RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE I
M.D. PAEDIATRICS
RAJARAJESWARI MEDICAL COLLEGE AND HOSPITAL,
BANGALORE- 560074
“CLINICAL AND ECHOCARDIOGRAPHICAL PROFILE OF CONGENITAL HEART DISEASES IN INFANTS AT A TERTIARY CARE HOSPITAL”
BY:
DR. HANUMANTHU VISHNUPRIYA
POST GRADUATE STUDENT
DEPARTMENT OF PAEDIATRICS,
RAJA RAJESWARI MEDICAL COLLEGE AND HOSPITAL,
BANGALORE – 560074
UNDER GUIDANCE OF:
GUIDE NAME:
DR. TAMIL SELVAN
PROFESSOR
DEPARTMENT OF PAEDIATRICS,
RAJA RAJESWARI MEDICAL COLLEGE AND HOSPITAL,
BANGALORE - 560074
HEAD OF DEPARTMENT
DR. ADARSH E.
PROFESSOR & HEAD
DEPARTMENT OF PAEDIATRICS,
RAJA RAJESWARI MEDICAL COLLEGE AND HOSPITAL,
BANGALORE- 560074
SYNOPSIS FOR PG DISSERTATION FOR MD/MS,
UNDER RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE.
NAME OF THE CANDIDATEAND
ADDRESS
(IN BLOCK LETTERS) / DR. HANUMANTHU VISHNUPRIYA
POST GRADUATE STUDENT
DEPARTMENT OF PAEDIATRICS,
RAJA RAJESWARI MEDICAL COLLEGE HOSPITAL, BANGALORE
NAME OF THE INSTITUTION / RAJA RAJESWARI MEDICAL COLLEGE HOSPITAL, BANGALORE
COURSE OF THE STUDY AND SUBJECT / M.D. IN PAEDIATRICS
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU KARNATAKA
ANNEXURE II
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATEAND ADDRESS
(in block letters) / DR. HANUMANTHU VISHNUPRIYA
POST GRADUATE STUDENT
DEPARTMENT OF PAEDIATRICS,
RAJA RAJESWARI MEDICAL COLLEGE HOSPITAL, BANGALORE
2. / NAME OF THE INSTITUTION / RAJA RAJESWARI MEDICAL COLLEGE HOSPITAL, BANGALORE
3. / COURSE OF STUDY AND SUBJECT /
M.D. DEGREE IN PAEDIATRICS
4. / DATE OF ADMISSION TO COURSE / 30th MAY 20125. / TITLE OF THE TOPIC / “CLINICAL AND ECHO- CARDIOGRAPHICAL PROFILE OF CONGENITAL HEART DISEASES IN INFANTS AT A TERTIARY CARE HOSPITAL”
6. / BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY
Congenital heart disease (CHD) refers to structural and functional defects of the heart due to abnormal development of the heart before birth. CHD affects about 8-10 per 1000 live births and is a leading cause of infant mortality(1)(2). The burden of CHD in India is enormous due to very high birth rate. It is known that 1,80,000 children are born with CHD every year in India. Approximately 10% of present infant mortality in India may be accounted for the CHD alone(3).
Although surgical and technological innovations have greatly advanced treatment of cardiovascular diseases in adult patients, treatment of infants and adolescents has not kept in pace even in advanced countries(4). The most obvious reason for this situation is that children are not smaller adults. If they were, the appropriate miniaturization of instruments and equipment, scaling down from adults to children, would be sufficient. However, when considering interventions in neonates, even fetuses, one must remember that they exhibit marked physiological characteristics that distinguish them from adults, such as increased heart rate and immature tissue development.
Unfortunately the privilege of early diagnosis and timely management is restricted to children in developed countries only. Majority of children with CHD in developing countries like India are under diagnosed and thus leading to major cause of mortality and morbidity(5). About 25% of CHDs are life-threatening and may manifest before the first routine clinical examination(6). Challenges for CHD management in developing countries include early diagnosis, transport of a sick neonate with CHD to a tertiary care centre, and limited availability of the state of the art pediatric cardiac centres(7).
The purpose of this study is to describe the clinical profile of all infants with congenital heart diseases in a tertiary care hospital.
6.2 REVIEW OF LITERATURE
The incidence and prevalence of CHDs depend upon several factors like sample collection, (all live births or all births), the source of information, on the spot examination by an expert pediatric cardiologist. The incidence is higher, if spontaneous abortions are also included. The reported incidence of CHDs in infants ranges between 3.7 – 17.5 per 1000 live births(8)(9)(10). World Health Organization reports, among all cardiovascular diseases, the incidence of congenital heart disease in India 15%, in Bangladesh and Myanmar is 6% each, and 10% in Sri Lanka.(11)The relative frequency of the most common lesions varies with different reports, but nine common lesions form 80% CHDs.(12)
The clinical presentation of these babies with CHDs were described as murmurs, precordial pulsations, central cyanosis and respiratory distress in different percentages. The clinical presentation of CHD varies with type and severity of defect.(13) In neonatal period the presenting feature of CHD are cyanosis (with or without respiratory distress), heart failure (with or without cyanosis) collapse, an abnormal clinical sign detected during routine clinical examination (e.g., absent femoral pulse or presence of a heart murmur).(14)
In infancy, the usual presenting features are cyanosis, digital clubbing, murmur, syncope, squatting, heart failure, arrhythmia, and failure to thrive. The spectrum of CHDs is varying with age of infant presentation to the hospital.(15)
6.3 AIMS AND OBJECTIVES OF THE STUDY
AIM:
The aim is to study the clinical and Echocardiographical profile of congenital heart diseases in infants at a tertiary care hospital.
OBJECTIVES:
1. To document the common symptoms and signs in infants and inborn babies presenting with congenital heart disease.
2. To study the variants of congenital heart disease in infants and inborn babies by doing Echocardiography.
7 / MATERIALS AND METHODS
7.1 SOURCE OF DATA
A prospective descriptive study conducted in pediatric patients (infants) both out-patients as well as in-patients and inborn babies in Raja Rajeswari Medical College Hospital, Bangalore during the period of one year from 01 December 2012 to 30 November 2013.
7.2 METHOD OF COLLECTION OF DATA :
A prospective clinical study on infants attending the OPD of department of Paediatrics and inborn babies and infants with congenital heart diseases at Rajarajeswari Medical College and Teaching Hospital, Bangalore will be included in this study.
The data will be collected from patients who will meet the inclusion criteria and the exclusion criteria after taking informed written consent.
Investigations like Bedside pulse-oximetry, ECG, Chest X-ray and Echocardiography are to be performed as and when needed to assess clinical severity and for accurate diagnosis
All infants and inborn babies with congenital heart disease attending the hospital during the study period of one year will be taken as the sample size.
INCLUSION CRITERIA
All infants and inborn babies with congenital heart diseases who attend to RajaRajeswari Medical college Hospital, Bangalore from 01 Dec 2012 to 30 November 2013 are included in the study.
EXCLUSION CRITERIA
Exclusion Criteria:
1. All babies who need emergency life saving non-cardiac surgery and near fatal cases are excluded from the study.
2. Hepatic or renal disease.
3. Malabsorptive disorders
4. Malignancy
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER ANIMALS, IF SO PLEASE DESCRIBE BRIEFLY.
YESInvestigations or Procedures:
a) CBC (complete blood count)
b) ECG (Electrocardiography)
c) Chest X-Ray
d) 2 D- ECHO Cardiography
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3? YES
LIST OF REFERENCES
1. Hoffman JIE., Kaplan S., “The incidence of congenital heart disease”, JACC, 2002;39:1890-1900
2. Saxena A., “Congenital heart disease in India: A status report”. Indian J. Pediatr., 2005;72(7): 595-598
3. Saxena A.,” Consensus on timing of intervention for common congenital Heart Diseases: Working group on management of Congenital Heart Disease in India”. Indian Pediatrics. 2008;45:117-126
4. Claude Lenfant., “Report of task force on Research in Pediatric Cardiovascular Disease”, Circulation, 2002;106:1037-1042.
5. Wren C., Reinhardt Z., Khawaja K., “Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations”. Arch Dis Child Fetal Neonatal Ed. 2008;93:F33-F35
6. Bakshi KD., Vaidyanathan B., Sundaram KR., Roth SJ., Shivaprakasha K., Rao SG., et al., “Determinants of early outcome after neonatal heart surgery in a developing country”. J Thoracic Cardio Vascular Surgery. 2007;134:765-771
7. Boneva RS., Botto LD.,Moore CA., Yang Q., Correa A. and Erickson JD. “Mortality associated with congenital heart defects in the United States: Trends and racial disparities 1979- 1997”, Circulation 2001; vol 103:no.19:2376-2381
8. Bolisetty S., Daftary A., Ewald D., Knight B., Wheaton G., “Congenital heart defects in Central Australia”. Med J Aust 2004;180:614-617
9. Khalil A., Aggarwal R., Thirupuram S., Arora R. “Incidence of congenital heart disease among hospital live births in India”. Indian Pediatrics 1994; 31: 519-527
10. Aggarwal R.and Srivasthava S. et al 2009 and ICMR Bulletin Communicable and noncommunicable diseases working group report 2011
11. Malik A., “Problems of cardiovascular disease in Bangladesh & other developing countries. Proceeding of the Bangladesh and Japan joint conference on CVD Dhaka, Bangladesh”, 1984
12. Jackson M., Walsh KP., Peart I., Arnold R. “Epidemiology of congenital heart disease in Merseyside -1979-1988”. Cardiol Young 1996; 6: 272-280
13. Kitchiner DJ., “Cardiovascular disease “in Mcintosh N., Helms PJ., Smyth RL. 6th Ed Forfer & Arneil’s “Textbook of Pediatrics”. Edinburgh. Churchil Livingston. 2003; 815-888
14. Vaidyanathan B., Satish G., Thoppil S., Mohanan., Sundaram KR., Warrier KKR. and Kumar RK. “Clinical screening for congenital heart disease at birth: prospective study in a community hospital in Kerala”. Indian Pediatrics. 2011; 48: 25-30
15. Kapoor R., Gupta S. “Prevalence of congenital heart disease, Kanpur, India”. Indian Pediatrics;2008; 45:309-311
9. / SIGNATURE OF THE CANDIDATE /
10. /
REMARKS OF THE GUIDE
/ Early identification and assessment of the risk profile of congenital heart diseases with an intention for early intervention will reduce the morbidity and mortality in infants with CHDs.11 / NAME AND DESIGNATION
(in Block Letters)
11.1 GUIDE / DR. TAMIL SELVAN
PROFESSOR
DEPARTMENT OF PAEDIATRICS,
RAJA RAJESWARI MEDICAL COLLEGE HOSPITAL, BANGALORE
11.2 SIGNATURE OF THE GUIDE
11.3 HEAD OF DEPARTMENT / DR. ADARSH E.
PROFESSOR & HEAD
DEPARTMENT OF PAEDIATRICS,
RAJA RAJESWARI MEDICAL COLLEGE HOSPITAL, BANGALORE
11.4 SIGNATURE OF HEAD OF
DEPARTMENT
12 / 12.1 REMARKS OF THE CHAIRMAN
AND PRINCIPAL / PRINCIPAL,
RAJA RAJESWARI MEDICAL COLLEGE HOSPITAL, BANGALORE
12.2 SIGNATURE
PROFORMA
Hospital:
Case No. IP No.:
Informer : Age:
Name of the patient: Sex:
Address: DOA:
DOD:
DIAGNOSIS:
PRESENTING COMPLAINTS :
· Cyanosis
· Feeding problem
· Hurried respiration
· Not gaining weight
· Excessive forehead sweating
· Decreased urinary output
· Puffiness of face / eyes
· Convulsion / Neurological deficit
PAST HISTORY:
· Respiratory tract infection
· Feeding Problem
· Previous hospitalisation
FAMILY HISTORY:
· Consanguity of marriage:
· Any H/o heart disease in the family:
· Health status of –Parents: -Siblings:
· Socio- Economic status (as per BG Prasad’s Classification):
ANTENATAL HISTORY:
· Health of mother during pregnancy:
· Any exanthematous lesions in mother:
· Irradiation / Drug intake during pregnancy:
NATAL HISTORY:
· Home delivery:
· Hospital delivery:
POSTNATAL HISTORY:
· Weight at birth:
· Cyanosis at birth:
· Hurried respiration:
· Feeding difficulty:
· Any NICU admission: If yes, duration of stay:
PHYSICAL FINDINGS:
A) VITALS:
PULSE
· Rate
· Rhythm
· Volume
· Peripheral pulses
· Radio-femoral delay
RESPIRATORY RATE
CAPILLARY REFILLTIME
BLOOD PRESSURE
TEMPERATURE
SPO2
B) ANTHROPOMETRY:
WEIGHT:
LENGTH:
HEAD CIRCUMFERENCE:
CHEST CIRCUMFERENCE:
SYSTEMIC EXAMINATION:
A) CARDIOVASCULAR EXAMINATION :
· Precordium :
· Shape of the chest :
· Apical impulse
- Location :
- Nature :
· Any other visible pulsations :
· Parasternal heave :
· Thrill :
· Heart sounds :
· Murmur :
- Location :
- Timing :
- Nature :
- Quality :
- Conduction/ Radiation :
B) RESPIRATORY SYSTEM:
C) PER ABDOMEN :
D) CENTRAL NERVOUS SYSTEM :
INVESTIATIONS :
i. CBC
· Hb :
· TLC :
· Hct :
ii. ECG :
iii. CHEST X-RAY:
iv. ECHOCARDIOGRAPHY :
SURGERY / INTERVENTION :
FOLLOW-UP :
ANY OTHER REMARK:
INFORMED CONSENT FORM
I have been explained and have understood all the details (need, type, duration) about this study “EVALUATION OF CLINICAL SPECTRUM OF CONGENITAL HEART DISEASES IN INFANTS AT A TERTIARY CARE HOSPITAL” and I have had the opportunity to ask relevant questions related to this study. I understand that inclusion of my ward ______in this study is voluntary and that I willingly allow doctor, staff or hospital authority to examine and perform the required tests as per my affordability which will assist them in this study. I understand that all those working with this study have access to my ward’s medical records without my permission. I agree not to restrict the use of data or results that arise from this study for scientific purpose. After understanding all the details, I willingly allow my ward to be included in this study and give full consent for the same.
I will not hold the doctor/ (s), staff, or hospital authority responsible if any untoward consequences happen to my ward during the study period.
Dt: Signature of the parent / guardian
(Name : )
Witnesses:
1.
2.