Dr. A. Rajalakshmi

Research projects of Neonatology submitted to NBE / IAP / NNF / Kerala University

Research Publications from Department of Neonatology, KIMS, Trivandrum: 2019-2020.

1. Nihaz Naha, Femitha Pournami, Jyothi Prabhakar, Naveen Jain. Nasal injury with continuous positive airway pressure: Need for privileging nursing staff. Indian Journal of Pediatrics 2019
2. Anand Nandakumar, Femitha Pournami, Jyothi Prabahkar, PMC Nair, Naveen Jain. Exclusive breast milk versus hybrid feeds in preterm babies- A Randomized Controlled trial comparing time to full feeds. Journal of Tropical Pediatrics 2019
3. Shobha Vijayan, Femitha Pournami, Jyothi Prabhakar, Naveen Jain. Euthermia in stable preterm babies: Cocooning for warmth! – A Randomized controlled trial. Journal of Tropical Pediatrics 2019
4. Femitha Pournami, Swati Upadhyay, Anand Nandakumar, Jyothi Prabhakar, Anand Nandakumar, Naveen Jain. Familial Hemophagocytic Lymphohistiocytosis- A rare mutation of STXBP2 on Exon 19. J Pediatr Genet 2020
5. Sujith KRGV, Femitha Pournami, Alok KMK, Anand Nandakumar, Jyothi Prabhakar, Naveen Jain. Analyzing cost of hospital care to a family with an extreme preterm neonate. Journal of Neonatal Nursing 2020.
6. Swati Upadhyay, Femitha Pournami, Anand Nandakumar, Jyothi Prabhakar, PMC Nair, Naveen Jain. Outcome of very preterm infants after early optimal nutrition strategy- A comparative cohort study. Nutrition in Clinical Practice 2019
7. Vivek Raju, Femitha Pournami, Anand Nandakumar, Jyothi Prabahakar, PMC Nair, Naveen Jain. Improving Microbe detection and Optimizing Antibiotic use in Neonatal sepsis with Multiplex Polymerase Chain Reaction- A Comparative Cohort study. Infectious diseases in clinical practice 2020
8. Ray C, et al, Femitha Pournami, Bhushan P. Human Milk oligosaccharides. The journey ahead. International Journal of Pediatrics 2019
9. Alok K MK, Femitha Pournami, Sujith K Reddy GV, Anand N, Jyothi P, Naveen Jain. Can early clinical status predict outcomes in extremely low birth weight neonates. Journal of Child Science 2020
10. Swati U, Femitha Pournami, Sujith K Reddy, Shibily R, Anand N, Jyothi P, Jayakumar RM, Naveen Jain. Neonatal laryngeal disorders- 12 years experience of a multidisciplinary unit. Airway 2020
11. Sujith KRGV, Femitha Pournami, Anand N, Jyothi P, Naveen Jain. Disability prediction by early Hammersmith Neonatal Neurological Examination – A Diagnostic study. Journal of Child Neurology 2020.

Child and Adolescent Counseling

Couselling can help children and family improve relationships, resolve problems and resume healthy and happy life . Through counseling children and parents can share their concerns, explore ways to resolve the problems , learn new skills to adapt and unlearn maladaptive behaviors .

Who will benefit ?
Children and adolescent with

• Anxiety – Generalized anxiety, Exam anxiety, Social anxiety, Presentation anxiety
• Adjustmet issues– with school, siblings, family and friends
• Behavioural issues – Temper tantrums, oppositional behaviors, aggression, hyperactivity
• Emotional issues– Depression, Anger , Fears
• School / Academic issues –concentration difficulties, forgetfulness, peer pressure, bullying
• Screen addiction – excessive gamming, social media dependency, unhealthy internet usage

Dear Medical Professional

The scope and expertise of our unit is to provide a level of care and services with advanced supports like high frequency ventilation and inhaled Nitric oxide therapy, peritoneal dialysis, parenteral nutrition etc.. for sick neonates. This includes years of experience in the care of neonates at thresholds of viability (23-25 weeks gestation). We are strongly committed to interdisciplinary involvement with Perinatology, High risk obstetrics, Pediatric Surgery, Laryngology, Retinal specialists, Pediatric Cardiology, Pediatric neurology, Pediatric Endocrinology.

Early parent participation in decision making as well as daily care processes is the crux of our unit. The dedicated Follow up services protocol- “Blue book” (which is now being practised in many other units) has been in place with a structured protocol for several years.

We believe that relentless improvement comes with academic endeavours and continuing education. Hence the commitment to teaching and training. We have been running the superspecialty DNB Neonatology program and Fellowships in Neonatology since 2008. Academic work includes involvement in clinical investigative research with a focus on translating science into better ways to deliver care and improve outcomes.
Our mission includes striving to quality improvement – not just in patient care, but also satisfaction of parents, staff and fellows. This includes extensive contributions to clinical research, national and international neonatal practice guidelines.

Microbiology: (Bacteriology, TB Culture, Mycology, Serology& Molecular testing)

Unique features are:

• Chip based RT PCR for COVID 19
• HCV Quantitative PCR in GeneXpert
• TB Culture and sensitivity tests in MGIT
• GeneXpert for detection of Mycobacterium Tuberculosis (MTB) & Rifampicin resistance.
• GeneXpert for Carba-R detection
• Immunofluorescence & Immunoblot testing for Neuro immunological diseases (only private centre in South Kerala)
• Biofire Micro array (multiplex PCR for meningitis, respiratory, gastro intestinal panels)
• Immunofluorescence, Immunoblot & ELISA testing for auto immune diseases

Equipment:

• VITROS 3600 & VITROS ECI
• Biomerieuxvidas
• Euroimmun 2P ELISA analyzer
• Vitek-2 Compact
• BACT/ALERT 3D
• BiofireMicro array
• Cepheid GeneXpert
• MGIT – BD Diagnostics
• Truenat Extractor &Analyzer
• Plexmat

Contact number – 0471-304100: 1145/1180

Histopathology and Cytopathology (Pathology)

Services offered:

Histopathology
This division provides

• Diagnostic surgical pathology services including:
  • On small biopsies like Renal biopsies, Transplant related biopsies, Endoscopic biopsies from gastro intestinal tract, naso pharyngeal tract, bronchoscopic biopsies including US guided endobronchial biopsy [EBUS], image guided trucut biopsy from internal organs and deep-seated soft tissue.
• Strong oncopathology:
  1. Providing frozen section for intra operative diagnosis and for marginclearance.
  2. Reporting protocol as stipulated in AJCC Cancer staging Manual, latest edition for grading and staging of surgical oncology specimens. (Eg: Mastectomy, Colectomy, Gastrectomy, Whipples, Lobectomy – lung, liver, thyroid, Nephrectomy, Panhysterectomy, Hemimandibulectomy, Bone resections etc).
  3. Immunohistochemistry back up in Oncopathology especially to provide diagnosis in Lymphomas, in detecting unknown primaries and in sub typing of carcinomas and soft tissue tumours. The division has IHC antibodies of about 85 numbers.
• Direct immune florescence, and routine H&E for Renal and Skin biopsies
• Fetal Autopsies done by pathologists and reported.

Equipments:

ASP 300S Closed Tissue processor, Leica Embedding machine, Cryostat for performing frozen section, Automated IHC stainer (Leica Bondmax)

Contact number – 0471-304100: 1125/1193

Hematology

Hematology, Clinical Pathology and Coagulation offers routine and special investigations of blood and body fluids to aid in the diagnosis of several medical conditions and in evaluating anemia, leukemia and coagulations disorders.

Peripheral blood smear and bone marrow smear examination done using routine stains and also by using special stains like Perl’s, PAS or Cytochemistry wherever applicable (eg: leukemia, myelodysplastic syndrome).

Equipment:

• Beckmen Coulter for doing Complete Blood Count
• Amax Destiny for Coagulation studies
• Automated analyzer by Beckman coulter for urine chemistry and microscopy.

Contact number – 0471-304100: 1262/1242

Biochemistry

Besides all routine biochemistry parameters, unique features are availability of rare tests like

• Osmolality measurement
• Sweat chloride analysis by pilocarpine ionotophoresis for cystic fibrosis screening
• Lead reference laboratory for Lead quantitation.
• Drug assays of Tacrolimus, Digoxin, Vancomycin, Phenytoin, Valproic acid
• First trimester screening (FTS)

Equipment:

• Cobas 8000 –Fully software controlled Modular analyzer
• Fully automated chemistry analyzer Cobas C 501
• Fully automated immunoassay analyzer E 411
• Biomerieuxvidas -immunology analyzer
• D-100 & D10Biorad for quantitative estimation of HbA1c,
• WaproOsmomat for osmolality measurement.
• Leadcare II for quantitative detectionof Lead poisoning
• Nanoduct for neonatal sweat chloride analysis.

Contact number – 0471-304100: 1246/1265

Cytology

• This sub division provides Cytology reports on Fine Needle Aspiration material, Pap smears, Body fluids, Sputum, Bronchial washing, Bronchial lavage, EBUS, Urine etc. Wherever needed, Thermo Scientific Cytospin 4 is used. The above diagnostic services are rendered using routine H & E stains, Pap/Giemsa stain.
• The Bethesda system is followed for reporting on cervical smears (2014) and on Thyroid FNAs (2017). Milan system (2018) for reporting on FNA from salivary gland is followed.

Follow up of normal and high risk neonates

Our consultants are available in the out patient services every day of the week.
We are proud of our High risk follow up program with dedicated Developmental Pediatrician, developmental therapists to assess and help babies.

Teaching and training

We have been training Fellows and Superspecialists in the field since …..under the auspices of National Board of Examinations, Indian Academy of Pediatrics and National Neonatology Forum. More than 45 doctors have completed their training programs and are practising successfully all over the world. We believe that continuous education and experience are what makes our team strive to get better and better.

Sick newborns / High risk newborns

If your pregnancy had concerns or baby has health issues after birth, our unit is equipped to take care of most situations. We are a Level IIIB (National Neonatology Forum India) accredited Neonatal Intensive care unit (NICU). This means that we take care of extreme preterm, extremely low birth weight neonates. Our smallest survivor was 520(??) g at birth. Babies born at 24 weeks and beyond have been cared for successfully and fortunately most of them are doing very well on follow up.

As for term babies, we do receive several sick neonates who need very advanced form of breathing supports, multidisciplinary care including Pediatric Surgery, Laryngology, Plastic Surgery, Retinal procedures, Pediatric Endocrinology, Pediatric Neurology and Medical Genetics. For babies who need cardiac surgery, we collaborate with units close to our hospital.

We have an advanced Neonatal transport facility 24X7 with a full medical team in an equipped ambulance to pick up sick neonates from other hospitals.

Postnatal classes

No doubt or query is silly!
We understand that as parents , you want to do all the right things for their baby, and thus you have many doubts about several things that may seem minor. We conduct daily education sessions on normal newborn care and feel it would benefit you if one class is attended before you go home.

At delivery

Be rest assured, that every delivery (even those expected to have no complications whatsoever) are attended by trained Pediatricians who are well versed in Newborn resuscitation. The baby is examined at birth itself to help those who need immediate help.

Getting prepared:

Apart from “medical check ups” for our pregnant mothers, we conduct “Antenatal education sessions”. These are detailed and interactive; conducted by many specialists including Senior obstetricians, Senior nursing staff, dieticians, physiotherapists and Neonatologists. We enjoy talking to you and listening to your queries, and are quite sure you would too… especially when you get to meet other families who are awaiting the arrival of their “bundle of joy”.

Dear parents/ grandparents/ family of a newly born

The birth of a baby is undoubtedly the most precious and happiest moment in our lives. When all goes well through pregnancy and your baby is expected to be born soon, here are some important facts that would help …
We at KIMS work as a team – the Obstetrics and Perinatology department with the Department of Neonatology.

Psychological Testings and Assessments

1. Intelligence Test – Standardized IQ tests helps to evaluate the level of cognitive development of the child .
2. Achievement testing – Gives an estimate of the child’s current proficiency and mastery of various academic skills. It can help to find out the current level of functioning of the child in various areas like reading , spelling , math calculations kills , academic knowledge etc .
3. Psycho- educational assessments –It helps to identify the causes of academic and behavioral issues and identify the plan for improving academic performance .It also helps in identifying learning disabilities.
4. Developmental assessments –to identify developmental delays and to analyze patterns of relative areas of strength and weakness
5. Academic skills assessments – to identify the level of academic competencies in each area of learning and also to evaluates the learning style of the child to guide for corrections if any .
6. Speech and language assessments –to evaluate the speech , language and communication skills of children .
7. Evaluation of Fine motor and gros motor skills- to assess muscle strength , power , endurance of the proximal stability muscular group and disassociation of limbs and joints
8. Sensory Evaluation -To identify the sensory causes of behavioral problems like over sensitivity to senses like smell ,

Occupation and Sensory Integration Therapy

Occupational Therapy helps children to improve with fine motor skills, Visual-perceptual skills, Improve eye–hand coordination, improve strength , balance and coordination .It helps in mastering basic life skills such as bathing, getting dressed, brushing teeth, and self-feeding and learn positive behaviors and social skills.

Sensory Integration Therapy -Integration of information from all the five senses and also the three other internal sense of our body are very important for the normal functioning of a child . Children with Autism and many other developmental disorders are found to have sensory processing deficits leading to problems in behaviors and life skills . For example they may be oversensitive or under reactive to sensory stimuli , avoid being touched , may avoid certain texture of food ,may have difficulties with motor skills , balance and eye – hand coordination . Sensory Integration therapy helps to calm the child and to slowly increase the threshold of tolerating sensory rich environment and help child to adjust well to surroundings .

OT and Sensory integration therapy are available for children with

• sensory processing disorders
• learning problems or disabilities
• Coordination Problems
• Autism
• ADHD
• Developmental delays
• Cerebral palsy, and other chronic illnesses
• Birth injuries or birth defects
• Traumatic injuries to the brain or spinal cord

Speech and Language Therapy

Speech and language therapy is the treatment for individuals with speech and language disorders. It will help to improve speech, language, communication, articulation, fluency and feeding skills in individuals with difficulties. We provide with effective individual sessions which include 45 minutes of therapy for the child and 15 minutes of parental counseling and training . Each sessions are individually tailored to the child’s needs and specific goals are taken for the betterment of the child. The session are completely transparent and the parents are involved in each session as they are also the crucial member during the intervention

Speech and language therapy Service are Provided children with

• Speech & Language Delay
• Speech Sound Disorder (Clarity Issues)
• Stuttering
• Autism
• Hearing Impairment
• Cleft Lip And Palate
• Apraxia Of Speech
• Global Developmental Delay
• Multiple Disability (Cerebral Palsy, Downs Syndromes)
• Mental Retardation (MR)

Early Child Intervention Programme

Early child intervention programmes is intended for children with developmental delays. A developmental delay means that the child is lagging behind in some area of development including physical, cognitive, communication , emotional, social and adaptive skills development. Our early intervention team consisting of developmental pediatrician, child psychologist, speech therapist and occupational therapist work as a team to devise a therapeutic plan and execute it meticulously to help the child overcome the developmental delays.

Programmes and Therapies

• Early intervention programme for children with developmental delays – This programme is intended for children between the age 1 to 4 , who were late to achieve the millstones like , late to walk , talk or communicate .The training aims at bridging the developmental gap and prevent further delays . The therapies will also aim at accelerating the development to child. A coordinated effort of intervention from the therapist and the parents will ensure optimal development.
• Play therapy – for social , emotional, creative and sensory development.
• Group intervention –Small group intervention to develop social skills , develop cooperative play and understand social behaviors .
• Oral placement therapy -for children with articulation difficulties and feeding difficulties
• School Readiness Programme. For children aged 4years to 6 years to develop basic literacy skills and to create the pre learning skills for school like ability to follow instructions, fine motor skills to hold on pencils , attention skills ,and sitting tolerence .

AUTISM INTERVENTION PROGRAMME

Autism Spectrum disorder is a neuro developmental disorder which is manifested as difficulties in social communication, restricted interests and repetitive patterns of behaviors . Parents may first notice poor eye contacts, delays in langue development, decreased interaction and repetitive mannerisms in the first two years of life which needs to be taken seriously and address at the earliest. Although ASD can be a lifelong disorder, early identification , treatments and effective parental involvement can improve a person’s symptoms and ability to function.

We have a multi disciplinary team of therapist consisting of Speech language pathologist , Occupation therapist , Psychologists and Educational therapists to cater to the need of children with Autism.

Programmes and Therapies

• Early identification of Autism spectrum disorders by multi disciplinary team –to get baseline assessments of the child and develop appropriate therapy plan.
• Earlier intervention for children with Autism – Early identification and intervention promises better chance for developing to their full potential .An individualized plan is made for each child according to age, challenges and
• Group Therapy – group therapy sessions of about 4-8 children for building basic communication skills , social skills and behavior control.
• Speech and language therapy for developing communication skills in children with Autism .
• Occupation therapy and sensory intervention for developing self care skills ,improve fine motor , gross motor skills , reduce hyperactivity and manage sensory issues.
• Augmentative and Alternative Communication training – to enhance childs ability to communicate and to reduce behavioral issues and facilitate verbal communication .
• Parental training programmes – for equipping parents with necessary skills and knowledge to manage problem behaviors ,give appropriate home training and help the child improve socially , emotionally and physically .

Learning Enhancement Programme

Poor scholastic achievement of children is a major concern for parents, teachers and the children, themselves in this present day of competitive world. An unrecognized and unresolved educational backwardness can cause lifelong impact on the child and the family. KIMS Learning Enhancement Centre helps in understanding the cause of the learning difficulties and gives systematic training to overcome it and become successful learners. We believe that every child has the ability to learn and succeed given the correct training and environment .We train children to develop thinking skills and langue skills to become competent and confident learners.

Who will benefit

• Children with Specific Learning Disabilities – Dyslexia, Dysgraphia, Dyscalculia
• Children with learning difficulties due to varied causes like langue delays, inadequate training and inattention
• Slow learners who may need differential instruction to acquire academic skills

Our Techniques

Orton – Gillingham multi sensory teaching strategies
Kansas University Satrategic Instruction Model (SIM)
NILD Education Therapy (National Institute for Learning Development)
RxDiscovery Math programme –
Rx for Discovery Reading
Instrumental Enrichment Programme (FIE)

Programmes and Therapies

Remedial Educational Training Programme – A programme for children with learning disabilities and learning difficulties using Internationally acclaimed techniques .It is tailor made programme for the needs of each child . It is a one to one session for one and half hours , minimum weekly twice aimed at building up basic academic skills like reading , spelling , writing , reading comprehension , language, and maths using multi sensory techniques . We aim at making children independent learners who can learn effectively .Along with the child training, we also equip parents to teach them by education then in the basic methods of teaching .

Online Remedial Educational Training program – As Remedial education is a specialized training available in limited centers in major cities , we provide online training for children who are residing in other districts or suburbs for whom it is not feasible to come for direct sessions to the hospital .

Education therapy – In this one on one therapy , an educational therapist will work with the child to overcome the learning challenges by strengthening the core skills like perception , cognition , emotional regulation and academic .This in turn will help the child to improve their ability to think, reason, and process information effectively . The goal of education therapy is to help children develop tools of independent learning in classroom and in life.

Study skills correction programme – Knowledge of effective study skills make meaningful and effective learners. We equip the children to understand the concepts, organize it meaningfully, retrieve information using efficient memory techniques, and present it effectively using specialized techniques and strategies.

Academic support and training for school dropouts – We provide guidance and training for children who had discontinued formal schooling, to appear for secondary and senior secondary examination conducted by the NIOS – National Institute of Open Schooling.

Attention Training Progamme and Behavior Management Programe – Difficulties in sustaining attention, , Hyperactivity ,Poor Impulse control and poor anger management may have many detrimental effects in the child’s academic and social life .This programme is aimed at training children improve concentration , academic skills and behavior and to become better functioning individuals .

Life skill training for slow learners /Intellectual disability – We provide tailor made training for young adult who are not equipped to live independently, with basic literacy training , interpersonal communication skills ,daily living activities , time and money management skills.