Dr. Nivedita Seehra

Eczema, or atopic dermatitis, is one of the most common chronic inflammatory skin conditions in children and is closely linked to allergy. It is part of the atopic march, the sequence of allergic conditions that often begins with eczema in infancy, followed by food allergy, then allergic rhinitis, and then asthma as a child grows. Eczema is driven by a combination of skin barrier dysfunction and immune system dysregulation that produces an inflammatory response in the skin, particularly in response to irritants, allergens, and infections. In many children, specific food allergens such as cow's milk, egg, peanut, wheat, and soy are triggers for eczema flares, particularly in infants and younger children with moderate to severe disease. Environmental allergens, including house dust mite and moulds, become more relevant as triggers in older children. The management of childhood eczema is structured around three principles: first, regular daily emollient use to restore and maintain the skin barrier, which reduces the frequency and severity of flares; second, topical anti-inflammatory treatment with topical corticosteroids or topical calcineurin inhibitors for active flares; and third, allergen assessment and avoidance, which requires identifying the specific triggers relevant to this child rather than applying blanket restrictions. At Nest Pediatric Clinic, Tilhari, Jabalpur, I assess children with eczema for associated allergic conditions, perform allergy evaluation where appropriate, and develop a personalised management plan that addresses both the skin care routine and the immunological triggers driving the flares.

Yes, and a specialist assessment is appropriate after two or more episodes of wheezing in a child, particularly when episodes are occurring more than once or twice a year, when a bronchodilator has been needed to manage an episode, when episodes are associated with specific triggers such as allergen exposure, cold air, or exercise, or when the child has other features of allergic disease such as eczema or persistent nasal symptoms. Treating each episode of wheezing individually without investigating the underlying cause means that the condition driving the recurrence is never identified and addressed. In many children with recurrent wheezing, the underlying mechanism is asthma, allergic airway disease, or both, and the appropriate management is not a repeat course of oral steroids and nebulisers at each episode, but rather a structured long-term treatment plan that includes a regular inhaled corticosteroid to reduce airway inflammation, a short-acting bronchodilator as a reliever, trigger identification and avoidance, and a written asthma action plan for parents. At Nest Pediatric Clinic, Tilhari, Jabalpur, I provide specialist allergy and asthma assessment for children with recurrent wheezing, using a detailed clinical history, examination, and where appropriate, objective lung function assessment, to identify the underlying mechanism and develop an individualised management plan.

Neonatal jaundice, the yellowing of the skin and whites of the eyes that appears in the first days of life, is one of the most common conditions in newborns and is caused by the accumulation of bilirubin, a yellow pigment produced when red blood cells break down. Most jaundice in healthy newborns is physiological, meaning it is driven by the normal, expected transition from fetal to newborn red blood cell physiology, peaks between day 2 and day 4 of life, and resolves on its own without treatment by 2 weeks in full-term infants. However, jaundice that appears in the first 24 hours of life is always abnormal and requires urgent assessment. Jaundice that is progressing rapidly, that is reaching a level determined by the baby's age in hours and gestational age to require treatment, or that is associated with a sick or unwell baby, also requires prompt medical management. Treatment for significant neonatal jaundice is phototherapy, where the baby is placed under special blue-spectrum lights that break down bilirubin in the skin, reducing the level safely and avoiding the rare but serious complication of kernicterus, where very high bilirubin levels cause brain damage. In severe cases, an exchange transfusion may be required. At Nest Pediatric Clinic, Tilhari, Jabalpur, and Jabalpur Hospital and Research Centre, I assess all newborns with jaundice using clinical evaluation and bilirubin measurement, and I initiate phototherapy promptly when indicated.

The IAP Fellowship in Neonatology is the subspecialty training pathway accredited by the Indian Academy of Paediatrics for neonatologists in India. It requires structured training at an approved neonatal centre and specifically covers the management of premature and low birth weight infants, neonatal intensive care interventions including respiratory support and monitoring, neonatal infections and sepsis management, neonatal jaundice assessment and treatment, feeding support for preterm and very low birth weight babies, and the structured high-risk infant follow-up programme that NICU graduates require as they grow and develop. This training goes beyond what the DCH or MD Paediatrics alone provides in the neonatal domain. As a clinician holding the IAP Neonatology Fellowship, I am trained to care for the smallest and most vulnerable newborns, including premature infants born as early as 28 weeks, infants who require ventilatory support, and babies with complex neonatal conditions that need intensive monitoring and specialist intervention. At Nest Pediatric Clinic, Tilhari, Jabalpur, and Jabalpur Hospital and Research Centre, this means that families whose newborn requires specialist neonatal care have access to Fellowship-trained expertise in Jabalpur without needing to transfer to a tertiary centre in another city.