Last week American talk show host Jimmy Kimmel made an impassioned plea on healthcare after his new born baby had to be rushed in for an emergency heart surgery.

Born with a congenital heart condition, the child had to go through an open heart surgery after a nurse noticed he was turning “purple” hours after he was born. Recounting the “terrifying experience” Kimmel made an emotional case for greater healthcare spending, specially on pre-existing illnessess like congenital heart diseases where it is difficult to get health insurance coverage.

Kimmel's plea was to an American audience but the heart condition he recounted is not alien to India.

It is a bigger problem in India than in the United States, with one in about 800 children here having congenital heart disease (CHD), says Kishore Kumar, Neonatologist and Chairman, Cloudnine group of hospitals that specialise in maternal and child care. It's only when a celebrity faces a problem that such issues get highlighted, regrets Kumar, pointing to the need for prenatal screening of babies to catch the condition early.

India has a high CHD prevalance possibly because of consanguineous marriage (where blood relatives get married), besides other reasons including smoking, diabetes or late pregnancies, he explains.

A child with CHD has heart problem from birth that could be structural or functional in nature. In a structural defect like a hole in the heart, valve malfunction or wrong positioning of blood vessels, the child needs immediate surgery or intervention. In a functional murmur of the heart also called an “innocent murmur”, the child may grow out of it, he explains.

In doctor parlance, this is described as a “pink” or “blue” type baby, he says, where the blue type needs immediate intervention and the other condition is treated between two and five years.

Prenatal screening

But that said, only 15 percent of the babies with CHD may need surgery and so diagnosis is critical, he says referring to a non-invasive blood saturation test that picks up whether the oxygen in the blood is normal. If the saturation is less than 95 percent, it is a red flag and needs to be corrected, he says. Ideally, the test is done when the baby is one day old, he adds. The test involves a band around the baby's toe that reads the oxygen and it is not expensive, at about Rs 100, he says. In fact, a good sonologist too can pick up such anamolies from an ultrasound scan at 24 weeks into the pregnancy, he points out, adding that about 90 percent of children with CHD continue to live a normal life.

Calling for prenatal screening to be made mandatory across the country, he says it is mandatory in Europe, for instance. Catching and treating CHD early is important because some critical congenital heart diseases can lead to death and it accounts for 10 percent of infant mortality.

Insurance blind spot

Touching on the expense of remedial surgeries, he says, insurances do not cover congenital problems. And even if they do, it requires extra premiums to be paid. Even there, he cautions, you need to read the small print. “Almost every day we see a parent who has paid their insurance premiums for the baby and find that conditions in their child are not covered. They get upset as nobody has told them about the fine print in insurance policies.”

jyothi.datta@thehindu.co.in

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