Deepa Hariharan

Sooriya Hospital,
India

Abstract Title:Organized Transport systems improve outcomes in NICU

Biography:

After fellowship in Neonatology at Children’s Hospital of Philadelphia, securing 99.5th percentile in Neonatal-Perinatal Certifying examination of American Board of Pediatrics, Dr Deepa Hariharan returned to India, and did pioneering work to improve NICU care in India. She designed the first state-of-the-art mobile NICU of South India in 2004, a landmark in neonatal transport in India. This was inaugurated by international cricket legend Sachin Tendulkar. Dr Hariharan was also the first person to introduce high-frequency ventilator in 2006 in India. She has trained doctors across India in these technologies. The first person to introduce the concept of cardiovascular NICU in India, she led her team to set a world record in introducing a permanent pacemaker in a baby weighing 900g. She recently conducted a workshop on neonatal transport with National Neonatology Forum of India and Oxford University UK.

Research Interest:

Transport is a vital component of NICU care. While 20% of neonates are born premature in India, and with birth asphyxia being a leading contributor to neonatal mortality, a strong transport system is crucial to improve NICU outcomes. Between 40% to 90% of infants admitted to level III NICUs are outborns. The pioneering transport system in our level IV NICU includes 2 fully equipped mobile NICU in ambulances, 16 nurses and 4 senior neonatal fellows trained in transport and emergency care. With 196 referring hospitals, the distance to our NICU varied from 2km to 250km. Of the 7056 babies transported in 10 years, 231 were ELBW (<750g BW), 3565 were VLBW (<1.5kg BW). In 1987 cases, our transport team resuscitated the baby in the delivery room. Pre-transport stabilization included delivery room CPAP, early surfactant and umbilical venous catheterization. Blood gas analysis (portable) and telecommunication was used. During transport, 59% of the infants received ventilator or CPAP support in the ambulance, there were 11 episodes of reintubation. Pneumothorax needing drainage was noted thrice. CPR was performed in 23 cases successfully. 7 babies were shifted on portable nitric oxide for severe PPHN diagnosed by functional ECHO. Prostaglandin for duct-dependent heart disease was given during transport in 32 cases, of whom 28 were diagnosed with congenital heart disease. Therapeutic hypothermia was started in 12 babies referred beyond 2 hours of age for birth asphyxia. On admission, the incidence of hypothermia was 11/ 7056. SpO2 <90% was noted in 371/ 7056 babies. Emergency escalation of cardiorespiratory treatment within 30 minutes of admission was needed in 187/ 7056 babies (2.6%). Our experience shows that investing in neonatal transport with adequate training of personnel and fully equipped mobile NICU improves NICU outcomes