AIMS Pediatric Centers of excellence

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Wesley Jennings
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1 AIMS Pediatric Centers of excellence

2 Why is it important Over 24,000 children die every day around the world. That is equivalent to: 1 child dying every 3.6 seconds ie children dying every minute A 2010 Haiti earthquake occurring almost every 9-10 days A 2004 Asian Tsunami occurring almost every 10 days An Iraq-scale death toll every days Just under 9 million children dying every year Some 79 million children dying between 2000 and 2007

3 Ideal route for better children s health Planning before conception Scheduled Prenatal Care Identify a pediatrician before delivery Exclusive Breast feeding Scheduled Immunization Well child care ; routine pediatric check-up Parental Understanding re: Nutrition; Growth & Development Routine Dental and Eye Exams

4 Nutritional Issues Obesity Malnourishment Anemia Vitamin & micronutrient deficiency Iodine deficiency

5 Infections Diarrhea Respiratory infections Malaria Measles Other viral illnesses

6 Life style issues Inadequate exercise Excessive TV/internet/video games Obesity Type II diabetes; Hypertension Hypercholesterolemia; increased risk for CAD Excessive parental/peer pressure Increased Incidence of ADHD, Autism & Asthma

7 Environmental Issues Pollution air quality : indoor vs outdoor Reactive airway disease Long term consequences

8 Excellence of Academic Departments depends on Excellence in Medical Education Research Clinical Care

9 Pediatric Divisions Academic General Pediatrics Pediatric Cardiology Pediatric Neurology Pediatric Nephrology Neonatology Pulmonology Pediatric ID Genetics/Metabolism Adolescent Medicine Intensivists Pediatric ER Pediatric Heme-Onc Allergy-Immunology Rheumatology Pediatric GI Pediatric Dermatology?? Pediatric Surgery : General surgery; ENT; Ortho; Ophthalmology; Pediatric Pathology; Pediatric Radiology

10 Pediatric Neurology Division headed by well known pediatric neurologist Major emphasis: Pediatric Epilepsy: Excellent infrastructure: PET, SPECT, FMRI, Electrophysiology, Electrocorticography, Video EEG Newer therapies for epilepsy including surgery Other clinical programs: Learning disabilities program with child psychologists and neurologist International collaboration (NY Einstein) Neurology Fellowship (2 year program)

11 Genetics Headed by pediatric geneticist with a team of counselors and cytogenetics lab staff Special emphasis on single gene disorders, lysosomal disorders, skeletal dysplasia disorders Prenatal diagnostic team with perinatologist International collaboration with Duke university (Durham, USA) and Freiburg University (Germany) One of the few centers in the world offering enzyme replacement therapy in Pompe s disease.

12 AIMS Fetal Cardiology program( ): 952 cases

13 The Pediatric Cardiac surgical Program at AIMS: Infrastructure > 7500 surgeries. State of the art pediatric cardiac intensive care unit 20 beds Dedicated intensivists Specially trained nursing staff

Newborn Heart Surgery at AIMS 90 80 70 60 50 40 Mortality No.

14 Newborn Heart Surgery at AIMS Mortality No. Of surgeries Bakshi K, Vaidyanathan B et.al. Determinants Of Early Outcome After Neonatal Cardiac Surgery In A Developing Country, J Th. Cardiovasc Surg, 2007

15 AIMS catheter based interventions: Data > 7500 cases. One of the largest single centre experience for PDA ( > 2000 cases) and ASD ( > 1000 cases) New techniques ( multiple coils for PDA) > 300 neonatal interventions.

16 Pediatric Cardiology International Collaborators Stanford, USA Harvard, USA Cornell, USA London, UK Lisbon, Portugal

17 Pediatric Nephrology Major referral center for kidney disorders Well trained medical and surgical team Major diagnostic center around 1200 histopathology specimens of per year Around 60 transplants in children/yr Cadaveric transplants recently started Excellent outcome

18 Neonatology Tertiary/Quaternary care NICU Conventional ventilation, HFOV, INO Prenatal consults HRDC Newborn screening Neonatal surgeries performed in the NICU Major referral center for all medical & surgical problems in newborns

19 NICU Nearly 400 admissions per year 24 beds (16+8) 50% outborn Survival%

20 Survival to discharge according to GA among 9575 VLBW infants born in NICHD NRN centers between January 1, 2003, and December 31, 2007 Stoll, B. J. et al. Pediatrics 2010;126:

21 Median length of hospitalization (in weeks) and median PMA at discharge (in weeks) according to GA at birth among 6859 VLBW infants who were born in NICHD NRN centers between January 1, 2003, and December 31, 2007, and survived to discharge Stoll, B. J. et al. Pediatrics 2010;126:

22 NICU Well trained staff: physicians, nurses, social worker, physical/occupational/speech therapist Excellent ancillary support Radiology, Lab, Pharmacy Subspecialty support Well developed EBM clinical pathways and clinical guidelines for nurses, physicians, students and residents.

23 Institute for Fetal Medicine Headed by perinatologist Antenatal scans, CVS,PUBS, Fetal Echo Counseling with geneticists, surgeons, neonatologists and cardiologists Fetal therapy: Medical Surgery

24 Pediatrics has evolved over the years General Pediatrician as the primary care provider is the main stay for a child s health care Pediatric Subspecialists complement the system in order to make it near perfect health care delivery.

25 Uniqueness of AIMS It is a one stop solution for all pediatric healthcare Every ancillary support service, available Every Pediatric subspecialty available Rare metabolic and genetic problems are treated Every pediatric medical and surgical emergency is managed by a team of physicians, nurses and other ancillary support services With the academia and the cutting edge technologies you get the best care and the opportunity to participate in the best international clinical research

26 AIMS Pediatric Training ISRO 2009, Pediatric Cardiac Care in India

27 Our Faculty

28 Faculty Pediatric Cardiology

29 Faculty - Neurology

30 Faculty - Genetics

31 Faculty - Rheumatology Dr. Suma Chief of Pediatric rheumatology Undergraduate and post graduate training in India Fellowship in Pediatric Rheumatology in UK for 2 years

32 Training at AIMS

33 Education Class rooms in each floor Auditorium Audiovisual dept Library Computers - WiFi

34 Research Priorities

35 Neonatology Fellowship Two year fellowship Autonomy, self directed learning, develop critical thinking skills & decision making skills Didactics, Journal clubs, Case discussions, M&M conferences, fetal and neonatal physiology lectures Research: Hypothesis driven research projects (clinical or bench) before graduation Close interaction with perinatologist

36 International collaboration Brigham women s and Children s Baylor Riley - IU CHOP Amrita Women s & Children s MCW CHW Denver Illinois Rainbow

Genetics Neonatology 2 yrs (DCH program) Requirements

37 Training programs in Pediatrics Pediatric residency 3 yrs (MD program); Fellowships: Cardiology Neurology Genetics Neonatology 2 yrs (DCH program) Requirements for fellowship training: completion of (3 yr) Pediatric Residency

38 Amrita Women s and Children s Hospital

39 Thank You For Your Attention

40 Heads of Academic Departments & Hospital Program Directors Academic Department Chair Hospital Program Directors Division Chiefs

41 Good Outcome High Cost Good Outcome Low Cost Outcome vs cost Poor Outcome High Cost Poor Outcome Low Cost

42 Strategies for better outcome Plan Do Act Study

43 What is a healing environment?

44 LDRP

45 AIMS Pediatrics Neurology: Cardiology Genetics Neonatology-Perinatology Pediatric Surgery CT; Ortho; ENT; Ophthal; Urology; Maxillofacial; Plastics Nephrology ID Heme-Onc Rheumatology Pediatric GI Clinical Research

46 1998 Estimated proportion of infants and newborns with critical CHD undergoing surgery within the first year of life 2004 Number undergoing surgery in the first year of life Estimated number of infants with critical CHD 2008

Letter to the AMGA Board of Directors...1 Introduction...3

Table of Contents Letter to the AMGA Board of Directors...1 Introduction...3 Section I: Executive Summary Survey at a Glance...6 Participant Profile...10 Survey Methodology...18 How to Use This Report...21