RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, …



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

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SYNOPSIS

OF

DISSERTATION

“ELECTROLYTE CHANGES IN NEONATES RECEIVING PHOTOTHERAPY FOR NEONATAL HYPERBILIRUBINEMIA WITH SPECIAL REFERENCE TO HYPOCALCEMIA IN A TERTIARY CARE HOSPITAL”

Submitted by

Dr. UDAY SHANKAR SURABHI

M.B.B.S.

POST GRADUATE STUDENT IN

PAEDIATRICS (M.D)

Under the guidance of

Dr. RAMALINGE GOWDA NISARGA

MBBS, DCh, MD

PROFESSOR AND HEAD,

DEPARTMENT OF PAEDIATRICS

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DEPARTMENT OF PAEDIATRICS

ADICHUNCHANAGIRI INSTITUTE OF MEDICAL SCIENCES,

B.G.NAGARA-571448

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

| | | |

|1 |NAME OF THE CANDIDATE |Dr. UDAY SHANKAR SURABHI |

| |AND ADDRESS |P.G. IN PAEDIATRICS, |

| |(in block letters) |ADICHUNCHANAGIRI INSTITUTE OF |

| | |MEDICAL SCIENCES, B.G. NAGARA, |

| | |MANDYA DISTRICT -571448 |

|2. |NAME OF THE INSTITUTION |ADICHUNCHANAGIRI INSTITUTE OF |

| | |MEDICAL SCIENCES, B.G.NAGARA. |

|3. |COURSE OF STUDY AND SUBJECT |M.D. IN PAEDIATRICS |

|4. |DATE OF ADMISSION TO COURSE |31ST MAY 2012 |

| | |“ELECTROLYTE CHANGES IN NEONATES RECEIVING PHOTOTHERAPY FOR NEONATAL |

|5. |TITLE OF THE TOPIC |HYPERBILIRUBINEMIA WITH SPECIAL REFERENCE TO HYPOCALCEMIA IN A |

| | |TERTIARY CARE HOSPITAL” |

|6. |BRIEF RESUME OF INTENDED WORK |APPENDIX-I |

| |NEED FOR THE STUDY |APPENDIX-IA |

| |6.2 REVIEW OF LITERATURE |APPENDIX-IB |

| |6.3 OBJECTIVES OF THE STUDY |APPENDIX-IC |

|7 |MATERIALS AND METHODS |APPENDIX-II |

| | | |

| |SOURCE OF DATA |APPENDIX-IIA |

| | | |

| |7.2 METHOD OF COLLECTION OF DATA : (INCLUDING SAMPLING PROCEDURE | |

| |IF ANY) |APPENDIX-IIB |

| | | |

| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO | |

| |BE CONDUCTED ON PATIENTS OR OTHER ANIMALS, IF SO PLEASE DESCRIBE | |

| |BRIEFLY. |YES |

| | |APPENDIX-IIC |

| |7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN | |

| |CASE OF 7.3 | |

| | | |

| | |YES |

| | |APPENDIX-IID |

|8. |LIST OF REFERENCES | APPENDIX – III |

| | | |

|9. |SIGNATURE OF THE CANDIDATE | |

| | |The topic chosen by the candidate is relevant to know the electrolyte |

|10. |REMARKS OF THE GUIDE |abnormalities while treating the neonate with phototherapy in our |

| | |institution. |

|11 |NAME AND DESIGNATION | |

| |(in Block Letters) | |

| | | |

| |11.1 GUIDE |Dr. RAMALINGE GOWDA NISARGA |

| | |MBBS, DCh, MD |

| | |PROFESSOR AND HEAD, |

| | |DEPARTMENT OF PAEDIATRICS, |

| | |AIMS, B.G. NAGARA-571448 |

| | | |

| |11.2 SIGNATURE OF THE GUIDE | |

| | |- |

| |11.3 CO-GUIDE (IF ANY) | |

| | |- |

| |11.4 SIGNATURE | |

| | | |

| |11.5 HEAD OF DEPARTMENT |Dr. RAMALINGE GOWDA NISARGA |

| | |MBBS, DCh, MD |

| | |PROFESSOR AND HEAD, |

| | |DEPARTMENT OF PAEDIATRICS, |

| | |AIMS, B.G. NAGARA-571448 |

| | | |

| |11.6 SIGNATURE | |

| | | |

|12 |12.1 REMARKS OF THE CHAIRMAN |The facilities required for the investigation will be made available by |

| |AND PRINCIPAL |the college |

| | | |

| | |Dr. M.G SHIVARAMU M.B.B.S., MD |

| | |PRINCIPAL, |

| | |AIMS, B.G. NAGARA. |

| | | |

| |12.2 SIGNATURE | |

APPENDIX-I

6.BRIEF RESUME OF THE INTENDED WORK:

APPENDIX –I A

6.1 NEED FOR THE STUDY:

Jaundice in newborn is quite common affecting nearly 60% of term and 80% of preterm neonates during first week of life.1 Hyperbilirubinemia is one of the most common sign encountered in newborns. In most cases its a benign problem. Nevertheless untreated, severe unconjugated hyperbilirubinemia is potentially neurotoxic and conjugated hyperbilirubinemia is a harbinger of underlying serious illness.2

Neonatal hyperbilirubinemia is a reflection of liver’s immature excretory pathway for bilirubin. Non physiological or pathological hyperbilirubinemia is known to occur in 5-10% of healthy term newborns and is the most common reason for readmission of neonates in first week of life in current era of postnatal discharge from hospital.3

Premature babies have much higher incidence of neonatal jaundice requiring therapeutic intervention than term neonates. Hyperbilirubinemia was found to be the most common morbidity 65% among 137 extremely low birth weight neonates born over a period of 7 years in AIIMS.4

AAP recommends that new borns discharged within 48 hours should have a follow-up visit after 48-72 hours for any significant jaundice and other problems.

Newborns appear jaundiced when the serum bilirubin level is more than 7 mg/dl. The term physiologic jaundice generally is applied to newborns whose total serum bilirubin (TSB) level falls within the normal range, but because of the significant differences in TSB levels in different populations, it is difficult to define what is normal or abnormal, physiologic or non-physiologic.

The yellow colour usually results from the accumulation of unconjugated, non polar, lipid soluble bilirubin pigment in the skin. It may also be due impart to deposition of conjugated, polar, water soluble bilirubin pigment. Conjugated Hyperbilirubinemia indicates potentially serious hepatic disorders or systemic illnesses. Unconjugated (indirect) hyperbilirubinemia occurs as a result of excessive bilirubin formation and because the neonatal liver cannot clear bilirubin rapidly enough from the blood.

Elevated levels of unconjugated bilirubin can lead to bilirubin encephalopathy and subsequently kernicterus, with devastating, permanent neurodevelopment handicaps.

Although most newborns with jaundice are otherwise healthy, every baby who is jaundiced necessitates attention at the earliest to look for features of pathological jaundice because; unconjugated bilirubin is potentially toxic to the central nervous system. And hence appropriate management of Neonatal Hyperbilirubinemia is of paramount importance.

Hyperbilirubinemia can be treated in three ways:

a. Exchange transfusion removes bilirubin mechanically;

b. Phototherapy converts bilirubin to products that can bypass the liver's conjugating system and be excreted in the bile or in the urine without further metabolism; and

c. Pharmacologic agents that interfere with heme degradation and bilirubin production, accelerate the normal metabolic pathways for bilirubin clearance, or inhibit the enterohepatic circulation of bilirubin.

Significant neonatal jaundice is defined as TSB level beyond which baby required intervention (Phototherapy and/or Exchange Transfusion) for neonatal jaundice.

As any treatment has its side effects, phototherapy also have its adverse effects5 like hyperthermia, feed intolerance, vomiting, decreased urine output, bronze baby syndrome, dehydration, electrolyte changes.

Unlike other side effects, a very few studies are currently available that depicts the adverse effects of phototherapy on serum electrolytes. Neonates requiring phototherapy are at a higher risk of developing hypocalcemia. Therefore, it is suggested that newborns requiring phototherapy, administration of calcium may be considered in them. Hence emphasis is given in special reference to hypocalcemia. Very few studies are available regarding the changes in the other electrolytes (sodium, potassium, chloride).

One of the side effect of phototherapy is diarrhoea.6 As diarrhoea can lead to electrolyte changes, the present study is conducted to find out any significant changes in sodium, potassium, chloride in addition to hypocalcemia.

APPENDIX –I B

6.2 REVIEW OF LITERATURE

Hyperbilirubinemia is defined as the value of bilirubin according to AAP Guidelines above which Phototherapy or exchange transfusion or both are required.7

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Guidelines for phototherapy in hospitalized infants of 35 or more weeks' gestation. TSB = total serum bilirubin.

Risk Factors = Isoimmune hemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis, or albumin ................
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