Babies with Congenital Cardio Pulmonary Malformation
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
REGISTRATION OF DISSERTITION
Name of the candidate and address / Dr.VARSHINI.P
Name of the institution / SREE RAJARAJESWARI MEDICAL COLLEGE AND HOSPITAL
Course of study & subject / MD PAEDIATRICS
Date of admission to course / 29.05.2013
Title of the study / STUDY OF SERUM SODIUM POTASSIUM AND CALCIUM LEVELS IN PERINATAL ASPHYXIA AND NEONATAL DEPRESSION
6. BRIEF OF THE INTENDED WORK:
6.1 : INTRODUCTION
Perinatal asphyxia is one of the most common primary cause of mortality(28.8%) and morbidity among neonates in India and is the commonest cause of still birth
(45.5%).
Failure to initiate and sustain breathing immediately after delivery is associated with hypoxic ischemic injury to central nervous system leading to long term neurodevelopmental disorder among survivor1,2.
6.2 Need For Study:
This study is done to find out any correlation of levels of sodium, potassium, calcium with different severity of neonate born with perinatal asphyxia.
Any deviation of above mentioned parameters from their normal levels in blood might cause convulsion, shock, and other metabolic abnormality.
Knowledge of these abnormalities to clinician is very valuable as it is an important variable affecting perinatal mortality.
6.3 Review of literature:
Gold standard definitionof birth asphyxia does not exist. It is better to use the term as perinatal asphyxia as asphyxia can occur in utero, at birth or postnatal period. WHOdefined birth asphyxia as “failure to initiate sustained breathing at birth”. The National Neonatal Perinatal Database2000 used similar definition for perinatal asphyxia as moderate if there is slowgasping breathing or APGAR 4-6 at one minute of age.
Severe asphyxia was defined as no breathing or APGAR score of 0-3 at 1 minute of age. As per AAP (American Academy of Pediatrics) and ACOG (American College of Obstetrics and Gynecology), all the following must be present for designation of asphyxia (a) profound metabolic or mixed acidemia (ph <7) in cord. (b)Persistence of APGAR scores 0-3 for longer than 5 min (c) neonatal neurological sequale(eg: seizures coma hypotonia) (d) multiple organ involvement (kidney, lungs, liver, heart, intestine).
According to NNPD 2003 data collected from 17 tertiary neonatal ICU in India, APGAR score <7 at 1 min (includes moderate and severe asphyxia) were documented in9%of all intramural deliveries. 2.5% babies continued to have APGAR <7 at 5 min. 20% of perinatal asphyxia was responsible for20% of neonatal deaths.
Severe consequences of asphyxia lead to multiorgan dysfunction. In term infants with asphyxia, renal, central nervous system, cardiac and lung dysfunction occur in 50%, 28%, 25%, 25%cases respectively.Hypoxic ischemic brain damage is the most important consequence of perinatal asphyxia.
The extent of organ system involvement determines the outcome of asphyxiated neonate. Metabolic involvement may include hypocalcaemia, hyponatremia (as a result of SIADH ordirect renal injury), and alterations in glucosemetabolism3.
Palab basu et al4studied the correlation of serum electrolytes and calcium levels in asphyxiated babies of different severity, he found serum sodium and calcium levels were significantly lower and serum potassium was higher in cases than controls. Hence he concluded hyponatremia and hypocalcaemia developed early and simultaneously and decrease in their serum level was directly proportional to each other and to the degree of asphyxia.
Shah GS et al5did hospital based observational study from feb 2010 to jan 2011and concluded neonates having birth asphyxia had metabolic derangements like hyponatremia, hypocalcaemia and hypoglycemia. He also noted other complications of acute renal failure moderate and severe asphyxia
Gupta et al6 showed lower serum sodium levels among asphyxiated babies as compared to the control group and no statistically difference in the serum potassium levels between cases and controls.
Varma vandana et al7carried out a study to determine status of basic biochemical and hematological parameters in asphyxiated babies and their relation with APGAR score and HIE staging and development of ARF. Electrolyte status showed no significant variation in cases and controls. Highly significant rise was seen in blood urea and serum creatinine values.
Alphonsus .N.onyiriuka8studied serum calcium levels in asphyxiated newborns found overall prevalence of early onset neonatalhypocalcaemia among infants with severe birth asphyxia. The mean total serum calcium levels in bicarbonate treated infants were higher than their counterpart without bicarbonate therapy.
Jajoo et al9measured serum calcium and phosperous in neonates with perinatal asphyxia and he found significant low calcium levels in asphyxiated infants than controls.
6.4 Objectives of study:
1. To analyze the electrolyte status in asphyxiated newborns and neonatal depression incomparison with normal newborns
MATERIAL AND METHODS:
7.1 Source of data analysis
Study Group:Case and control are selected based on inclusion and exclusion criteria admitted in RRMCHBENGALURU.
Study design: Case control study
Inclusion criteria:
Study group:1) Babies with APGAR score of less than 7 at 1 minute.
2)History of delayed cry at birth.
3) Intrapartum signs of fetal distress as indicated by non reassuring
NST on continuous electronic fetal monitoring.
4) Intrauterine growth retardation.
Control group: Full term new born babies with APGAR score more than 7 at 1 minute.
Exclusion criteria:
- Babies with congenital cardio pulmonary malformation
- Those born mother with diabetes mellitus and hypertension treated with diuretics, general anaesthesia, phenobarbitone, pethidine, magnesium sulphate and other drugs likely to cause depression.
- Suspected metabolic diseases.
- Neonates born to mothers on anti epileptics.
7.2 Method of collection of data:
Cases were selected based on inclusion criteria and detailed clinical examination was done and physical findings were recorded on pre designed proforma After informed consent obtained from parents sample was collected and following investigations were done hemoglobin, total count. Differential count, serum sodium potassium and calcium.
PROCEDURE:Serum electrolytes will be analyzed by automated machine.
Plan for data analysis: Descriptive statistics for representation of data.
Appropriate test of significance will be used to analyze the data.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
ANIMALS:Nil
OTHER HUMANS: Serum sodium, potassium and calcium levels to be estimated in normal newborn taken as controls
ON PATIENTS : Serum sodium, potassium, and calcium levels to be estimated in asphyxiated newborns taken as cases
INTERVENTIONS: NIL
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
The study has been submitted for ethical clearanceand clearance has been obtained.
8. LIST OF REFERENCES:
- NNPD Network.National Neonatal Perinatal Database – ReportFor The Year 2002 – 2003. NNF NNPD Network. New Delhi:2005.
- Apgar V. A Proposal For A New Method Of Evaluation Of TheNewborn Infant.Curr Res Anesth Analg1953; 32: 260-267.
- Agarwal R, Jain A, Deorari Ak, Paul Vk. Postresuscitation Management Of Asphyxiated Neonates. Indian J Of Paediatr 2008;75:85‐90.
- Pallab Basu,Sabyasachi Som1, Harendranath Das And Nabendu Choudhuri.Electrolyte Status In Birth Asphyxia.Indian J Pediatr 2010; 77 (3) : 259-262]
- Shah Gs ,Agarwal J.Clinico-Biochemical Profile Of Neonates With Birth Asphyxia In Eastern Nepal 201;32(3)
- Gupta Bd, Sharma P, Bagla J, Parakh M, Soni Jp. Renal FailureIn Asphyxiated Neonates.Indian Pediatrics2005; 42: 928-934.
- Varma Vandana, Varma Amit, Varma Meena, Bharosay Anuradha, Bharosay Vivek, Varma Deepak. Study Of Basic Biochemical And Haematological Parameters In Perinatal Asphyxia And Its Correlation With Hypoxic Ischemic Encephalopathy Staging. Journal Of Advance Researches In Biological Sciences 2011; 3(2):79-85.
- Alphonsus.N.Onyiriuka.Prevalaence Of Neonatal Hypocalcaemia Among Full Term Infants With Severe Birth Asphyxia.Pacific Journal Of Medical Science 2011;8:
- Jajoo D, Kumar A, Shankar R, Bhargava V. Effect Of BirthAsphyxia On Serum Calcium Levels In Neonates.Indian J Pediatr1995; 62: 455-459.
10 / REMARKS OF THE GUIDE / Outcome of the study will provide guidelines for better management of birth asphyxia.
11.1 / NAME AND DESIGNATION OF GUIDE / DR. TAMILSELVAN
PROFESSOR AND UNIT HEAD
DEPT OF PAEDIATRICS RRMCH, KENGERI,
BENGALURU
11.2 / Signature
11.5 / Head of Department / DR.ADARSHA.E
PROFESSOR AND HOD
DEPT OF PAEDIATRICS
RRMCH, KENGERI,
BENGALURU
11.6 / Signature
12.1 / Principal
12.2 / Signature