1. PLAN OF DISSERTATION ETIOLOGICAL STUDY OF JAUNDICE IN NEONATES ADMITTED IN NEONATAL UNITS ATTACHED TO SMS MEDICAL COLLEGE, JAIPUR SUBMITTED FOR THE PARTIAL FULFILLMENT OF MASTER DEGREE (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 finding with 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 the skin 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. All healthy 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 for the early therapeutic interventions.

6. PROFORMA GENERAL INFORMATION Name Paediatric Medical unit: Age Registration number: Sex Religion: Address Consanquity: Weight of the patient HISTORY ANTENATAL HISTORY NATAL HISTORY H/o of diabetes. H/o Trauma Parity (Gravida/Para): Induction of Labour (oxytocin) H/o Jaundice in Previous Siblings Drug intake: Asphyxia: Fever Delayed cord clamping: Rash POST NATAL Day of onset of jaundice Colour of stool and urine Feeding Pattern

7. General Examination Gestational age Weight Depth and distribution of jaundice Eyes Pallor Significant Bruises Cephalhematoma Rashes Umbilical Sepsis Hepato splenomegaly Systemic Examination CNS P/A CVS Resp.

8. INVESTIGATIONS Hb - Mother Blood Group (MBG) TLC - Baby Blood Group (BBG) DLC PCV  DIRECT COOMBS TEST (DCT)  PBF for Hemolysis  Reticulocytes  S. Bilirubin - Direct - Indirect  G 6 PD (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. शोध का विवरण मैं अपनी इच्छा से इस शोध मैं सम्मिलित होने की सहमति प्रदान करता / करती हु। मुझे इस शोध के विषय क़े बारे मैं बता दिया गया हैं। मुझे बता दिया गया है की इस शोध से मैं किसी भी समय अपनी स्वेच्छा से बाहर हो सकता / सकती हु। इसके लिये मुझे सिर्फ अपने डाक़्टर य़ा पालक को बताने कि जरुरत होगी। ( य़दि विषयक कि उम्र काफी कम है तो यह अनुमति पालक स्वय दे सकता है ) ----------------------------------- दिनांक हस्ताक्षर (Subject) इस शोध के स्वरूप व विषयक कि भूमिका के बारे मे उप्रोक्त विषय़क नाम ------------------------- को बता दिया गया हैं और उप्रोकत विषय़क़ इसकी अनुमती प्रदान करता है। ----------------------------------- दिनांक पालक (guardian) के हस्ताक्षर ऍवम रिश्ता ------------------------------------ दिनांक शोधकर्ता : Dr. Chuba Kumzuk Longchar शोधकर्ता (Researcher) ds gLrk{kj

11. SEED ARTICLES SPECTRUM OF NEONATAL HYPERBILIRUBINEMIA: AN ANALYSIS OF 454 CASES P.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….