Download rajiv gandhi university of health sciences, bangalore

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
Name of candidate & address
DR.BABU.M
s/o DR.M.JAYAPRAKASH
#545, “CHIRANJEEVI”
OPP. R.K. NURSING HOME,
S.N.PET THIRD CROSS,
BELLARY 583101
M.V.J. MEDICAL COLLEGE AND
RESEARCH HOSPITAL
2.
Name of the Institution
3.
Course of study and subject
M.D.(PAEDIATRICS)
4.
Date of admission to course
18/04/2009
5.
Title of the topic : COMPARATIVE STUDY OF NUCLEATED RED BLOOD
CELLS IN CORD BLOOD OF NEONATES WITH MECONIUM STAINED
AMNIOTIC FLUID AND CLEAR AMNIOTIC FLUIDS.
6.
Brief resume of intended work
6.1 Need for study:
Meconium stained amniotic fluid is an indirect marker of fetal hypoxia. It is
a major cause of respiratory distress in the newborn due to aspiration before or
during deliveries with complications such as pneumonia, atelectasis, air leak
syndromes and pulmonary hypertension.
Early identification and intervention in newborns with meconium stained
amniotic fluid will improve the outcome and avoid the need for expensive and
invasive treatment.
Simple tests like nucleated red blood cells could supplement costly tests
like erythropoietin etc. as a marker of fetal hypoxia in a resource limited setting.
The present study is undertaken to evaluate nucleated red blood cells in
meconium stained amniotic fluid and supplement the available data.
6.2 Review of literature
Meconium stained amniotic fluid occurs in 10-14% of all pregnancies1.
Nucleated red blood cells are commonly found in the cord blood of the
newborn.Researchers claim that elevated nucleated red blood cells in term infants
is related to intrauterine hypoxia. Darkhaneh et al showed that as hypothesized,
infants with meconium stained amniotic fluid had higher absolute nucleated red
blood cell counts than infants with clear amniotic fluid. Tissue hypoxia results in
increased levels of erythropoietin ,which in turn leads to stimulation of
erythropoiesis and increased number of circulating nucleated red blood cells.2
In 1945 Clifford3 suggested that meconium was passed by the fetus when hypoxia
developed.
Later Walker4 noted an association between meconium passage and a reduced
umbilical vein oxygen saturation to < 30 % suggesting that the finding of the
meconium in amniotic fluid in labor indicated a deficient oxygen supply to the
fetus.
The time it takes for the nucleated red blood cells to increase after acute hypoxic
stress is not known but studies in lambs showed that with in hours fetal hypoxia
stimulates fetal erythropoietin production which in turn stimulates erythrpoiesis 5.
Fetal hypoxia stimulates fetal evacuation of meconium.6
6.3 Objectives of study:
a) To compare the levels of nucleated red blood cells in the cord blood of
newborns with meconium stained and clear amniotic fluids.
b) To establish the level of nucleated red blood cells as indicators of
meconium aspiration syndrome.
7
Materials and methods :
7.1) Source of data:
The study will be conducted over a period of two years from November
2009 to October 2011 on term newborns delivered in MVJ Medical College and
research hospital.
In this period hundred newborns delivered through meconium stained
amniotic fluid and hundred newborns delivered through clear amniotic fluid will
be studied.
7.2) Method of collection of data:
Inclusion criteria:
All term newborns
Exclusion criteria:
All mothers with illnesses like diabetes mellitus, hypertension,
pre eclampsia, and chorioamnionitis will be excluded from the study.
All infants with low birth weight and infants with cyanotic heart disease
will be excluded from the study.
Immediately after delivery 2ml of umbilical cord blood will be collected
into a vial containing EDTA. Hemoglobin and white blood cell count will be
determined using automated hematologic blood cell counter. A thin blood smear
will be made and nucleated red blood cells per 100 white blood cells will be
determined manually. All data will be statistically analysed using chi square test.
7.3) Does the study require any investigations or interventions to be conducted on
patients or other animals? If so please describe.
Yes. Hb%,WBC/cubic mm and nucleated red blood cells/100WBC of the
cord blood will be performed.
Informed consent of parents will be taken before investigations.
7.4) Has ethical clearance been obtained from your institution in case of 7.3
-YES-
8
List of references :
1) O P Ghai. Newborn infants : in Essential Pediatrics.5th edn, Ed OP Ghai; Mehta
publishers, 2001, p 145
2) Darkhaneh RF, Asgharni M, Yousefi TZ, comparison of NRBC in Term
Neonatal Umbilical Cord Blood Between Neonate with Meconium-Stained
Amniotic Fluid (MSAF) and Clear Amniotic Fluid , J Turkish German Gynecol
Assoc 2008;9(2):00-00
3) Clifford SH. Clinical significance of yellow staining of the vernix caseosa, skin,
nails and umbilical cord of the newborn. Am J Dis Child 1945;69: 327-8
4) Walker j. Fetal anoxia. J obstet gynecol br emp 1954;61: 162-80
5) Mimouni F,Miodovnik M,Siddiqi TA,et al Perinatal asphyxia in infants of
insulin-dependent diabetic mothers.J Pediatr 1988;113:345-53.
6) Cunningham AS.When to suction
Contemporary Pediatr1993;12:91-109.
the
meconium-stained
newborn?
9
Signature of candidate:
10
Remarks of the guide: There is a need for simpler tests to recognize and manage
newborns with meconium stained amniotic fluid in rural population. Hence this
study is recommended.
11
Name & designation of the guide:
11.1) Guide : Dr.K.GOPAL
Professor,
Department of Paediatrics,
M.V.J Medical College & Research Hospital
11.2) Signature :
11.3)Co-guide:Dr.Ramesh.B.H
Associate Professor,
Department of Pathology,
MVJ Medical College and Research Hospital
11.4)Signature:
11.5) Head of department : Dr.Ravichander
Professor & HOD,
Department of Paediatrics,
M.V.J Medical College & Research Hospital
11.6) Signature :
12
12.1) Remarks of chairman & Principal :
12.2) Signature: