RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS
(In block letters)
/ DR. KEERTHI.S
DEPARTMENT OF PAEDIATRICS.
VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE.
#82, E.P.I.P. AREA,WHITEFIELD,
BANGALORE-560066.
2. / NAME OF THE INSTITUTION / VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE, BANGALORE-560066
3. / COURSE OF STUDY AND SUBJECT / M.D (PAEDIATRICS)
4. / DATE OF ADMISSION TO COURSE / 5TH JUNE 2013
5. / TITLE OF THE TOPIC / A CLINICAL STUDY OF CUTANEOUS LESIONS IN NEWBORN.
6.1 NEED FOR THE STUDY:
Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting. URIs range from the common cold (mild, self-limited, catarrhal syndrome of the nasopharynx)-to life threatening illnesses(epiglottitis).
Each year, the average child will have about five such infections and the average adult will have two to three infections.
The etiology of upper respiratory tract infection in young children is still not fully understood and numerous clinical and laboratory investigations has been carried out in an attempt to elucidate this problem.
The present study is to find out clinical and microbiological profile of pediatric patients who present to the institute. The findings may be of interest in treatment intervention appropriate to the microbial etiology of upper respiratory tract infection in pediatric age group.
Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting. URIs range from the common cold (mild, self-limited, catarrhal syndrome of the nasopharynx)-to life threatening illnesses(epiglottitis).
Each year, the average child will have about five such infections and the average adult will have two to three infections.
The etiology of upper respiratory tract infection in young children is still not fully understood and numerous clinical and laboratory investigations has been carried out in an attempt to elucidate this problem.
The present study is to find out clinical and microbiological profile of pediatric patients who present to the institute. The findings may be of interest in treatment intervention appropriate to the microbial etiology of upper respiratory tract infection in pediatric age group.

6.1 NEED FOR THE STUDY:

INTRODUCTION:

Neonatal skin provides physical protection and assists in fluid balance, immunosurveillance and thermoregulation, thus playing a vital role in the newborn’s transition from an aqueous to an air-dominant environment. The skin of the infant differs from that of the adult, in that it is thinner, delicate, has weaker intercellular attachments and produces fewer sweat and sebaceous gland secretions and is more susceptible to several infection.(1)

CLINICAL IMPLICATIONS OF INFANT SKIN:

1. Blisters can be formed easily during inflammatory processes due to loose adherence of epidermis to dermis.

2. Increased transepidermal water loss, increased percutaneous absorption, increased thermal instability.

3. As the epidermal barrier is not fully developed, it is more susceptible to antimicrobial attack, more apt to react to irritants and more prone to maceration due to moisture retention.

4. Neonatal skin is more susceptible to ultraviolet (UV) light induced damage because of less melanin content of epidermis.

5. Soaps and cleansers can disturb the epidermal barrier and acid mantle of the skin making it drier and more prone to damage.

A large number of changes from transient physiological to grossly pathological lesions are seen in the skin of a neonate .The majority of the disorders in the newborn are physiological, transient and self-limited and require no therapy .Worried parents often seek medical advice from their child’s physician regarding skin lesions. Thus, a working knowledge of both normal and abnormal cutaneous lesions of the neonate is required to determine which skin lesions require early intervention.(2)

Some disorders first manifesting during the neonatal period may also represent harbingers of potential problems during adulthood .Hence this study is taken to identify accurately infectious diseases and from benign transient neonatal dermatosis.(3)

6.2 REVIEW OF LITERATURE

A study conducted by Moneim EL states that, the birth of the baby represents a sudden transition from the intrauterine life to the external environment. Analysis of the characteristics of neonates with infectious skin lesions versus those with non-infectious skin lesion was one in this study. A significant positive association was found between infectious skin changes and normal birth weight of the newborns, with low birth weight infants less likely to have skin disorders. Fungal infections were more frequent in NBW neonates (58.8%) while bacterial infections were more frequent in LBW (62.5%) . No significant association was found between maternal smoking and infectious skin changes in neonates. Mothers living in rural areas were more likely to have newborns with infectious skin lesions 87.5% of neonates with bacterial infections and 66.2% of neonates with fungal infections were resident in rural areas.(1)

Muhamed J in his study found that, Total numbers of neonates with skin lesions were (34.75%) .Numbers of neonates with skin infections were (25.12%).Neonates with nappy rash were(16.0%),Mongolian spots (21%), erythema toxicum neonatrum were (16%). Numbers of neonates with milia (10.22%), numbers of cases with erythema were (4.67%), there were cases of neonatal acne (4.33%), haemangioma (1.73% ) there were 2 cases of café-eu-lail, seborrheic dermatitis, collodian baby one case of harlequin fetus, Epidermolysis bullosa, Sucking blister Scalded Skin Syndrome, Neonatal pustular melanosis.(2)

According to the study done by Bryan N,Chakrabrty physiological skin changes in the early neonatal period as observed in this study were Mongolian spots(68.8%).Pathological skin manifestations were observed in(41.2%) neonates. These changes have been classified as (1) Transient non-infective diseases, (2) Naevi and other developmental defects, (3) Infections like neonatal herpes simplex infections (0.2 %), neonatal impetigo (1.2 %), mastitis (0.4%), omphalitis (1.6 %), oral candidiasis (1.8 %) and cutaneous candidiasis (2.6), (4) Dermatitis like perianal dermatitis (2.8 %), intertrigo (3.2 %), cradle (4.4%) and infantile Seborrhoeic dermatitis (2.4%) pe (5) Inherited disorders like tuberous sclerosis (0.2 %) and epidermolysis bullosa simplex(0.2%). (3)

Gagan A,Vijay K in his study said that Skin rashes are common in neonate and can cause parental anxiety. Many of these are transient and physiological, but some may require additional work up rule a more serious disorder. Hence, it is important for the paediatrician to recognize these physiological states and to differentiate these from pathological states. Benign dermatoses in new-borns must be distinguished from more serious disorders with cutaneous manifestations, and recognition of these dermatoses allows the physician to proceed appropriately, reassure the parents and initiate further evaluation or treatment as necessary.(4)

According to Goyal T,Varshney A dermatoses in neonates present as vesicles, pustules, bullae, erosions and ulcerations during their first 28 days of life. They differ considerably in etiology, age of first appearance and pattern of lesion distribution, necessitating a systematic approach to their evaluation and timely treatment. Also, differentiation between transient and noninfectious and potentially life threatening disorders is essential for saving unnecessary anxiety amongst both treating physician, parents and also saving valuable lives by timely diagnosis and intervention.(5)

6.3 OBJECTIVES OF THE STUDY

1) To study the prevalence of neonatal skin lesions.

2) To correlate clinical diagnosis with laboratory investigations in suspected bacterial, viral, fungal infection of newborn.

7.  MATERIALS AND METHODS:
7.1  Source of data
All newborns below 28 days of life admitted in postnatal ward/Opd in VIMS & RC, Bangalore.
(a)Duration of study: one year
(b) Inclusion criteria:
Term neonates less than 28 days of life of either Inborn / Opd will be included in the study.
(c)Exclusion criteria:
1. Neonates above 28 days of life.
2. preterm neonates
3.Neonates born to mothers with history of drug and alcohol abuse, Maternal illness.
4.Neonates with gross congenital malformations.
5.Critically sick neonates on ventilator.
7.2 Method of collection of data:(including sampling procedures if any)
Prospective cross sectional study done in postnatal ward/Opd,VIMS &RC.
A minimum of 250 patients will be taken up for study.
1. All neonates below 28 days of life born in this hospital /Opd cases are included in this study after taking written consent from parents who fulfill inclusion criteria.
2. After taking relevant maternal as well as neonatal history, the entire skin surface of the neonate, including the scalp, mucous membranes, genitilia, hair and nails were examined in proper ambient temperature and adequate light. Proper hand washing and sterilisation procedure were done before examination of neonate. Clinical examination of mother or any other close contact was recorded when required. Diagnosis of skin lesions was done by paediatrician under clinical impression, in few cases consultation with dermatologist were taken to clarify the diagnosis.
3.Relavent investigations like pus swabs for bacterial culture, smears from pustules for gramstaining , srappings for KOH examination ,Tzanck smear, blood culture and if required skin biopsy to confirm the diagnosis will be done.
Statistical analysis
Test of proportion, Chi – Square test
7.3  Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, describe briefly
Yes, In neonates with suspected pathological skin lesions relavant non invasive investigations like pus swabs for bacterial culture, smears from pustules for gram-staining and microscopic examination in suspected bacterial infection, srappings from the lesion will be taken with a preflamed blunt scalpel after through cleaning with alcohol or by washing with distilled water and taken onto the slide and 10% KOH is added and examined under microscope in fungal infections, Tzanck smear(giemsa stain is used for staining ) from vesicles in suspected viral infections, skin biopsy to confirm the diagnosis will be done after taking the consent from the parents.
7.4  Has Ethical clearance been obtained from your institution?
Yes (copy enclosed)
REFERENCES:
1.El-Moneim A,El-Dawela R. Survey of skin disorders in newborns. Eastern Mediterraean Health Journal .2012;18(1):49-55.
2.Muhamed J.Clinical Spectrum of neonatal skin disorders. Our Dermatol Online.2013;3(3):178-179.
3.Nobby B,Chakrabrty N.Cutaneous manifestations in the new born.Indian J Dermatol Venereol Leprol 1992;58:69-72.
4.Gagan A,Vijay K ,et al.A Study On Neonatal Dermatosis.J Community Med Health Educ .2012;169.
5.Goyal T,Varshney A.Incidence of vesicobullous and erosive disorders of neonates.J Dermatol Case Rep.2011;5(4):58-63.
6.Sankar R,Srikanta Basu,et al.Skin care for the newborn.2012;47:593-598.
7.Robert M,Joseph G,et al.Diseases of neonates.Textbook of Nelson.19;2218-2220.
Signature of the candidate
Remarks of the guide / Is a good study, identify the spectrum of skin lesions in neonates clinically and bacteriologically to manage adequately to predict long term prognosis of some diseases.
Name and Designation of Guide / Dr.Susheela.C
Professor of Department of Pediatrics, VIMS & RC
Signature
Head of Department / Dr. M G Javali
Professor and HOD
Department of Pediatrics,
VIMS & RC
Signature
Remarks of the principal
Signature