Dr. Preetha Joshi

AREA(S) OF INTEREST:

Neonatal, Paediatric Critical Care and Paediatric Cardiac Critical Care

TREATMENTS/PROCEDURES OFFERED:

Specialised Services in Intensive Care Neonatal, Paediatric and Cardiac, Management and Treatment of Very Preterm Babies (completed 6 months of pregnancy or less than 1000 gm), Special types of Ventilation like High Frequency Ventilation & use of Nitric Oxide, Postoperative Cardiac Critical Care, Post operative Organ Transplant care ( Liver, Kidney, Lung and Heart), Ventricular Assist Device, Peritoneal and Haemodialysis including Hemofiltration, Extracorporeal Membrane Oxygenation (ECMO) –in Cardiac or Respiratory Failure

FELLOWSHIPS:

Fellowships: 2001-2007

Neonatal Fellowship:

• University of Sydney- Royal North Shore Hospital, Royal Hospital for Women
• McMaster University, Canada

Pediatric Intensive Care Fellowship

• University of Sydney- Sydney Childrens’ Hospital
• University of Toronto

Pediatric Cardiac Critical Care Fellowship

• University of Toronto (Pediatric Cardiac Critical Care and Critical Care Transport)

Certificate Training:

• ECMO

Dr Preetha has pursued Post graduation degree in Paediatrics from Lokmanya Tilak Municipal Medical College-Sion. She also has experience of training and working in Australia and Canada for 7 years. She was the Chief Fellow in the Department of Paediatric Critical Care at Hospital for Sick Children, Toronto.

At KDAH, she manages Neonatal and Paediatric ICU which has Transport facility of Critically Ill Newborns and children up to 18 years. She was Involved in the care of Preterm Quintuplets, 4 of the 5 babies survived and are thriving well at 7 years. She also looks after postoperative cardiac surgery patients in the Paediatric Cardiac ICU which sees 500 postoperative children per year.

KDAH Experience :

Neonatal Intensive Care Unit at KDAH has 17 beds which admit :

• Premature babies as young as 24 weeks of gestation
• Extremely low birth weight infants as low as a birth weight 500 gm
• Respiratory failure in premature and term newborns requiring advanced ventilatory modes such as High Frequency Ventilation and Inhaled Nitric Oxide therapy like severe hyaline membrane disease, meconium aspiration syndrome etc.
• Babies with complex surgical problems like congenital diaphragmatic hernia, intestinal atresia, Hydronephrosis, congenital hydrocephalus etc.
• Babies with septicaemia

This unit has looked after 2,400 sick newborns in the last 7 years with mortality rates less than 2.5 per cent

Paediatric Intensive Care Unit is a quaternary level unit with 10 beds. The care offered by the ICU is :

• Treatment of Severe Malaria, Dengue, Septic shock
• Respiratory failure: High Frequency Ventilation and inhaled Nitric Oxide in ARDS
• Postoperative care after Neurosurgery (Tumour, VP shunt, Neurointervention), Gastrointestinal Surgery, Urological surgery
• Postoperative care in Renal and Liver Transplants
• Management of Kidney Failure in snake bite poisoning & accidental poisonings
• Management of Severe Infections with Multiple Organ Failure
• Treatment of Severe Paediatric Trauma especially Head Injury in children
• Renal Replacement Therapy- Peritoneal Dialysis, Continuous Renal replacement therapy, Haemodialysis & Hemofiltration
• ECMO in Cardiorespiratory failure

This unit has Managed 3,000 critically ill children in the last 7 years

Paediatric Cardiac Critical Care :

• 25 bedded tertiary Paediatric Cardiac ICU
• The unit has taken care of more than 3000 Post Cardiac Surgery patients
• Preoperative Stabilization of babies with Complex Cardiac Anomalies
• Postoperative care of Complex Cardiac Surgery for TGA, TOF, TAPVC
• Postoperative care in Complex Cardiac Surgery in Neonates- more than 400 babies
• ECMO in Cardiac and Respiratory Failure-25 children.

Transport of critically ill newborns and children:

She has been involved in the setting up of a state-of-the-art transport service for critically ill children. There is a dedicated neonatal and paediatric ambulance with neonatal transport incubators and neonatal and paediatric ventilators. Children are picked up from many peripheral hospitals and nursing homes in the outskirts of Mumbai.

Outpatient Clinic :

• Follow up of Preterm Babies with Neurodevelopmental Assessment up to 5 years of age.
• Follow up of babies discharged from the paediatric and neonatal ICU

Academic Achievements :

• Speaker at international and National Conferences of Critical Care
• Conducts training workshops in Neonatal, Paediatric and Cardiac Critical Care all over India.
• Teacher for Indian Academy of Paediatrics- Fellowship in Neonatology
• Institute Fellowship in Neonatal and Paediatric Critical Care
• Nursing Fellowship in Neonatology and Paediatric Critical Care
• Research: Presented more than 20 papers in National and International Conferences
• Publications in 15 National and International Journals and Textbooks
• Published- Work On Ventilation in Preterm Babies (APRV)
• Case Series of severe H1N1 Infection cases in Paediatric ICU (World Critical Care Congress, Sydney 2011
)
• Presentation at World Congress at Sydney (2012) and Toronto (2016). The latest presentation was on Complex Congenital Heart Surgery outcomes in Newborns and 4 papers
• Presented Transfusion Related Lung Injury in Newborns (Canadian Paediatric Society and World Paediatric Critical Care Congress, Geneva, 2007)
• Presented several papers at World Paediatric Critical Care Congress (Sydney, Australia)

Chapter :

• Newborn Intensive Care Handbook.
• Paediatric, Neonatal Intensive Care Textbooks
• Anaesthesia textbook
• Nursing textbooks

Association :

• Executive Board Member of Indian Academy of Paediatrics (Mumbai Branch)
• Ex-Executive Board Member of Indian Academy of Paediatrics (Critical Care Division)
• Visiting Consultant in Paediatric ICU (Lokmanya Tilak Municipal Medical College)
• Fellowship Teacher for Paediatric and Neonatal Intensive Care ( Indian Academy of Paediatrics)
• Examiner for Paediatric Critical Care and Neonatal Critical care Fellowships
• Life member of Indian Academy of Paediatrics
• National Neonatology Forum
• ECMO Society of India
• Society of Critical Care Medicine

Dr. Preetha Joshi | Dr. Vinay Joshi: ECMO Treatment to treat 2.5 month old infant

Extracorporeal Membrane oxygenation (ECMO) is the only life-saving technology available to support and rest organs in case of organ failure- heart, lungs etc

Last month, we treated an infant 2 and a half month old-  on ECMO-first of its kind in the country and the baby is going home.

We are at present treating a 9 yr old with ECMO and CRRT in a case of ARDS with multiorgan failure.

This has been achieved due to team effort by the entire PCICU, PICU team and especially Pediatric Cardiac surgeons, Perfusionists (who are working round the clock), the intensivists and the nursing team.

Dr. Suchitra Pandit, Dr. Vinay Joshi and Dr. Preetha Joshi | Gynaecologist & NICU Team

Mrs. Shreya Singh Jitan delivered a healthy baby boy (2.8 Kgs) today at 5.35 pm. She was with us in the hospital for 3 months (since Feb, 2011). She had presented with a pregnancy of six months (26 weeks - 600 gms) with a very short cervix and funnelling of internal os with bulging membranes (mouth of the womb was very short and open with the membranes bulging into it). This meant she would deliver very soon. At this stage one can put a stitch on the cervix called as a rescue cerclage of the internal os but due to the funnelling and bulging of membranes the water bag could easily burst, infection chances and a premature delivery are extremely high. Results with these cerclages are not very promising at such a stage. Maybe we could pull on for a few days only. The baby being extremely small (600gms) would have to spend many weeks in the ICU and dangers of prematurity like respiratory distress syndrome (breathing problems), hemorrhages (bleeding in the brain), feeding problems are possible and good outcome cannot be promised.

As against this we counselled her and her family, offered her a conservative management a stay in the hospital, antibiotics, head low position, uterine relaxants, Inj Betnesol inj (2) and vigilant care from the team which could carry on the pregnancy as far as possible.

We had done a similar plan for a patient Mrs ABC, last year and were successful. Since we are in a hospital with an excellent NICU team we were assured of the fact that we could do our best in case of a premature delivery. Our team of doctors headed by Dr Suchitra Pandit, Dr. Vinay & Dr. Preetha Joshi (baby doctors), Staff nurses, Radiologist Dr.Shefali Sardar, our junior doctors Jatinder, Deepali, Dimple were all very vigilant and offered reassurance at every visit. The family was told about the entire plan and they were very supportive.

We scanned her every fifteen days. The cervix got shorter & uterine pain was there but with medication we could avert labour.

It was only when we crossed 34 weeks ( 8 months) that we breathed a sigh of relief as lungs by then are mature. On 20th May, 2011 she was term and she was in early labour on 21st May. Short and sweet labour, a vacuum delivery - 2.8kgs baby boy.

What was very rewarding was the cooperation from the patient, the entire family. The family agreed and believe me as each week passed by we would pray that we sail through another week successfully.