The Hindu : Kerala News : Scope of Paediatric Cardiology

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Monday, Apr 07, 2008
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Kerala

Scope of Paediatric Cardiology

Shabnam Shafique, Director NIMS Medicity, releasing the 1st issue of NIMS News at a function at the hospital on 25-3-08.

Paediatric cardiology deals exclusively with heart diseases involving children. It may be surprising for the lay public and even medical fraternity that defects and deviations in the formation of heart forms the commonest congenital malformations. About 8 newborns out of one thousand live births will have one form of cardiac defects or other, ranging from minor to very complex ones. This would automatically entail fairly bulky health care burden. However it is a paradox that even the best educated are tuned to recognising the existence of cardiac maladies as those afflicting predominantly the adult population. Both the public and private hospitals are readily catering to adult coronary heart diseases, which, albeit being very justifiable sometimes borders on to lucrative economic equations.

Cardiology super speciality training in India is yet again predominantly an adult oriented one simply because of lack of paediatric cardiac surgery facilities and trained personnel. A paediatric cardiologist in the western training system has to undergo rigorous 5 years systematic peer reviewed practical residency programme. Cardiac surgeons undertaking paediatric cardiac surgeries are yet again a rare dedicated breed. Truly, looking after children with heart diseases is a multidisciplinary affair with Paediatric cardiologist, Paediatric cardiac surgeon, specialist paediatric cardiac anaesthetists and, if at all available, a paediatric cardiac intensivist, just to talk about the important “bits” of a much bigger corum.

The true role of a paediatric cardiologist starts much before a baby is born at least from 18 to 20 weeks of gestation of a pregnant woman in the form of foetal echocardiography and more importantly responsible non-threatening counselling of the anxious parents in the presence of, if deemed appropriate, the grandparents who play a great supportive role in our culture.

Neonatologists and general paediatricians roles are now on the rise in recognising children with heart problems. An honest third generation paediatrician will readily agree that even a “simple” problem like coarctation of aorta (narrowing of the main body artery) can be easily missed by even the “most experienced” and this unfortunately can result in deaths, many a times with wrong diagnostic labels.

Think about this; a nation like U.K with a population nearly same as that of Kerala has at least 13 state-of-the-art Paediatric cardiology and Paediatric cardiac surgical centres, whereas in India in its entirety doesn’t have more than 5 such arguably comparable centres!

Though Paediatric cardiology has been one of the first paediatric subspecialties to be evolved in paediatrics in the west complete absence of exclusive paediatric cardiology training facilities and immense economic and infrastructural demands and above all extreme scarcity of medical personnel trained exclusively in paediatric cardiology precluded so far any significant growth of this paediatric subspecialty. However hope is not all lost as more and more private sector hospitals are now gradually developing dedicated centres to look after these children who are no less dear.

Dr. Eapan Thomas (MD (paed.), DCH, MRCP (UK), MRCP (I), MRCPCH),Paediatric Cardiologist, St. Jude Hospitals & Ananthapuri Hospital, TVM (Formerly Consultant Paediatric Cardiologist, Royal Liverpool Children’s Hospital, UK)

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