1. PLAN OF DISSERTATION ETIOLOGICAL STUDYOFJAUNDICEINNEONATESADMITTED INNEONATALUNITSATTACHEDTOSMSMEDICALCOLLEGE, JAIPUR SUBMITTED FOR THE PARTIAL FULFILLMENT OFMASTERDEGREE (M.D.) IN (PAEDIATRICS) 2013 By Dr. Chuba Kumzuk Longchar Under the Supervision and Guidance of Dr. J.N. Sharma Associate Professor Department of Pediatrics S.P.M.C.H.I., S.M.S. Medical College,Jaipur (Rajasthan)

2. INTRODUCTION Jaundice is the commonest abnormal physical findingwith an incidence of about 60% in term babies and 80% in preterm babies. It is the commonest cause of admission to the hospitals in the newborn period. In preterm babies, the percentage is exceedingly high due to their physiological handicaps and other hazards of prematurity like asphyxia, septicemia, respiratory and circulatory insufficiency. Non physiological or pathological jaundice is also known to occur in (8-9%) of newborns with approximately 4% after 72 hours of age. Its timely detection and optimal management are crucial to prevent brain damage and subsequent neuromotor retardation due to bilirubin encephalopathy. The etiology in the majority of these cases is blood group (ABO) incompatibility, although this might not always be confirmed. Jaundice refers to the yellowish discolouration of the skin and sclera of newborn babies that results from accumulation of bilirubin in theskin and mucus membrane (>5mg/dl) and in adults (>2mg/dl).(Porter & Dennis, 2002) 3. There is a wide variation in the etiology of neonatal jaundice. Allhealthy newborns are at potential risk if their jaundice is unmonitored or managed inappropriately. In india healthy neonates are usually discharged within (24-48 hrs) after a normal delivery. Due to continuing rise of bilirubin and absence of follow-up and supervision for ensuring optimal feeding, neonates discharged before completing (48-72hrs)are at high risk of developing undetected significant jaundice(National Neonatology Forum,2011) . There is a need to address the social demand for patient safety and to respond to calls for a public health policy to better manage in preventable injury by identifying of risk factors for severe hyperbilirubinemia prior to discharge from hospitals, lactation support to ensure optimal feeding, and parents education and keeping follow-up appointments. Thus the present study was planned to know the various etiologies of neonatal hyperbilirubinemia in our establishments and the need forthe early therapeutic interventions. 4.

AIMS & OBJECTIVES

To find out the etiology of jaundice in neonates admitted in neonatal unit attachedtoSMS MedicalCollege, Jaipur.

5.

MATERIALS AND METHODS

Study Design :This will be an observational study.

Setting :The Department of Pediatrics, Neonatal Units of SPMCHI,Zanana Hospital, Mahila and Gangori Hospital, SMS Medical College,Jaipur, Rajasthan.

Duration :October 2011 to September 2012.

Sample Size:Accepting the prevalence of neonatal jaundice to be 60% and assuming power of test to be 80% anderror 0.05, minimum sample size was calculated to be 350 and the present study will include 500 study subjects.

Sample Selection :

a. Inclusion Criteria: All neonates admitted in theNeonatologyUnit with neonatal jaundice would be clinically evaluated andinvestigated.

b. Exclusion Criteria:

-More than 28 days of age.

-Neonates admitted in the paediatric surgicalunits.

METHODS:Each case will be evaluated clinically and pre-testedproforma will be filled. Each case would be investigated to find out the etiology. Other investigations will be doing depending upon the clinical presentation and the report of initial investigation .Data collected will be analysed statistically.

6. PROFORMA GENERAL INFORMATIONName Paediatric Medical unit: AgeRegistration number: Sex Religion: AddressConsanquity: Weight of the patient HISTORYANTENATAL HISTORY NATAL HISTORYH/o of diabetes. H/o TraumaParity (Gravida/Para): Induction of Labour (oxytocin)H/o Jaundice in Previous Siblings Drug intake: Asphyxia: Fever Delayed cord clamping:Rash POST NATALDay of onset of jaundiceColour of stool and urine Feeding Pattern 7. General Examination Gestational age Weight Depth and distribution of jaundice EyesPallor Significant BruisesCephalhematomaRashesUmbilical SepsisHepato splenomegaly Systemic ExaminationCNS P/A CVS Resp. 8. INVESTIGATIONSHb - Mother Blood Group (MBG) TLC - Baby Blood Group (BBG) DLC PCV DIRECT COOMBS TEST (DCT) PBF for Hemolysis Reticulocytes S. Bilirubin-Direct -Indirect G 6PD (male child)-Methylene blue reduction test. OTHERS: CRP (C-Reactive protein) Blood C/S(culture sensitivity) Urine Complete Microscopy; Culture Sensitivity. SGOT/SGPT T 3 ,T 4 ,TSH Cranial USG USG Abdomen TORCH Profile, Galactosemia(Urine for Reducing Substance) 9. FLOW CHART 10. lgefr i= 'kks/k dk uke %Etiological study of Jaundice In Neonates Admitted in Neonatal Unit Attached to SMS Medical College, Jaipur. / / ( ) ----------------------------------- (Subject) ------------------------- ----------------------------------- (guardian) ------------------------------------ : Dr. Chuba Kumzuk Longchar (Researcher)ds gLrk{kj 11. SEED ARTICLES SPECTRUM OF NEONATAL HYPERBILIRUBINEMIA: AN ANALYSIS OF 454 CASESP.K. Singhal, Meharban Singh, et al (1991). Division of Neonatology, Department of Pediatrics, All India Institute of Medical Science, New Delhi. Out of total 7680 live births, 454 developed hpyerbilirubinemia (serum bilirubin >12mg/dL. The most common cause of hyperbilirubinemia was idiopathic 34.6% followed by prematurity in ABO Iso-immunization. The most common cause of hyperbilirubinemia requiring exchange transfusion was ABO isoimmunization. ETIOLOGY OF NEONATAL JAUNDICE AN EXPERIENCE AT TERTIARY HOSPITAL (2007). Medical Channel Vol. 17-2-2011 (53-56).Hussain Bus Korejo, Ghulam Rasool Bhurgri, et al, Muhammad Medical College, Mirpur Khas Sindh, Liaquat University of Medical and health Science. 100 cases NNJ, out of them 62 Male, 32 females age range was 1-15 days. In this study sepsis (52) followed by hemolysis (30) most important cause. 12. Thank You.