METHODOLOGY STUDY DESIGN = Prospective observational study (diagnostic test) MATERIAL & METHODS Inclusion Criteria: Sick neonates less than 72 hours of age admitted in the department of neonatology who need hemodynamic monitoring Exclusion Criteria: Major Congenital Anomaly, Congenital Heart disease. Sample Size : Convenient sample for 1 year according to the nicu admission rate of sick newborn less than 72 hours of age PROCEDURE : All neonates less than 72 hours of age admitted in the NICU will be analyzed by SNAPPE II score. Neonate with Score ≥ 38 will be enrolled for study after obtaining consent from parents. After recruitment, baseline data will be entered in data entry form. .Hemodynamic monitoring will be done by investigators for the recruited neonates for 48 hours from the time of enrollment. The monitoring will include the following clinical parameters: Heart Rate, Pulse rate, capillary refill time, cold extremities. SVC flow will be measured by echocardiography. Recording of PI and PVI will be done by pulse oximeter. TIME SCHEDULE FOR MONITORING: For all recruited babies, every 8th hourly, from the time of recruitment till 48 hrs. In babies with shock , every 20 minutes till perfusion is normal and thereafter as scheduled. Heart rate monitoring: Done by investigator uses stethoscope when baby is not agitated Extremities cold to touch: Using dorsum of the hand to feel temperature on abdomen and feet. If both are warm, then the baby is normothermic and if the abdomen is warm and the foot is cold, then the baby is in cold stress or shock. Pulse volume measurement: Central pulse- The volume of brachial pulse and femoral pulse Peripheral pulse-The volume of radial pulse and posterior tibial pulse Capillary refill time: After application of pressure on chest for 3-5 seconds,time taken for return of colour would be assessed. Blood pressure measurement: It is measured in a supine position with appropriate size cuff in a quiet environment in the right upper limb,when the baby is not agitated[14]. The width of the cuff being 60-70% of the arm length. PI recording: It will be obtained from recording of pulse oximeter having signal extraction technology.Measurement will be taken from the right upper limb after application of pulse oximeter probe, when limb is at rest and without agitation. Masimo Monitor would be used. PVI : Using PI, PVI is calculated according to equation PVI = PI max – PI min / PI max X 100 % SVC flow measurement: By following formula : SVC flow(ml/kg/min)=[{pi*(mean SVC D/2)2 (cm)2}*VTI(cm)*HR(BPM)]/BODY WEIGHT(KG) SVC internal diameter measured in 2d mode echocardiography at the point the SVC starts to open up into RA and a mean of maximum and minimum diameter within the cardiac cycle would be used for calculation of the flow[[i]]. SVC VTI will be measured with pulse doppler tracing in subcostal view with box positioned at the junction of SVC and RA[18]with an angle <15 degree. The mean velocity of blood flow will be averaged from 5 consecutive cardiac cycles. GE Vivid S60N Echocardiographic machine will be used. Clinical criteria to define shock or poor perfusion: Weak and fast pulse( >180 bpm) Capillary refill time >3 sec Cold extremities with or without following : pale, lethargy, not arousable on stimulation STATISTICAL ANALYSIS : We plan to compute the linear dependency among two variables using Pearson product movement correlation and use a statistical test to check the significance of the linear correlation .We then fit a linear regression model to predict the response variable for a given covariate. .To identify the effect of covariate on the different quantiles of the response variable,we also plan to use “linear quantile regressionâ€for predicting different quantiles of the response variable .All the computed results will be reported by the function of statistical software ‘R’. Ethical Consideration : The project will be started after obtaining permission from Scientific and Ethical committee. Funding – No |