The only centre under GNCTD performing Liver and Kidney transplants.

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.

Service Highlights

  • 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 Rendered

Services 2014 2015 2016 2017
New patients attended OPD 1899 1612 1709 2114
Admissions in Pediatric ward 589 599 587 682
Pediatric admissions in ICU 14 20 26 52
Diagnostic UGIE 134 189 211  

Therapeutic UGIE

Sclerotherapy

Band ligation

FB removal

 

25

29

01

 

28

35

02

 

30

37

1

 

28

51

01

ERCP 10 32 16 30
HVPG 08 10 2 30
Colonoscopy 19 22 26 20
Sigmoidoscopy 12 08 9 15

Liver Biopsies:

Percutaneous

TJLB

HVPG

HV Angioplasty

IVC Angioplasty

TIPSS

 

104

07

08

02

-

02

 

122

05

10

01

-

01

 

139

6

8

3

-

2

 

153

10

8

01

01

03

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.
  • Monthly Teleconference: The department runs a monthly teleconference with Texas Children’s Hospital on first Tuesday of every month. This teleconference is an opportunity for pediatric hepatology teams from each centre to discuss latest research, clinical approach and other topics on the subject. This conference gives an opportunity to our residents to interact with international faculty and discuss issues related to day-to-day management of patients, management protocols as well as research topics. So far we have had 6 such sessions.

Course Offered

Name of the course Number of candidates/year Students admitted in Year 2017 Students passed out in Year 2017
DM in Pediatric Hepatology 1 Dr Priti Vijay Dr Bikrant Bihari Lal
PDCC in Pediatric Hepatology 2 Dr Stanzen Chakdour
Dr Sneha Madasu
Dr Sheetal Ganjur
Dr Ruchika Kumar

Departmental Achievements

  • C.P Mittal award for Young Investigator- Awarded to Dr Bikrant Bihari Lal at 4th Annual conference of ISPGHAN held at Guwahati India in 2017
  • Best Oral Paper award in Hepatology section- Awarded to Dr Bikrant Bihari Lal at 4th Annual conference of ISPGHAN held at Guwahati India in 2017
  • Best Oral Paper Award at Master class in Liver Disease (MCLD) 2017 held in Chennai India- Awarded to Dr Snehavardhan Pandey for paper titled ‘Profile and Outcome of first 109 cases of Pediatric Acute liver Failure at a Specialised Pediatric Liver Unit in India’
  • Second prize in ‘Best thesis Award’ category- Awarded to Dr Bikrant Bihari Lal at Annual conference of IJP held at AIIMS New Delhi India in 2017

Conference Presentations

26th Annual Conference of Asian Pacific Association for Study of Liver Diseases (APASL) 2017, Shanghai, China held on 16-19th Feb 2017.

  • Oral presentation titled ‘Predictors of Acute kidney Injury in Children with Acute-on- chronic Liver Failure’ by Dr. Seema Alam
  • Oral presentation titled ‘Plasma Lactate Predicts Mortality in children with Hyperacute Liver Failure’ by to Dr. Arti Pawaria
  • 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
  • Poster presentation on “Duct Paucity in children: Spectrum, clinical Profile and Outcome” by Dr. Babu Lal Meena

50th annual European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) meeting held at Prague, Czech Republic in May 2017.

  • Oral paper presentation by Dr Rajeev Khanna titled ’Prevalence, Clinical Spectrum and Outcome of Pediatric Drug Induced Liver Injury’

Annual Conference of American Association of Liver Disease ‘The Liver Meeting 2017’ held in Washington DC, USA.

  • Paper presentation by Dr Seema Alam titled ‘Decompensated Wilson’s disease: Advanced Hepatic Encephalopathy and High Bilirubin decide the need for Liver Transplantation. Does the New Wilson’s index help?’
  • Paper presentation by Dr Seema Alam titled ‘Analysis of the efficacy and safety of sequential therapy using Pegylated Interferon and nucleos(t)ide analogue versus standard therapy for treatment of immunotolerant and immunoclearance cases of chronic hepatitis B infection in children’.
  • Poster presentation by Dr Babu Lal Meena titled ‘HVOTO in Children- Etiology, Clinical Profile and Outcome following Radiological Interventions’
  • Travel Award to Dr Arti for her paper ‘Plasma Lactate Predicts Mortality in children with Hyperacute Liver Failure’

4th Annual conference of ‘Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition 2017’ held in Guwahati, India

  • Oral presentation by Dr Bikrant Bihari Lal titled’ Weekly regimen of Vitamin D3 supplementation is better that stoss therapy for vitamin D deficiency treatment in children with CLD’
  • Oral presentation by Dr Bikrant Bihari Lal titled ’Sequential therapy versus standard therapy for treatment of immunoactive and immunoclearance children with chronic hepatitis B infection’
  • Poster presentation by Dr Babu Lal Meena titled ‘HVOTO in Children- Etiology, Clinical Profile and Outcome following Radiological Interventions’
  • Clinical aspect of “Clinicopathological correlation” in a case of “Infantile liver failure” from PGIMER, Chandigarh presented by Dr. Rajeev Khanna.

Visiting faculty to the department in 2017

Name Institution/strong>
Dr. Tamir Miloh Department of Pediatric Gastroenterology and Liver Transplantation, Children’s Hospital, Houston, Texas, USA
Dr. Marianne Samyn Department of Pediatric Hepatology, King’s College hospital, UK
Prof. S.K. Yachha SGPGIMS, Lucknow, India
Dr. Anshu Srivastava SGPGIMS, Lucknow, India
Prof B R Thapa PGI Chandigarh, India
Dr Naresh Shanmugam Global Hospital, Chennai, India
Dr Malathi Sathiyasekaran Kanchi Kamakoti Child’s Trust Hospital, Chennai, India
Dr V.S Sankaranarayanan Chennai, India
Dr Ashish Bavdekar KEM Hospital, Pune, India
Prof Jayantee Kalita Department of Neurology, SGPGI, Lucknow, India
Dr J. Barath Department of Pediatrics, JIPMER, Pondicherry, India
 

Faculty

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

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