescent care
• Management of gynaecological problems
• Contraceptive advice and family planning services
• Comprehensive care of matured women
• Preventive oncology
• Assisted reproductive techniques (IUI, IVF, ICSI, P- ICSI)
• Gynaecological surgeries
• Gynaecological cancer surgeries
• Gynaecological endoscopic surgeries
• Robotic Surgery

SPECIAL CLINICS

• Adolescent Clinic
• Gynae Endoscopy Clinic
• High Risk Pregnancy Clinic
• Clinic for Matured Women
• Gynae Oncology Clinic
• Urogynaecology Clinic
• Infertility Clinic
• Family Planning Clinic

Introduction

The surgery of newborn, infants and children

-The aim of Paediatric Surgery in India is to set standards, not to create a monopoly

Paediatric Surgery deals with the surgical care of newborn babies, infants and children to the age of 18 years. This branch is highly specialized, not only because one has to handle very delicate and miniature tissues, but also because it requires a great deal of patience, compassion and understanding to handle the little babies and their very anxious parents.

Children are not miniature adults and hence, require experienced and highly qualified personnel that can cater to their needs. Babies suffer from diseases and surgical conditions which are different from adults. Also, their physiology is different and they handle surgical stress differently. The principles of surgical management in children are entirely different from adults.

The Department of Paediatric Surgery at Hind Multispeciality Hospital, New Delhi, is at the forefront among centers that provide comprehensive surgical care to children, including tertiary care. The department was established in 1980 and was one of the earliest centers in private sector in North India. The faculty comprises of very experienced surgeons in the speciality. A team of doctors including Senior Paediatric Surgeon, post-graduate senior resident and the trainee resident doctors provide comprehensive surgical care to the children round the clock.

Dr Rajeev Kulshrestha is the Chairman and Head of the Department of Paediatric Surgery. He is an eminent Paediatric Surgeon with more than thirty years of experience in the speciality. Dr Alpana Prasad, Senior Consultant has an experience of more than 15 years and has special interest in Newborn Surgery, Paediatric Urology and Minimal Access Surgery in children. Dr Tripta Dutta and Dr Shalini Agarwal are the other senior faculty members in the Department and are taking active interest in the departmental activities. The Department is accredited by the National Board of Examinations for the super-speciality training in Paediatric Surgery. Besides clinical care and teaching, the department is actively engaged in research, relevant to clinical care of the infants. The faculty participates in international and national conferences and has published several papers in international journals, written books and chapters in the textbook of Paediatric Surgery.

The department has been providing comprehensive, state-of-the-art surgical care in children, ranging from operations in newborns to various sub-specialties of Paediatric surgery. On an average the department performs more than 1000 operations in a year of varying complexity and magnitude. The operative results are comparable to the best centers in India and abroad.

The department undertakes all kinds of operations in children. These include:

Common Operations - Conditions like inguinal hernia, hydrocele, and undescended testis are very common in children. These conditions require surgical intervention. The results are excellent if done by an experienced Paediatric surgeon. These operations are usually done as day-care surgery.

Neonatal Surgery - Some of the congenital defects in newborn, if not corrected immediately after birth, will result in death viz. congenital diaphragmatic hernia, esophageal atresia with tracheo-esophageal fistula, neonatal intestinal obstruction and anorectal malformations (imperforate anus). Some anomalies require very aggressive preoperative care so that the baby is in an optimal condition for operation viz. abdominal wall defects. Other birth defects include spina bifida and hydrocephalus. All kinds of emergency and elective surgeries in the newborn babies (even those who are premature and very high-risk) are being performed in our department routinely with excellent results. Antenatal diagnosis by maternal ultrasonography has given another dimension for better newborn care by early postnatal referral for surgical intervention in relevant cases.

Paediatric Thoracic Surgery - Anomalies of Lung viz. congenital lobar emphysema, congenital cystic adenomatoid malformation of the lungs, cyst in the lungs, bronchogenic cyst and mediastinal masses, are being routinely operated. We also perform bronchoscopies in children to remove inhaled foreign bodies from the air passages. Thoracotomy and decortication is being done successfully in the department for chronic empyema. We are doing VATS (video assisted thoracoscopic surgery) in children.

Paediatric Urology - Abnormalities of the kidneys and bladder account for 35-40% of surgical cases in children. Operations are done for both congenital and acquired clinical conditions of the kidneys, ureters, bladder and urethra in children including in newborn as well as older children.

These operations are done for conditions like hydronephrosis, vesicoureteral reflux and posterior urethral valves. Some of these operations are done endoscopically using a cystoscope. We are routinely performing cystoscopy and cystoscopic procedures in newborn babies too, besides doing these in older children.

Paediatric Gastrointestinal Surgery - Complicated operations on the gastrointestinal system, liver and bile ducts are routinely undertaken. These are done for conditions like imperforate anus, hirschsprung's disease, biliary atresia, choledochal cyst among others.

Paediatric Cancers - The department undertakes surgical treatment of childhood solid tumors like Wilms' tumor (tumor of the kidney), neuroblastoma, rhabdomyosarcoma, teratoma, lymphoma, etc.

Paediatric Plastic Surgery - Plastic reconstruction in childhood deformities like cleft lip, cleft palate and hypospadias and epispadias repair are routinely undertaken with excellent results.

Paediatric Laparoscopy -Laparoscopy for diagnosis and laparoscopic surgical procedures are being performed routinely in our department.

Future Plans -

• 1. Community service and outreach clinics in remote areas.
• 2. Fetal surgery
• 3. Stem-cell therapy in Paediatric surgical practice.

Endoscopic procedures

Endoscopy is the examination and inspection of the interior of body organs or cavities using a device called an endoscope. Our unit performs all fertility promoting endoscopic procedures. Endoscopy involves laparoscopy as well as hysteroscopy.

Laparoscopy involves visualization of pelvic structures (uterus, tubes & ovaries) with the help of a special optical device called as laparoscope. Operative intervention can be done simultaneously, which helps in restoring the pelvic anatomy & improving your chance of conception.

Hysteroscopy is a surgical procedure that enables us to diagnose and operate on pathologies inside the cavity of the uterus. This consists of the introduction of an instrument with fibre optics called hysteroscope, through the cervical canal, which enables us to visualize the cavity of the uterus. We can diagnose and treat any existent uterine pathologies simultaneously.

We have state of the art, fully equipped dedicated theatres where these endoscopic procedures are performed usually as day care procedures and the patient does not need to be admitted overnight.

Endoscopic fertility enhancing procedures

Laparoscopy: Virtually all of the operations that are done by traditional open surgery can be performed by laparoscopy

• Evaluation of pelvic structures and tubal patency test/
• Diagnosis and treatment of endometriosis
• Diagnosis and treatment of pelvic adhesions
• Tubal surgery (obstructed Fallopian tubes)
• Managing ectopic pregnancy (pregnancy outside the uterus)
• Management of ovarian cysts
• Ovarian Drilling for polycystic ovaries
• Removal of tumors in the uterus (fibroids)

Hysteroscopy: Different surgeries performed hysteroscopically include

• Removal of fibroids
• Removal of polyps
• Some uterine malformations (septum or partitions)
• Intrauterine adhesiolysis
• Tubal cannulation (Obstructed Fallopian tubes)
• Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is placing of sperm into a woman's uterus around the time of ovulation. This is achieved with a thin flexible tube (catheter) that is passed into the vagina, through the cervix, and into the uterus.

Insemination procedures are the simplest and least expensive methods of assisted reproduction. No anesthesia or surgery is needed. In IUI, sperm of the male partner is used. IUI is often combined with superovulation medication to increase the number of available eggs so as to enhance pregnancy rates.

Prior to insemination, the sperm are processed (washed and concentrated). Placing unwashed sperm directly into the uterus can cause severe cramps. Concentration is accomplished by selectively choosing highly active, healthy sperm that are more capable of fertilizing an egg. IUI is done on an outpatient basis with without any use of anaesthesia.

There are registered and approved sperm banks from which donor sperm can be used for couples where the male partner is unable to produce sperm or has an extremely low sperm count or carries a risk of transmittable genetic disease to the offspring.