NICU Complex

NICU, Department of Neonatology has bed strength of 42 and total area of 6275.50 sq. feet.

Location: Ward 38, 10th Floor, MSB Building, KEM Hospital, Parel, Mumbai.

Areas	Type of Services	Cot strength
Inborn unit	Babies born in K.E.M. Hospital who are not infected are cared in Inborn unit.	13
Inborn and outborn unit	Babies born in K.E.M. hospital who are at risk of developing infection or babies transferred from other hospitals are managed here.	12
Transitional care unit	This section renders intermediate care to the neonates. The babies who do not require close and continuous monitoring are looked after here.	12
Advanced ventilation unit	The babies requiring advanced ventilatory care are closely monitored and managed in this section.	05

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Neonatal Care

The department of Neonatology caters to over 7500 deliveries per year including high risk referrals, approximately 35% being LBW babies requiring special care. Neonatal Intensive Care services: Level III Neonatal Intensive Care Unit manages over 1800 – 2000 neonatal intensive care admissions per year. NICU is the major referral centre for babies from various municipal as well as private hospitals and maternity homes. The facilities for providing advanced neonatal care are available in the unit. We ventilate approximately 225 – 250 babies annually. We have 2 High frequency ventilators, 12 class 1 ventilators, 2 Variable flow CPAP machines, & 8 Bubble CPAP machines. We practice patient triggered ventilation as well as High Frequency Ventilation. The sick neonates are closely monitored with multiparameter monitors, capnometers, transcutaneous monitors, and online airway graphics. These babies also receive total parenteral nutrition which is prepared under the laminar flow housed in the NICU. We have a facility for in house ultrasonography. We provide Total body cooling therapy & Nitric oxide therapy. We have facility to monitor cerebral function.

1. Care of Preterm babies upto 25 weeks gestation
2. Care of Micropremie babies with weight less than 700 gms
3. High frequency ventilation
4. Conventional ventilation
5. Bubble CPAP and HHHFNC facility
6. Whole body therapeutic hypothermia for asphyxia babies
7. Cerebral function monitoring
8. Pre and post-operative Neonatal surgery care
9. Pre and post of neonatal cardiac surgery care
10. Inhaled nitric oxide facility
11. Capnography
12. In house 2 D echocardiography
13. Point of care ultrasonography
14. Total parenteral nutrition with in house laminar flow facility
15. In house retinopathy of prematurity screening
16. Palliative care treatment
17. Counselling of mothers along with in house counsellor
18. In house Point of care CRP,INR, Procalcitonin, Bilirubin and routine blood tests
19. In house ABG analysis

The doors of NICU were opened for mothers of critically ill babies to get them actively involved and participate in the care of their babies. Humane Neonatal Intensive Care approach was established by observing an ideal NICU protocol for protection of babies from over stimulation and by observing the minimal handling protocol to reduce the NICU environmental stress related complications for optimal recovery and positive health of sick neonates.

HMB is an institution established for the purpose of collecting, screening, processing, storing & distributing donated human milk that is dispensed to recipients who are not the biological offsprings of the donor mother. For better survival of preterm and low birth weight babies, it is very important that we guarantee a constant and adequate supply of human milk. Today a more controlled system of to ensure the availability of bacteriologically safe milk exists in form of HMB. HMB is possible as there are mothers whose lactation exceeds the requirements of their infants.

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Mothers’ Resting Area:

Vatsalya is resting area for mothers whose babies are admitted in NICU.

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Palliative Care Unit:

Very sick babies who are nursed in any of the above sections are given supportive care, psychological counselling and social support.

The department is selected as the center of excellence for initiating KMC for Low Birth Weight babies in India. We are the first in the country to start Ambulatory KMC Center inaugurated on 15th August 2005. LBW infants discharged from NICU are regularly followed up for growth, neurodevelopmental status & early intervention therapy is instituted when required.

BSID Center

Follow up care program: We believe in well organized and multidisciplinary follow up care program for better neurodevelopmental outcome of high risk NICU graduates. We run a BSID centre twice weekly at Kangaroo Mother Care Centre where these babies are followed up longitudinally for a period of 5 years. Hearing and visual assessment is done in the centre itself by the experts for all high risk babies and early intervention therapy is instituted when indicated.

High Risk Clinic

Every Wednesday
Timing: 1:30 pm to 3:30 pm
Location: First Floor, MSB Building, KEM Hospital, Parel, Mumbai.

KMC Clinic

for NICU Graduate’s with weight less than 2 kgs

Monday to Saturday
Timing: 10:00 am to 1:00 pm
Location: KMC Center, Behind KEM Orthoperidics Building, Parel, Mumbai

Bayley Scale of Infant Development Clinic

Every Wednesday and Friday in KMC clinic
Timing: 10:00 am to 1:00 pm
Attended by Assistant Professor trained in BSID.

Hearing Screening Clinic

Every Saturday
Timing: 10:00 am to 1:00 pm
Location: KMC Center, Behind KEM Orthoperidics Building, Parel, Mumbai

Well Baby Clinic

Monday / Wednesday / Friday
Timing: 1:30 pm to 3:30 pm
Location: First Floor, MSB Building, KEM Hospital, Parel, Mumbai.

Birth Defect Clinic

Every Thursday (OPD No. 10) Timing: 1:30 pm to 3:30 pm
Attended by various specialties (Paediatric surgery, Obstetrics, Plastic surgery and neonatology combined)

• Recognized by M.U.H.S. for DM degree 3 years course. It is also a centre for conducting DM Neonatology examinations.
• No. of seats: DM degree: 4 per year
• The unit consists of 2 RECOGNISED TEACHERS.
• Residents: 4 in each of the three batches, Senior Resident post– 4, SSMO – 4
• Lectures are delivered for UG, PG students.
• Teaching program from Monday – Friday. (12:00PM – 1:00PM)
• Topics for teaching program are distributed. On Monday- pathophysiology discussion by DM Residents, Tuesday- seminar by paediatric residents, Wednesday – Case analysis by DM resident, Thursday -Journal Club discussion by DM Residents, Friday – Faculty lecture.
• Residents are encouraged to attend various workshops and present papers and posters in conferences in rotation.
• Residents are encouraged to present cases / seminars in the All India DM Resident program every once in two months.

Apart from central library, the department houses books on various subjects of Neonatology for ready reference - 24 X 7.
We have books pertaining to the field of paediatrics, neonatology and Obstetrics. Journals are available in our library. All research work done in the department in form of thesis are also catalogued in our library.

KEM internet library facilities: for online journals & books.

Suggested books for reading:

1. Avery’s Diseases of the Newborn
2. Cloherty and Stark’s Manual of Neonatal care
3. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the fetus and Infant.
4. Goldsmith’s Assisted Ventilation of the Neonate: An Evidence-Based Approach to newborn Respiratory care.
5. Volpe’s Neurology of Newborn.
6. Textbook of Neonatal Resuscitation (9th Edition)
7. Physical Diagnosis in Neonatology by Mary Ann Fletcher
8. Fetal and Neonatal Physiology by Richard A. Polin MD
9. Neonatal Practice Guidelines-Evidence based Management by Ruchi Nimish Nanavati.
10. IAP textbook of clinical Neonatology
11. Atlas of neonatal Functional Echocardiography by Pradeep Suryawanshi
12. Atlas of Point of Care Neonatal Cranial Ultrasound by Pradeep Suryawanshi

Schedule for Academic activity

Sr. No.	Pathophysiology	Long Seminars
1	Pathophysiology of EUGR	Update on HIE
2	CVS development	Golden hour management
3	Physiology of thyroid hormone & congenital hypothyroidism	Management of hypernatremic dehydration
4	Physiology of thyroid harmone and congenital hypothyroidism	Evidenced based management in respiratoty care
5	Calcium homeostasis	Amplitude integrated EEG
6	Bilirubin Metabolism	Ventilator graphics
7	Pathophysiology of NEC	Functional echocardiography
8	Pathophysiology of BPD	Cranial Ultrasonography
9.	CNS Development	BSID
10	Pathophysiology of intracranial haemorrhage	Necrotising Enterocolitis
11	Antenatal corticosteroids	Kangaroo mother care
12	Pathophysiology of PPHN	Thyroid disorders
13	Pathophysiology of MAS	Hydrocephalus management
14	Pathophysiology of neonatal AKI	Early intervention therapy
15	Pathophysiology of apnea of prematurity	Neonatal Chest X-Rays

…..etc

Patient Feedback:

We take counselling sessions of our patients on periodic basis about their baby’s clinical condition and take feedback on how they feel about the management and the care providers. We try to look into the social aspect of the patient’s care by involving the pscychologist and social worker. We believe that our patients are our true assessors and their feedback will help us improve our care.

Patient Education:

We educate our patients about various aspects of newborn care including breastfeeding, milk expression, importance of MOM (Mothers’ Own Milk) , milk donation, kangaroo mother care, identification of danger signs. Our team carries out awareness sessions weekly on various aspects of neonatal care among the parents of the newborns admitted in our NICU. We educate them about the post discharge care. We teach our patients to be self-confident and impart knowledge on post discharge newborn care. Parents are counselled on the need of regular follow ups and developmental assessments of their child as and when called upon.

UNITS:

We are currently a single unit department, headed by Dr. Anitha Haribalakrishna

• Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Antimicrobial Resistance Collaborators. Lancet. 2022 Feb 12;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0. Epub 2022 Jan 19. PMID: 35065702

• Mascarenhas D, Goyal M, Nanavati R. Neonatal palliative care practices: an Indian perspective. Paediatr Int Child Health. 2022 Feb;42(1):22-28. doi: 10.1080/20469047.2022.2089821. Epub 2022 Jun 21

• Kulkarni T, Majarikar S, Deshmukh M, Ananthan A, Balasubramanian H, Keil A, Patole S Probiotic sepsis in preterm neonates-a systematic review. Eur J Pediatr. 2022 Jun;181(6):2249-2262. doi: 10.1007/s00431-022-04452-5. Epub 2022 Mar 29

• Ananthan A, Balasubramanian H, Mohan D, Rao S, Patole S. Early erythropoietin for preventing necrotizing enterocolitis in preterm neonates - an updated meta-analysis. Eur J Pediatr. 2022 May;181(5):1821-1833. doi: 10.1007/s00431-022-04394-y. Epub 2022 Feb 5. PMID: 35122138

• Jeevan A, Ananthan A, Bhuwan M, Balasubramanian H, Rao S, Kabra NS. Umbilical cord milking versus delayed cord clamping in term and late-preterm infants: a systematic review and meta-analysis.  J Matern Fetal Neonatal Med. 2022 Dec; 35(25):5478-5488. doi: 10.1080/14767058.2021.1884676. Epub 2021 Feb 10.

• Singh S, Ananthan A, Nanavati R. Post-INSURE Administration of Heated Humidified High-Flow Therapy Versus Nasal Continuous Positive Airway Pressure in Preterm Infants More Than 28 Weeks Gestation with Respiratory Distress Syndrome: A Randomized Non-Inferiority Trial. J Trop Pediatr. 2022 Jun 6; 68(4):fmac062. doi: 10.1093/tropej/fmac062.

• Nanavati RN, Mogra G, Mascarenhas D. (Eds.) Neonatal Practice Guidelines – Evidence – based Management. 1st Edn. December 2022.

• Nanavati RN, Suman Rao PN. Neonatal adaptation to extrauterine life. In: Gandhi A, Tank P, Purandare A. (Eds), FOGSI’s Textbook of Postgraduate Obstetrics, New Delhi, Jaypee Brothers, 2022; pp 682-87.

• Nanavati RN, Kirthana SB. Kangaroo Mother Care. In: Tiwari S, Bharadwa K. bang A. (Eds), IAP-IYCF Essentials of Maternal, Infant, Young Child and Adolescent Nutrition,; 2022; pp 166-71.

• Nanavati RN, Chauhan A. Toxoplasmosis – Perinatal Perspective. NNF Clinical protocols in Perinatology, 2022.

• Nanavati RN. Low Birth Weight: Aetiology and Classification. IAP PG Textbook of Pediatrics, 2022.

• Nanavati RN, Bajaj S. Approach to Neonatal Encephalopathy. India Point of Care. September 2022.

• Vamsi Krishna Vaddi, Medha Goyal, Dwayne Mascarenhas, Anitha Haribalakrishna. Successful management of a cutaneous abscess caused by Candida albicans in a very low birth weight neonate. J Clin Neonatol. 2022 Oct 4, 11 (4).

• Nanavati R, Mogra G, Masarenhas D. Neonatal Practice Guidelines. Evidence based management 1st Edn. Dec 2022.

• Mascarenhas D, Goyal M, Nanavati R. Favourable outcome of a severe bradyarrhythmia in a neonate: a case report. Cardiology in the Young. 2022 Aug 8:1-3.

• Goyal M, Mascarenhas D, Shah J, Ranadive A, Nanavati R, Mayadeo N. Perinatal COVID-19 Infection and Outcomes: A Retrospective Observational Study from a Low–Middle Income Setting. Journal of South Asian Federation of Obstetrics and Gynaecology. 2022 Aug 22;14(4):374-80.

• Goyal M, Mascarenhas D, Nanavati R. Antenatal Betamethasone dosing schedule: an ongoing conundrum!. Pediatr Oncall J. 2022 Nov 09. doi: 10.7199/ped.oncall.2023.10

• Prashanth RR. Effect of Kangaroo Mother Care on Cerebral Hemodynamics in Preterm Infants. Indian Pediatr. 2023 Jan 15; 60(1):13-14. PMID: 36639969.

• RR P, Haribalakrishna A, Mhatre S. An unusual case of spontaneous staphylococcal scalp abscess in a newborn: A case report. Pediatr Oncall J. 2023 Mar 29. doi: 10.7199/ped.oncall.2025.29.

• Raghavendra PR, Nair S, Haribalakrishna A, Tekwani RV. Isolated macrostomia with bilateral facial cleft in a preterm neonate. J Clin Neonatol 2023; 12:120‐2.

• A case of neonatal I-cell disease with multiple intrauterine fractures Sri Lanka Journal of Child Health, 2023 ( In Press)

• How early is too early: Diagnosis of tuberous sclerosis complex in a neonate. 2023 Journal of Postgraduate Medicine | Published by Wolters Kluwer - Medknow (In press)

1. Amplitude-Integrated EEG in Preterm Infants: Correlation between Amplitude-Integrated EEG and severity of intraventricular haemorrhage- A prospective observational study. 
2. Blood transfusion in very low birth weight infants: A prospective observational study".
3. Correlation of lung ultrasound score & NICHD Neonatal Bronchopulmonary Dysplasia (BPD) outcome estimator score for predicting the risk of BPD in preterm neonates: A prospective observational study from Western India.
4. Development, optimization, and validation of LC-MS/MS-based laboratory tests for new-born screening 
5. Diagnostic accuracy of Neutrophil Lymphocyte ratio in neonatal sepsis in comparison to body fluid culture- A Retrospective Observational Study.
6. Diagnostic accuracy of point-of-care testing for C-reactive protein, Interleukin-6 and Procalcitonin in neonates with suspect sepsis. a prospective observational study
7. Use of point-of-care testing for C-reactive protein in reducing the duration of antibiotic therapy- A randomized control trial from Western India”
8. Diagnostic accuracy of point-of-care testing for International normalized ratio in neonates with coagulopathy - A prospective observational study. 
9. Perinatal Palliative Care (PPC) and Parental satisfaction scores: A prospective observational study from a tertiary care neonatal intensive care unit in Western India
10. Risk factors and ocular outcomes of treatment in preterm infants with treated retinopathy of prematurity : A retrospective observational study from Western India
11. Rapid vs slow advancement of early enteral nutrition in neonates with perinatal asphyxia on therapeutic hypothermia: a randomized controlled trial.
12. Paper-based diagnostic device for detecting neonatal sepsis
13. Neonatal palliative care in a tertiary level NICU: A prospective and retrospective observational study from Western India
14. Development, optimization, and validation of LC-MS/MS-based laboratory test for newborn screening

• Newspaper / Magazine report / TV program :

World Breastfeeding week celebration: Dr. Omkar Nerurkar won the first prize in Breastfeeding slogan competition during world breastfeeding week celebration organized by Mumbai Breastfeeding Promotion Committee in 2022.

• Inaugural function of world breastfeeding week was jointly hosted by Seth GS Medical College & KEM Hospital, Department of Neonatology and MBPC on 2nd august 2023.

• Breastfeeding week celebration was conducted in the Neonatology department with emphasis on improving the Knowledge, Attitude and Practice in nursing mothers.

• World prematurity day was celebrated in the department of Neonatology.

• A symposium was organized by the department of Neonatology on preterm nutrition. Dr. Sanjay Patole, a renowned Neonatologist based in Perth, Australia was the guest faculty.

• Department of Neonatology recognized as the regional “Regional Collaborative Center for Facility Based Newborn Care” under National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India. 
• First Capacity building program for training doctors and nurses from all over India was conducted for a batch of 50 participants under FBNC program.
• International Board Certified Lactation Consultant course was conducted in KEM Hospital for the first time by Department of Neonatology in collaboration with BPNI Maharashtra in August 2022.
• Bayley Scale of Infant Development (BSID IV) workshop was conducted in the department in September 2022.
• Dr. Ruchi Nanavati: Faculty in IAP NEOCON 2022, The International Neonatology  Summit & XIIIth Conference of  Neonatology Chapter of the Indian Academy of Pediatrics, May 2022
• Dr. Anitha Haribalakrishna: Faculty in NEOCON 2022-41st Annual Convention of National Neonatology Forum in December 2022.
• Dr. Anitha Haribalakrishna: National Faculty in MAHANEOCON 2023 in July 2023
• Dr. Anitha Haribalakrishna: National Faculty & In charge Regional Collaborative Centre of Facility Based Newborn Care Program under National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India.
• Organization of 10 SNCU Observership Training Programs (14 days each)  and two capacity building for pediatricians & nurses from various districts of Maharashtra, under NUHM, National Reproductive and Child Health Program of Ministry of Health & Family Welfare, Government of India
• Dr. Ruchi Nanavati published the first edition of neonatal Practice Guidelines, Evidence based management in December 2022
• Dr. Omkar Nerurkar won the first prize in Breastfeeding week slogan competition during world breastfeeding week celebration organized by Mumbai Breastfeeding Promotion committee.
• DR Medha Goyal was awarded Dr sanjay Oak best superspeciality resident for the year 2021.
• Dr Swati Dubey won the third prize in E slogan competition during the world breastfeeding week 2023

• IAP NEOCON 2022, The International Neonatology  Summit & XIIIth Conference of  Neonatology Chapter of the Indian Academy of Pediatrics, May 2022- Oral presentation-Post Insure administration of Heated Humidified High Flow therapy versus nasal continuous positive airway pressure in preterm infants >28 weeks gestation with respiratory distress syndrome: A randomized non-inferiority trial by Dr. Srijan Singh.
• VI national Conference of Kangaroo Mother Care in India KMCCON April 2022-Poster presentation- Kangaroo mother care in neonates with birth weight 2-2.5 Kg: a quality improvement study by Kirthana S. B.