Pediatric Hepatology

Pediatric Hepatology

Institute of Liver and Biliary Sciences (ILBS) was the first centre to officially establish a department of ‘Pediatric Hepatology'. Although Pediatric Liver units were working in the various centres of the world. but “pediatric hepatology” as a specialty was not recognized in India. Department of Pediatric Hepatology at ILBS is a full fledged department with well trained faculty and senior residents. We  have established a fully functional pediatric hepatology ward which is well equipped for prompt management of infectious, metabolic and hereditary liver diseases in neonates, children and adolescent. There are a lot of structural, infective, inborn errors of metabolism and autoimmune diseases of the liver amongst children. These disorders are very distinct from the liver disease seen among adults. The OPD attendance in the department of Pediatric Hepatology has also shown remarkable exponential growth. Majority of the patients are referred cases of neonatal and childhood liver diseases from all parts of the country. We have referrals from various hospitals of Delhi where junior doctors accompany patient to learn the work and understand the management of the patients and then discuss the monitoring of the patient with us from time to time. The Department has about 60 admissions each month in the ward and PICU. There was pressing need of the increase in beds in PICU as well NICU. The second phase building has already given us the much required increase in beds in ward, NICU & PICU this year. Diagnostic and therapeutic Pediatric GI endoscopies and procedures like hepatic vein pressure gradient and hepatic vein angioplasty as well as stenting are being performed. Fully functioning Pediatric liver transplant unit at ILBS has done 35 Pediatric liver transplants in the last 5 years. Intramural and extramural research are being done regularly in the department to tackle unanswered queries in the field of metabolic and infectious childhood liver disease. We have about 12 research projects involving the faculty and residents of the department. The academic activity of the department includes holding of regular lectures, case presentations, seminars and symposia, journal club, group discussions, clinical meetings and clinical grand rounds.

Our Mission

The dual mission of the Department of Pediatric Hepatology has been well sketched out. On one side we are dedicated to the state of art patient care. And at the same time we as a department have been making a continued effort in causing more awareness among the pediatricians regarding identification and management of common childhood liver diseases. From time to time we participate in mass awareness programs also, to help in the prevention and identification of the common hepatic diseases among children. Besides we have participated in the prevention of infective hepatitis on televisions and school health programs.

Services Rendered

  • Outdoor facilities for evaluation of neonatal and childhood liver disease.
  • Pediatric Hepatology Ward for prompt management of infectious, metabolic and hereditary liver diseases in neonates, children and adolescent.
  • Age and clinical profile appropriate protocol based approach to various metabolic liver disease in neonates, children and adults.
  • Diagnostic and therapeutic Pediatric GI endoscopies.
  • Procedures like hepatic vein pressure gradient and hepatic vein angioplasty as well as stenting are being performed
  • Plasmapharesis in the Acute liver failure and acute on chrnic liver failure patients to bridge the gap to liver transplant.
  • Pre-transplant evaluation and post-transplant monitoring done by the department along with the HPB surgery and various specialities.
  • Pediatric hepatobiliary surgeries like Kasai’s portoenterostomy, Hepaticojejunostomy and Partial Hepatectomy are being done routinely and we provide pre and postoperative care for these patients.
  • Splenic artery embolization and radiofrequency ablation are the radiological interventions are performed routinely at ILBS for pediatric cases.
  • Counseling is done to parents through ILBS website and are in the process of developing a “Query Corner” on ILBS website to help the general pediatricians with the diagnosis and management of different childhood liver diseases.
Services 2013 2014 2015 2016
New patients attended OPD 1617 1899 1612 1709
Admissions in Pediatric ward 495 589 599 587
Pediatric admissions in ICU 17 14 20 26
Diagnostic UGIE 119 134 189 211

Therapeutic UGIE

Sclerotherapy

Band ligation

FB removal

 

23

20

03

 

25

29

01

 

28

35

02

 

30

37

1

Stricture dilatation 02 - 02 -
APC 1 01 - -
ERCP 07 10 32 16
EUS 04 01 - 2
ESWL 02 02 01 2
HVPG 07 08 10 8
Colonoscopy 18 19 22 26
Sigmoidoscopy 10 12 08 9
Polypectomy 01 01 01 1
Capsule endoscopy 01 01 - -
Polypectomy 01 01 01 1

Liver Biopsies:

Percutaneous

TJLB

HVPG

HV Angioplasty

IVC Angioplasty

TIPSS

 

98

07

07

01

01

01

 

104

07

08

02

-

02

 

122

05

10

01

-

01

 

139

6

8

3

-

2

New Services and Facilities

  • It was for the first time felt at our centre that algorithm guided approach to metabolic liver disease would help cost-effective investigative work up and early detection of the disorders. Diagnosis of the metabolic liver disease has been made easier and cost-effective by the development of age and clinical profile appropriate protocol based approaches to various presentations of liver disorder in neonates, children and adults. We have proven that it increases the case detection as well as decreases the cryptogenic/ indeterminate cases.
  • Complete evaluation of the hereditary liver and pancreatic disorders is available in the department.
  • Pediatric Liver Transplant Program available at the lowest cost in India.

Educational Activities

Details of the Educational activities (CME/Conf/workshop) hosted by thedepartment in 2016 under following headings:

  • Clinical Scenarios in Pediatric Liver Disease 2016 (CSPLD 2016): Department of Pediatric Hepatology organizes annual conference with the aim to popularize Pediatric Hepatology among young Pediatricians and fresh Post graduates. After immense success of CSPLD 2014 and 2015, CSPLD has been made an annual feature at ILBS. This conference is an ongoing initiative taken to create awareness about case scenarios in pediatric liver diseases faced by pediatricians on day-to-day basis and lay emphasis on approach based learning for their management We discussed 20 different clinical scenarios commonly seen in pediatric hepatology in a unique manner. The case was presented by freshly passed out post graduates and senior residents. Each such case was allotted a moderator who advised the presentation of the case and also posed questions during the presentation in order to send across clear concepts. Mostly questions were posed to the audience to have a two way interactions and then one of the two or three panelists answered the query in detail. The event has participation from dedicated international & national faculty working in the field of Pediatric Hepatology.

Course Offered

Name of the course Number of candidates/year Students admitted in Year 2016 Students passed out in Year 2016
DM in Pediatric Hepatology 1 Dr.Snehavardhan Pandey Dr Vikrant Sood
PDCC in Pediatric Hepatology 4 Dr Babu Lal Meena
Dr Sheetal Ganju
Dr Ruchika
Dr Aditi Kumar

Departmental Achievements

  • Prof Seema Alam, had a month long visit (01/08/2016 till 31/08/2016) at Pediatric Hepatology and Liver Transplantation section at Texas Children’s Hospital, Houston, USA. This visit was meant to basically get ideas and understand the methods to improve the teaching and training at department of Pediatric hepatology as well as expanding the experience of pediatric liver transplantation.
  • Dr Rajeev Khanna, Associate Professor, spent an year (Dec’14 to Nov’15) at King’s College Hospital, London which has one of the world’s busiest and the oldest Pediatric Liver set up. There he received further experience in handling a variety of pediatric liver cases including those going for liver and multivisceral transplantation.
  • Travel award and Oral presentation at Asia-Pacific Association for the Study of the Liver (APASL) 2017 to be held on 16-19th Feb 2017 at Shanghai, China to Dr. Arti Pawaria – Tilted ‘Plasma Lactate Predicts Mortality in children with Hyperacute Liver Failure’
  • First Prize in Poster presentation at 3rd  annual conference of Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN) on 24th-25th September 2016, at Kolkatta, India to Dr Bikrant Bihari Lal- Titled- Profile and Outcome of Acute kidney Injury and Hepatorenal syndrome in pediatric patients with liver disease
  • Award for poster presentation in Indian Society of Clinical Nutrition Conference, held at Institute of Liver & Biliay Sciences, New Delhi from 14-16 October 2016 to Dr. Arti Pawaria- Titled ‘Alterations in Hormonal Profile in Children’.
  • Oral Plenary Session award at 24th Annual Scientific meet of Indian National Association for Study of the Liver (INASL), held in New Delhi, India on 5th–7th August, 2016 to Dr. Vikrant Sood.
  • Young Investigator Award at the 49th annual meeting of the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) held in Athens, Greece in May 2016 to Dr. Vikrant Sood.
  • Professor Anil Dhawan, Director and Head, Pediatric Liver Unit, at King’s College Hospital, London, visited the institute and department of Pediatric Hepatology on 17th September 2016. He delivered a talk on ‘Hepatocyte Transplantation’ and also discussed few difficult cases with students.

Conference Presentations

  • 57th Annual Conference of Indian Society of Gastroenterology – ISGCON 2016 held at New Delhi from 15th-18th December 2016 : Case presented at Liver Clinics – ‘Case of Portal Hypertension in a patient with PDA’ by Dr Bikrant Bihari Lal,
  • World Congress of Pediatric Gastroenterology, Hepatology and Nutrition (WCPGHAN) held at Montreal, Canada from 5th-8th October 2016: Poster Presentation titled “Study of Prevalence of Fatty Acid Oxidation Defects in children and adults with Acute Liver Failure: Significance of Carnitine/Acylcarnitine and Aminoacid Profile” by Dr. Vikrant Sood
  • 3rd Annual Conference of Indian Society of Pediatric Gastroenterology,  Hepatology & Nutrition (ISPGHANCON); Kolkata from 23-24th September 2016
  • Oral Presentation on “ Predictors of Acute kidney Injury in Children with Acute-on- chronic Liver Failure” by Dr. Bikrant Bihari Lal
  • Poster presentation titled- Profile and Outcome of Acute kidney Injury and Hepatorenal syndrome in pediatric patients with liver disease by Dr Bikrant Bihari Lal
  • Poster presentation on “Subjective Global Nutritional Assessment Vs  Conventional anthropometry” by Dr. Arti Pawaria.
  • Poster presentation on “Liver involvement in Hemophagocytic lymphohistiocytosis – Experience from a tertiary liver referral centre” by Dr. Arti Pawaria
  • Oral Presentation on “Duct Paucity in children: Spectrum, clinical Profile and    Outcome” by Dr. Babu Lal Meena
  • 24th Annual Scientific meet of Indian National Association for Study of the Liver (INASL), held in New Delhi, India on 5th–7th August, 2016; Oral Plenary presentation titled “Study of Prevalence of Fatty Acid Oxidation Defects in children and adults with Acute Liver Failure: Significance of Carnitine/Acylcarnitine and Aminoacid Profile” by Dr. Vikrant Sood
  • 3rd Kunwar Viren Oswal Course in Pediatric Gastroenterology, Hepatology, Liver Transplantation and Nutrition on 7-10th August 2016 at Indraprastha Apollo Hospitals, New Delhi
  • Oral Presentation on “ Predictors of Acute kidney Injury in Children  with Acute-on- chronic Liver Failure” by Dr. Bikrant Bihari Lal
  • Poster presentation titled- Profile and Outcome of Acute kidney Injury    and Hepatorenal syndrome in pediatric patients with liver disease byDr Bikrant Bihari Lal
  • Poster presentation on “Subjective Global Nutritional Assessment Vs Conventional anthropometry” by Dr. Arti Pawaria.
  • Poster presentation on “Liver involvement in Hemophagocytic lymphohistiocytosis – Experience from a tertiary liver referral centre” by Dr. Arti Pawaria
  •  Oral Presentation on “Duct Paucity in children: Spectrum, clinical Profile and    Outcome” by Dr. Babu Lal Meena
  • 49th annual meeting of the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) held in Athens, Greece in May 2016
  • Case Presentation – “Adolescent with Massive Splenomegaly”- by Dr. Arti Pawaria .
  • Paper (e-Poster and Poster) titled ‘’Study of Familial Tendency and PNPLA3 Polymorphism in Pediatric Non Alcoholic Fatty Liver Disease’’ and ‘’Non Cirrhotic Portal Fibrosis in Pediatric Population- Breaking the Myths!!’’ by Dr. Vikrant Sood
  • Hepaticon 2016 held at Mumbai on 9-10th April 2016; Case presentation- “Young child with hemetemesis”  by Dr Arti Pawaria
  • 8th  Master Class in Liver Diseases held at Chennai on 21-23rd January 2016; Oral presentation- “Plasma Lactate Predicts Mortality in children with Hyperacute Liver Failure” by Dr. Arti Pawaria
  • For the 26th Annual Conference of Asian Pacific Association for Study of Liver Diseases (APASL) 2017, Shanghai, China to be held from 16-19th Feb 2017, a total of two oral presentations and three posters have been accepted.
 

Faculty

  • ECHO
  • ECHO
  • APASL
  • Acuteon
  • DORSO
  • NSI
  • HBSCE

Copyright © Institute of Liver & Biliary Sciences 2016. All rights reserved. Designed & Developed by Cyfuture