Profile of Children with Heart Defects Registered Under Rashtriya Bal Swasthya Karyakram and Effect of COVID-19 on Referral at a Newly Established Center of Northern India

Dear Editor, Congenital heart defect (CHD) is one of the most common birth defects[1] and is emerging as a major public health problem in India. Rashtriya Bal Swasthya Karyakram (RBSK) is a unique program dealing with 4 Ds that includes birth defects,[2] in which children are screened and provided with all the care of various specialties under a single roof free of cost under National Health Mission. The advent of COVID-19 pandemic compromised already limited pediatric cardiac services in India[3] and also affected the services under the RBSK program. A recent multicentric study from 24 centers across India found 74.5% reduction in outpatient services during the pandemic.[4] Multiple reasons such as nationwide lockdown, fear of the pandemic, closure of schools (no active screening was possible), RBSK team being engaged in COVID-19-related activities, and the majority of Tertiary Care Hospitals, especially in government sector were converted into COVID-19 care facilities. A retrospective hospital-based study was carried out where all consecutive cases from September 2017 to August 2022 (suspected or diagnosed elsewhere) with heart defects referred to the Pediatric Cardiac Unit, JNMCH established under the RBSK Scheme were included. The study was divided into two eras first between September 2017 and March 2020 (pre-COVID-19) and second between April 2020 and August 2022, to study the impact of COVID-19 on the referrals of the patients. A total number of 9889 patients were referred to District Early Intervention Centre, out of which 2311 patients were of heart defects and were from 70 districts of Uttar Pradesh. There were 1344 patients with CHD registered during pre-COVID-19 phase; however, this number came down to 967 during COVID-19 period. The referral was the majority of 6–18-year age group with very few referrals in the neonatal period. COVID-19 has impacted uniformly all the age groups, the surgeries and interventions also decreased substantially during the pandemic. Our analysis showed a total of 23.5% of patients with heart defects were referred to our center which is similar to previous studies.[5] The maximum number of patients in the age group of 6–18 years was likely due to an active search of cases in schools by the RBSK team. But what was concerning was the dismally low numbers of neonates and infants being referred. This points toward major lacuna in the screening as this is the age of presentation of critical CHDs which need immediate attention. The district-wise referral showed an irregular pattern where a few districts showed a higher referral as compared to other districts. This nonuniform referral pattern seen in our study is dependent on various factors such as proficiency of the screening team and their active efforts in the detection of CHD, approachable destination, and motivated parents. There is ever ever-increasing number of children waiting for definitive surgeries. Thus, we need to step up the number of elective procedures by increasing the number of pediatric cardiac centers, especially in the state of Uttar Pradesh. RBSK is a unique initiative in which there is a comprehensive evaluation of the child, especially children with CHDs. It is because of this program, lot of children with heart defects even from the remotest area have received timely intervention and are thriving well. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.