NeoStar: Munish Kumar Raizada
Name : Munish Kumar Raizada
Birth Place: Narnaul , India
Academic Qualification: MBBS from Mahatma Gandhi Institute of Medical Sciences, Maharashtra, India (1985 - 1990)
MD Neonatology from John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States (2003-2006)
MD Pediatrics Long Island Jewish Medical Center, New Hyde Park, New York (2006-2008)
Languages you speak/write : English and Hindi
What do you do?
I am an attending neonatologist practicing in the Illinois, USA.
When or how did you get hooked to Neonatology? Was it love at the first sight or was it a 'chronic infection'?
During my internship while pursuing MBBS, I started liking Pediatrics. And if you like Pediatrics, then you are bound to love neonates.
Name 2-3 medical conditions or diseases or settings that you just love (in terms of professional affinity, teaching/handling/dealing with)? And why?
Dealing with RDS, PPHN and extreme prematurity.
Treating preemies at 24-28 weeks is a day-to-day challenge, and it is incredibly satisfying when babies successfully navigate through that critical period. You feel that you are contributing significantly to their journey. As a doctor, you observe, wait, and make anticipatory decisions to achieve the best outcomes for such babies.
Dealing with Respiratory Distress Syndrome (RDS) can be daunting, as it never presents in a very predictable way. However, treating RDS and making decisions regarding the course of action are always both challenging and enjoyable. When you apply your medical knowledge and skills, such as using surfactant or choosing between CPAP and SIMV (Synchronized Intermittent Mandatory Ventilation) or oscillatory ventilation, and these interventions lead to favorable outcomes for your patients, it fills you with immense satisfaction and a sense of adventure.
Persistent Pulomnary Hypertesnion (PPHN): Oh boy! Dealing with PPHN fills our hearts with challenges, anxiety, uncertainty, and a sense of being on a battlefield. Timely anticipation, accurate diagnosis, and taking the right and optimal steps are crucial for managing PPHN. Having excellent pediatric cardiology support is an added bonus during these critical moments.
The pathogenesis of which disease mesmerizes you? Or makes you hate so?
Prader-Willi Syndrome (15 p deletion). Uniparental Disomy- the phenomenon itself is very strange. When the deletion happens in the chromosome 15 contributed by father, we get Prader Willi, but when it happens from maternal side, we get Angelman Syndrome (Happy puppet).
What procedures you love doing or are very comfortable doing while caring for neonates?
Endotracheal intubation, chest compressions and even radial puncture.
What procedures you hate doing or are not very keen about it while caring for neonates?
PICC line insertion - no love for that, frankly.
What branches of Neonatology you like more than others? And Why?
Genetic disorders are my pet passion. I love reading about genetic and chromosomal disorders. Observing dysmorphic features and putting them together to make a diagnosis is always a satisfactory experience. Though most of the time, when we suspect a genetic disorder (if not diagnosed or alerted by antenatal testing), reaching out to a geneticist is the next step. But being part of the diagnosis and decision-making process, itself is interesting.
Which meds are your favorite or you like dealing with while treating babies?
Starting a Prostaglandin E1 (PGE1)/Alprostadil drip is no less than a roller coaster. And fiddling with D10W and its variants in challenging hypoglycemia is like going on a cruise. You feel a sense of triumph and joy when you overcome low blood sugars with measures like D12.5W, D15W, and even Diazoxides. Writing neonatal TPN/Hyperal is day-to-day fun in NICU.
Infectious Diseases: Which bugs are your favorite topics when it comes to dealing with/learning or facing them as a healthcare provider?
1. Group B streptococcus (GBS)
2. Herpes Simplex Virus (HSV)
3. Congenital CMV
4. Neonatal sepsis as such
The pathogenesis of which bug(s) mesmerizes you or makes it an enigma? Or makes you hate so?
Listeria monocytogenes when you realize that the bug thrives in refrigerated food.
Neonatal Cardiology: Tell us your pet points in the dreaded world of cardiology.
Dealing with hypoxemia is always a difficult situation. Excluding respiratory causes and focusing on the cues that lead to the pathway of cyanotic congenital heart disease requires careful attention and experience. Not dismissing soft signs (e.g., borderline O2 sats while not overplaying it) requires judgment and experience. Time is of the essence in such cases. I have traveled this path many times in my career, and every time it is a challenge and rewarding.
When was your first ever (independent) experience with endotracheal intubation and how did it go?
As a post graduate in India, I intubated the newborn who was blue. I had just started my PG, and this baby landed on the radiant warmer with a blue color. I was accompanied by my house officer and a couple of interns/med students, feeling as if I was the commander in chief! Luckily, I got it right, and the color change was instant. It was breathtaking for me, personally. (Note: I had some experience with intubating adults and pediatric patients prior to that, but having a blue baby put in your lap in an acute setting was something entirely new for me, and I still remember that baby/situation).
Who do you idolize in Neonatology? It could be a human or a something medical. And why?
Not idolizing, but I often refer to the sharp observations of Sister Jean Ward, a British nurse who noticed - in 1950s- the relationship between sunlight exposure and improvement in jaundice.
What is your take when the topic of neonatal jaundice comes?
Dealing with neonatal jaundice is a day-to-day affair for us - neonatologists. Yet, we take it seriously.
Has neonatal jaundice made you unsettled ever?
I have seen serum bilirubin levels in the 30s (while doing my Peds residency in India, where families from remote villages would walk down to our hospital in Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram with babies as yellow as turmeric). I have done quite many exchange transfusions in India. In the USA, I have encountered occasional situations as well. However, serum bilirubin levels can be troubling, and like every neonatologist, I have had my share of dealing with levels between 18-25 mg %, with each situation being unique in its own way.
Have you ever used laryngeal mask airways (LMA) for ventilation during neonatal resuscitation?
Nope so far.
Too many to count. But I am glad that I was able to sign up Udit Narayan ji and Kailash Kher for the two songs for my web series "Transparency Pardarshita" (long stories to be narrated for some other occasion). Accomplishing each song from beginning to end was an episode in itself. Making the web series was a long and unpredictable journey.
If given a choice, what alternate career would you have opted for?
When I graduated from med school, I was weighing the options between clinical and Forensic Medicine. I ended up in Pediatrics as I couldn't muster the courage to choose Forensic Medicine over a clinical specialty (although I still like Forensic Med).
In the USA, while I opted for Neonatology, I developed a liking for Pediatric Endocrinology because of its mathematical nature. The Genetics rotations during my Pediatrics residency also interested me a lot.
After years of clinical practice, my interest in Public Health has steadily increased over the years.
What else would you like to tell about yourself?
The lives of Martin Luther King and Nelson Mandela continue to inspire me. Policy and democracy reforms are my passions.