Dr. István Kocsis

In Hungary, infant mortality, including premature deaths, has shown a strong downward trend in the last five years. It is no coincidence: the field of neonatology has seen dramatic progress in recent years. The success can be attributed to the combined result of a change in professional attitudes, developing technology and medical science, believes Dr. István Kocsis, associate professor, head of the neonatology department at TritonLife Róbert Private Hospital, chief physician of infant and pediatric medicine, anesthesiologist and neonatologist, and an internationally recognized representative of the science dealing with newborns.

Infant mortality has decreased by more than 30% in the past five years. Why is this an important result?

– The earlier a baby is born, the greater the likelihood that he will develop serious complications, permanent damage, and later become a child with special educational needs. The goal of one of the most dynamically developing parts of medicine, dealing with newborns and premature babies, is now not only to fight for the survival of seriously ill or extremely immature babies, but also to avoid serious, permanent complications.

You are a prominent representative of the view that in order to improve the development of a premature child, parents have a place next to the baby, even in the intensive care unit

– Our clear experience is that the more the parent is involved in the care of the baby in the intensive care unit, the better the baby develops and the fewer complications he develops. By establishing skin-to-skin contact, the baby feels the warmth of the body, the heartbeat, breathing, and voice of the parent, which is an important condition for early bonding in the moments after birth. The benefits of the kangaroo method are also invaluable in the following days and weeks in premature care. The essence is that the baby spends as much time as possible in direct skin-to-skin contact on the mother's or father's chest - if his condition allows, even with respiratory support.

From what week is a newborn viable?

- The current limit is around the 23rd-24th week of pregnancy. At this stage of development, many premature babies have a good chance of surviving, but permanent complications occur in a high proportion until the 26th-28th week of pregnancy. At the limit of viability, each extra day spent in the protection of the uterus reduces the risk of developing serious complications by up to 3%. A baby born at 29 weeks of gestation has a much lower chance of serious, permanent complications, and with proper care, physiotherapy, and extra attention, they can quickly catch up with their peers born at term in development. And besides, I cannot emphasize enough the importance of family-centered care from the first day of life.

Among other things, the approach you represent plays a big role in this: after the premature intensive care unit, you also run the newborn ward of the TritonLife Róbert Private Hospital along family-friendly guidelines

– Indeed, although it must be emphasized that there is no premature intensive care unit in Róbert, mostly healthy, full-term babies are born here. The great success of recent years is that maternity wards are increasingly trying to provide elements of a family-centered birth experience. In our hospital, it is possible to choose birth positions that differ from the classic positions. There is a possibility of giving birth in water. Dads were allowed to attend the birth even during the COVID pandemic and could stay with the mother and newborn until they were discharged home. After the birth, the “Golden Hour/Hours” option is available to everyone, as well as skin-to-skin contact (in the case of a cesarean section, fathers are also included in skin-to-skin contact). It should be mentioned separately that there is also the option of a “Gentle Caesarean Section”, an element of which is that the newborn remains on the mother’s chest from the moment of birth throughout the operation.

As the head of the neonatology department, how did you manage to ensure family-friendly care in the neonatal ward?

– In accordance with the rooming-in approach we apply, the baby can be with the mother and father 24 hours a day, and we do not interrupt the mother-child relationship for even a minute during the hospitalization. All examinations and interventions take place in the presence of the parents, and we avoid any situation that would disrupt the experience of childbirth and the process of becoming a family. We organize all medical and nursing activities in such a way that patient safety is as high as possible, but we have also refined the methods of health interventions so that parents feel the “classic hospital feeling” as little as possible.

Did you always want to be a doctor?

– From my teenage years until university, I was an orienteer and an active sportsman, but I was also always attracted to natural sciences, and when choosing a career, I was primarily interested in the medical profession. I also decided early on that I wanted to become a neonatologist and pediatrician. I obtained my general medical degree at Semmelweis University in 1998. But already in 1996 – even before I graduated – I participated in the work of the Peter Cerny Premature Foundation Ambulance Service, and then I worked as a nurse in the premature unit of Semmelweis University. The topic of my PhD degree was also related to the physiology of premature babies, which I defended at the First Pediatric Clinic of Semmelweis University in 2002. The infant and pediatric specialty examination was followed by the anesthesiology and then the neonatology specialty examination. I am also proud of the fact that I headed the Pediatric Department of the Szent Lázár County Hospital in Salgótarján for a period of one year. I gained lifelong experiences that I was able to put to good use later on. This was followed by a five-year, very intensive and challenging period, during which I was the head of the Perinatal Intensive Care Unit of the 2nd Department of Obstetrics and Gynecology of Semmelweis University. During this period, in addition to the complete reconstruction and development of the equipment of the premature intensive care unit to Western standards, I was also able to participate in shaping its approach. In addition to promoting non-invasive care, in the spirit of family-centeredness, in 2015 we were the first in Hungary to implement premature baby-mother rooms, where mothers could not only visit their children 24 hours a day, but the incubator itself was also right next to the mother’s bed – thus, we involved mothers in the care of premature babies from the very early stages of their premature birth. Thanks to this, not only were we quickly vindicated by the numbers, positive results, and feedback, but we also managed to create an intensive care unit that is outstanding even at the Western level, together with our colleagues and professional staff.

What professional goal have you set for yourself?

Currently, the development of perinatology is my main interest. This branch of science covers the second and third trimesters of pregnancy and the months immediately after birth. It mainly involves the care of fetuses at risk for some reason in the womb, but it also includes the prevention of premature birth, the care of premature babies and sick newborns, in which obstetric and pediatric professional knowledge meets and even overlaps. This requires, in addition to close cooperation and joint thinking with obstetrics, the knowledge and learning of obstetric aspects as a neonatologist. In America, this is a separate specialized exam, but in Hungary there is still no separate and specifically specialized group of professionals. However, it would also be of particular importance because the development of perinatology could further reduce the number of fetal and premature deaths. I am a restless type, I believe that it is essential not only to follow the development of the medical profession – since medical knowledge can be completely renewed in just a few years – but also to have new perspectives and forward-looking ideas, and to implement these we must have the necessary will, faith and perseverance. My will to do is also shown by the fact that I am not only closely interested in healing on a medical level, but I have also tried and am trying to understand its economic aspects, so that I can help my little patients even more and better. As a result, in 2020 I obtained a master's degree in the Health Management Training Department of Semmelweis University.

Is sport still a hobby in your life?

Yes, I orientate 2-4 times a week, as time allows. In the summer, in addition to running and hiking, I get my energy from paddle boarding (SUP – stand up paddle) on natural waters. Great terrain for this in our country is Lake Balaton, Lake Velence, or even Lake Tisza a little further away. Running in the forest is a pleasant feature of my place of residence: because although I am originally from Jász, I have been living in Nagykovácsi for more than 10 years, where, literally living next to the forest, nature is at my fingertips.