SYNOPSIS
OF
DISSERTATION
DR. SUNIL KUMAR P.
DEPARTMENT OF PEDIATRICS
SREESIDDHARTHAMEDICALCOLLEGE
TUMKUR
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME AND ADDRESS OF THE CANDIDATE /DR. SUNIL KUMAR P.
POST GRADUATE IN PEDIATRICS,DEPARTMENT OF PEDIATRICS,
SREESIDDHARTHAMEDICALCOLLEGE, B.H. ROAD, AGALAKOTE, TUMKUR-572107,
KARNATAKA.
ADDRESS FOR CORRESPONDENCE / POST GRADUATE IN PEDIATRICS,
DEPARTMENT OF PEDIATRICS,
SREESIDDHARTHAMEDICALCOLLEGE, B.H. ROAD, AGALAKOTE, TUMKUR-572107
KARNATAKA.
2 / NAME OF THE INSTITUTION / SREESIDDHARTHAMEDICALCOLLEGE AND RESEARCH CENTRE, B.H.ROAD,AGALAKOTE
TUMKUR-572107,
KARNATAKA.
3 / COURSE OF STUDY AND SUBJECT / M.D. PAEDIATRICS
4 / DATE OF ADMISSION / 31ST MAY 2008
5 / TITLE OF THE TOPIC / “A COMPARATIVE STUDY OF CALF CIRCUMFERENCE WITH OTHER ANTHROPOMETRIC MEASUREMENTS AS A MEASURE OF LOW BIRTH WEIGHT”
6.1NEED FOR STUDY
Low birth weight infant is a major problem in developing countries. In India prevalence of low birth weight is very high. Low birth weight babies have less chances of survival during first year of life and those who survive have high risk of psychomotor retardation and poor school performance.(1)
Identification of low birth weight babies in community and their screening to ascertain required level of care is paramount importance to achieve normal goals in child survival.(2)
In the developing countries including India recording of birth weight has always been problem. Majority of deliveries in our country is conducted at home by traditional birth attendants or relatives. Therefore the newborn remain unweighed at birth due to lack of weighing scale, hence it is essential and important to look for an alternative method to identify the low birth weight babies at birth in village setup.(7)
Various studies have shown high sensitivity and specificity of calf circumference in identifying low birth weight babies at birth in comparison to other anthropometric measurements.(5,7,8,12,14)
Since majority of deliveries are conducted at home it is imperative to develop methodologies and tools, which are simple and sensitive for use at community level, to screen low birth weight babies for their appropriate management.(12)
Different studies have shown sensitivity for calf circumference in identifying low birth weight babies varying from 82.3% to 98% and specificity varying from 72% to 98%.(5,7-9,12,14)
Hence present study is designed to compare the sensitivity and specificity of other anthropometric indicators of detecting low birth babies at birth viz- mid arm circumference, chest circumference and thigh circumference and to find out the feasibility of calf circumference in detection of low birth weight babies at birth.
It is a comparison to evaluate the relative usefulness and validity of calf, thigh, chest and arm circumference in identification of LBW infants, which will be the subject of a future communication.
6.2 REVIEW OF LITERATURE
Low birth weight babies are “neonate, with birth weight equal to and less than 2500gm irrespective of the period of gestation”. Very low birth weight babies are those babies, weighing 1500gm and need highly specialized and close supervision of expert staff. Though weighing at birth is most reliable method for detecting low birth weight but in developing countries because of limited resources, rugged condition and majority of domiciliary birth it is imperative to develop methodologies and tools which are simple but yet maintain acceptable level of reliability in screening the low birth weight at birth as an alternative to birth weight. (1)
In 2000 an estimated 53 million females in developing countries gave birth with no professional care and births were unregistered. Main causes of neonatal death are birth asphyxia(24%), perinatal infection(32%) and prematurity(24%), and LBW is an important secondary factor in 40-80% of neonatal deaths according to WHO estimated in 2001. More than 90% of LBW babies are born in developing countries. The LBW babies born in India is 8.1 million in 1990.(2)
A study was conducted on consecutive single live born babies. They co-related thigh circumference and other anthropometric parameters with birth weight and they concluded that thigh circumference of 14.5cm had sensitivity and specificity of 98.11% and 87.25% respectively in predicting birth weight ≤ 2500gm, thigh circumference of 13.5cm in predicting birth weight ≤ 2000gm with sensitivity and specificity of 94.28% and 66.37% respectively.(3)
A study showed that the co-relation of birth weight with various anthropometric measurements in neonates, birth weight was found to be significantly co-related with mid arm circumference and head circumference.(4)
A study was conducted to test the predictive value of various anthropometric measurements to identify low birth weight newborn at birth. The results of this study clearly established the superiority of calf circumference as an indicator of low birth weight as compared to all other measurements. Though both mid arm circumference and thigh circumference correlated well with birth weight, the sensitivity of these two measurements was far below that of calf circumference and there was possibility of missing 25-30% of low birth weight neonates, where as with calf circumference only 5-6% of infant could be missed.(5)
A colour coded strip for calf circumference for measuring LBW babies was developed. It has point marked at 6.5cm and 8.25cm from the notch. These distances correspond to the birth weight 2-2.5kg respectively. It was found that the strip was able to identify 60% of LBW babies and missed 40%. The same strip was able to identify 98% of normal infants and missed only 2%.(6)
A study on newborns concluded that there is significant correlation of anthropometric measurements to birth weight of which calf circumference and thigh circumference had best correlation with birth weight. With calf circumference of ≤10.8cm as the cut-off limit almost 98% of LBW were screened with a fair degree of accuracy and calf circumference found to be a simple, cheap, reliable and quick indicator for predicting LBW in community.(7)
A study on consecutively delivered neonates concluded that calf circumference followed by thigh circumference at birth had the best correlation with birth weight and can be used as simple reliable cost effective method of identifying LBW in neonates.(8)
A study conducted on newborn babies showed that birth weight was significantly correlated with thigh circumference, mid arm circumference, calf circumference and head circumference. Head circumference and thigh circumference appears to be better indicator for picking up low birth weight babies. And mid arm circumference and calf circumference appears to be better indicator for picking up of very low birth weight babies.(9)
A study conducted on live born babies concluded that mid arm circumference can replace the weight record as measure of fetal growth and helps in identifying babies with low birth weight. Babies with mid arm circumference ≤ 8.6cm, which is predictor of birth weight, ≤ 2500gm require level-I neonatal care provided by primary health workers. While neonates with mid arm circumference ≤ 7.4cm which is predictor of birth weight ≤ 2000gm requires referral to hospitals or centers providing level-II neonatal care. And mid arm circumference≤ 6.1cm which is predictor of birth weight ≤1500gm require level-III neonatal care provided by skilled health personnel for skilled management.(10)
A study demonstrated the usefulness of thigh circumference in newborns for prediction of birth weight of babies. They concluded that thigh circumference of 14.7cm indicates birth weight equal or less than 2500gm and 13.9cm of thigh circumference co-relates with birth weight equal to or less than 2000gm.(11)
Calf circumference showed highest degree of correlation with birth weight followed by arm and chest circumference. Sensitivity in screening LBW infants(<2500gm) showed 95.7% critical limit of calf circumference. It showed calf circumference is useful in screening most of LBW babies in communities where weighing scales are not available or cannot be used by peripheral workers.(12)
A study on full term babies and concluded that calf circumference correlates best with birth weight <2500gm, yet concluded that the cut off values may vary for different geographical areas and racial distribution.(14)
6.3 OBJECTIVES OF THE STUDY
1. To compare sensitivity and specificity of calf circumference with sensitivity
and specificity of other anthropometric indicators viz- mid arm circumference, thigh circumference and chest circumference in detection of low birth weight babies at birth.
2. To find out the predictability of calf circumference in detecting low birth weight babies at birth.
7. MATERIAL AND METHOD
7.1 SOURCE OF DATA
300 consecutive live born normal neonates delivered at SREE SIDDHARTHA MEDICAL COLLEGE & HOSPITAL, TUMKUR from November 2008 – April 2010 will form cohort of this prospective study.
7.2 METHOD OF COLLECTION OF DATA
All anthropometric measurements will be carried out with in 24hrs of birth by the investigator to avoid any interpersonal measurement error. All anthropometric measurement will be taken with the newborn lying down in supine position. All the circumferences will be measured to the nearest 0.1cm using a flexible non-stretchable tape.
INCLUSION CRITERIA:
All the live born normal neonates irrespective of gestational age are included and anthropometric measurements will be carried out within 24hrs of birth.
EXCLUSION CRITERA:
Babies with congenital anomalies will be excluded from the study.
PROCEDURE:
1. MEASUREMENT OF WEIGHT:
Newborn will be weighed nude on an electronic type weighing scale to the nearest 1gm.
2. HEAD CIRCUMFERENCE:
The measurement will be taken with tape by passing over glabella anteriorly and posteriorly at the most prominent part of the occiput.
3. CHEST CIRCUMFERENCE:
Will be measured at the level of xiphoid process anteriorly and below the inferior angle of scapula posteriorly. The measurement will be taken during quite respiration.
4. MID ARM CIRCUMFERENCE:
Measurement will be taken mid way between tip of acromion process and olecranon process of ulna in left upper limb.
5. THIGH CIRCUMFERENCE:
It will be recorded in supine position using the left thigh at the level of lowest fold in gluteal region. Tape is placed perpendicular to long axis of the lower limb with its top edge just under gluteal fold.
6. CALF CIRCUMFERENCE:
Most prominent point in semi flexed position of the left leg.
DATA ANALYSIS:
Data will be analyzed by screening test parameters (sensitivity, specificity, positive and negative predictive value) and receiver operating characteristic curve. The correlation between LBW and indicators are, estimated by multiple regression and Karl Pearson Correlation co-efficient.
7.3DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
YES.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED
FROM YOUR INSTITUTION IN CASE OF 7.3.
YES.
PROFORMA:
Serial No:
- Mother’s Name:
- Father’s Name:
- Address:
- Family Income:
- Date & Time of birth:
- Place of birth:
- Birth Order:
- Delivery Type: Normal Vaginal:
Instrumental:
Caesarian Section:
- Anthropometric measurements within 24 hrs of birth:
- Weight:
- Chest circumference:
- Mid arm circumference:
- Thigh circumference:
- Calf circumference:
8. LIST OF REFERENCES
- Singh M. Care of the new born. 6th ed.New Delhi, Sagar Publications 2004. p. 224-44.
- Rennie JM. Roberton’s textbook of neonatology. 4th ed. London(UK), Elsevier Churchill livingstone 2005. p. 114,116.
- Sharma JN, Saxena S, Sharma U. Thigh circumference at birth as the best predictor of low birth weight babies. Indian Pediatr 1989;26:18-21.
- Sharma JN, Saxena S, Sharma U. Ratio of mid arm circumference to head circumference as a predictor of small for gestational age babies. Indian Pediatr 1989;26:348-50.
- Raman L, Nella J, BalaKrishna N. Comparative evaluation of calf, thigh, and arm circumference in detecting low birth weight infants- Part II. Indian Pediatr 1992;29:481-4.
- Sachar RK, Soni RK, Singh H, Sachdeva R, Mangat S, Sofat R. Efficancy of color-coded strip based on calf circumference for detection of low birth weight babies. Indian J Maternal and Child health 1995;6:57-8.
- Gupta V, HatwalSK, Mathur S, Tripathi VN, Sharma SN. Calf circumference and predictor of low birth weight babies. Indian Pediatr 1996;33:119-21.
- Samal GC, Swain SK. Calf circumference as an alternative to birth weight for identification of low birth weight babies. Indian Pediatr 2001;38:275-7.
- Taksande A, VilhekarKY, Chaturvedi P, Gupta S, Deshmukh P. Predictor of low birth weight babies by anthropometry. Journal of Tropical Pediatr 2007;53:420-3.
- Sharma JN, Sharma BS, Gupta ML, Saxena S, Sharma U. Mid arm circumference at birth as a predictor of low birth weight babies and early neonatal mortality. Indian Pediatr 1986;23:915-9.
- Ramji S, Marwah J, Satyanarayana L, Kapani V, Mohan M, Bhargava SK. Neonatal thigh circumference as an alternative indicator of low birth weight. Indian J Med Res 1986;86:653-4.
- Neela J, Raman L, Balakrishna N, Rao KV. Usefulness of calf circumference as a measure for screening low birth weight infants. Indian Pediatr 1991;28:881-84.
- Sharma JN, Saxena S, Sharma U. Relationship between birth weight and other neonatal anthropometric parameters. Indian Pediatr 1998;25:244-8
- Virdi VS, Jain BK, Singh H. Calf circumference for identification of low birth weight babies. Indian Pediatr 2001;38:934-5.
9. Signature of Candidate:
10. Remarks of the guide :.This study is done to assess the birth weight by measuring calf circumference. This can be done even in rural setup which does not require much skill and also cost effective.
11. Name and Designation :
11.1 Guide :DR. VATSALA KUMARI DCH, MD
PROFESSOR,
DEPARTMENT OF PEDIATRICS,
SREESIDDHARTHAMEDICALCOLLEGE,
TUMKUR-572107.
11.2 Signature :
11.3 Co-guide(if any) :
11.4 Signature:
11.5 Head of Department : DR. H.M. VISWANATHA KUMAR.M.D, FRCP, FCCP
PROFESSOR AND H.O.D.
DEPARTMENT OF PEDIATRICS,
SREESIDDHARTHAMEDICALCOLLEGE,
TUMKUR-572107.
11.6 Signature :
12.
12.1 Remarks of the Chairman and Principal:
12.2 Signature :
SreeSiddharthaMedicalCollege
Agalkote, B.H.Road,Tumkur-572107.
(Recognised by Medical Council of India & Affiliated to Bangalore University/R.G.U.H.S)
Ph:0816-278867 Fax:0816-2752110 email:
______
Ref No SSMC/PRI/ /2008-2009
TO,
The Registrar,
R.G.U.H.S.,
Jayanagar, 4th block,
Bangalore-560011,
KARNATAKA.
Respected Sir,
SUB: Institutional Ethical Clearance
…………
With regard to subject mentioned above the dissertation subject titled “A COMPARATIVE STUDY OF CALF CIRCUMFERENCE WITH OTHER ANTHROPOMETRIC MEASUREMENTS AS A MEASURE OF LOW BIRTH WEIGHT” is justifiable & has taken ethical clearance from the institution.
Thanking you,
Yours Faithfully,
Principal,
S.S.M.C, Tumkur.
SreeSiddharthaMedicalCollege
Agalkote,B.H.Road,Tumkur-572107.
( Recognised by Medical Council of India & Affiliated toBangalore University/R.G.U.H.S)
Ph:0816-278867 Fax:0816-2752110 email:
______
Ref No SSMC/PRI/ /2008-2009
TO,
The Chairman,
Ethical clearance committee,
SreeSiddharthaMedicalCollege & Hospital,
Tumkur.
Respected Sir,
SUB: Institutional Ethical Clearance
…………
With regard to subject mentioned above the dissertation subject titled “A COMPARATIVE STUDY OF CALF CIRCUMFERENCE WITH OTHER ANTHROPOMETRIC MEASUREMENTS AS A MEASURE OF LOW BIRTH WEIGHT” I request you to kindly issue an ethical clearance certificate for the same.
Thanking you,
Yours Faithfully,
Dr. SUNIL KUMAR P.
P.G. IN PEDIATRICS,
S.S.M.C, Tumkur.
SreeSiddharthaMedicalCollege
Agalkote, B.H. Road,Tumkur-572107
(Recognised by Medical Council of India & Affiliated to Bangalore University/R.G.U.H.S)
Ph:0816-278867 Fax:0816-2752110 email:
INFORMED CONSENT FORM
Title of the study: “A COMPARATIVE STUDY OF CALF CIRCUMFERENCE WITH OTHER ANTHROPOMETRIC MEASUREMENTS AS A MEASURE OF LOW BIRTH WEIGHT”
Name of the participant:______
Name of the principal investigator: Dr. Sunil Kumar P.
Name of the institution: SreeSiddharthaMedicalCollegeHospital and Research Centre
I, mother/father of ______aged______hrs/daysdelivered atSreeSiddharthaMedicalCollege, Hospital & Research Centre, Tumkur have been explained in my own language the need for the study andthe measurements of anthropometry and the birth weight of the baby by using measuring tape and electronic weighing scale.
Hereby give my consent to include my child as a participant in the study : “A COMPARATIVE STUDY OF CALF CIRCUMFERENCE WITH OTHER ANTHROPOMETRIC MEASUREMENTS AS A MEASURE OF LOW BIRTH WEIGHT”
The doctor has explained the proposed procedure in my own language and I understand the procedure.
I understand that a doctor other than the Consultant may conduct the procedure. I understand this could be a doctor undergoing further training.
I REQUEST TO HAVE THE PROCEDURE
Name ______Signature of the parent______
Date ______Time ______
Name ______Signature of the impartial witness ______
Date ______Time ______
Name ______Signature of the Investigator ______
Date ______Time ______
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