Salting Newborns - Paediatrics - Lecture Slides, Slides of Pediatrics

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Salting Newborns:

Pickling Them Or Killing Them?

A Practice That Should Be Stopped

Introduction

Some traditional practices regarding newborn care, had been followed since few thousands of years, generation after generation. Some of these

practices are useful , some are potentially harmful , and some

are killing.

Salting newborn babies is one of the traditions that started since several thousands of years ago, since the Greeks and the Romans. A practice which continued after Judaism and Christianity in various forms and names. Baptism probably is a continuation or a modification of these practices. Salting babies is also practiced in Japan and many other countries.

Nothing in Islam is with or against Salting babies, but this habit is still practiced in most of the Arab countries. Unfortunately it is still widely practiced by various sectors of the population in Jordan.

During the last year four salted babies presented to our clinic, three of them required admission to the hospital, one of them died.

Case 1: Ghofran cont.

 Investigations: Severe hypernatremia ( Na 194 mmol/l), renal insult (urea 39 mg/dl, creatinine 2.2 mg/dl), and severe metabolic acidosis( PH 7.04, PCO2 16.8, B.Ex –16 ).  CSF Analysis:WBC 2,100% Lymph-RBC 17590 Fresh-Prn 700-Sug 380/ serum.  Sepsis workup was done and then she was started immediately on I.V. antibiotics, fluids, and dopamine.  ALL Cultures were negative.  She developed intractable and repetitive attacks of convulsions that didn’t respond to conventional anticonvulsant.  Brain CT revealed brain edema, intraventricular and subarachnoid hemorrhage.

Case 1: Ghofran cont.

 In spite of all supportive measures and mechanical ventilation, she deteriorated steadily with an increase in the pressure of the anterior fontanel.

 EEG showed a flat isoelectric record.

 She died after 13 days.

Ghofran was salted by rubbing her skin with salt & oil, wrapping her daily and rubbing salt into her mouth.

Case 3 - Ahmad

AHMAD presented to Jordan Hospital clinic at two weeks of age with severe skin scarring after being salted daily for 3 days with salt & oil. At time of presentation physical examination was normal except for the skin manifestation. Head circumference was 36 Cm.

• Head circumference at birth was 35.5 cm on the 50 th centile at birth.
• At age of 6 months head circumference is 42.5 cm , on 10 th^ centile.
• Brain CT not done because of financial reasons.

Case 4 - Sultan

Sultan was admitted to J H at the age of 5 days :  Presented with fever , hypoactivity, and jaundice.  Examination:Jaundice&poor moro reflex with no focus of infection apparently.  Sepsis workup was done and antibiotics, fluids, and phototherapy were started.  Investigations proved to have meningitis, wbc count 246, 60% Neutrophils , protein 85 mg/dl, Glucose 29 mg/dl.  Urine Analysis:WBC 54,RBC 8,Prn&Sug Nil.Repeated:WBC 4.  Urine C&S:Klebsiella Pneumoniae.  Serum Na 142mmol/l.

Sultan was salted by rubbing skin with salt and oil.

Methods & Subjects - 4

 One of the physicians interviewed the mothers and filled the questioner first.

 112 mothers in the maternity ward were interviewed during one month which constitute all the deliveries except 4 mothers who were missed.

 After completing the questions, the mothers were given an educational pamphlet explaining possible dangers of salting and the complications of hypernatremia and its signs and symptoms.

Preliminary Results - 1

 Maternal age: range 20-42 years old.

78 mothers (70%) knew about salting.

 34 mothers (30%) never heard about salting.

 48 mothers (43%) had been salted themselves as newborns.

 37 mothers (47%) salted their babies at least once.

Of these, 17 (46%) university / college graduates. 20 (54%) high school or lower education.

Preliminary Results – 3: Disadvantages of Salting

• 5 (13.5%) knew the disadvantages but salted

their children.

• 18 mothers (16%) ONLY, of all the sample,

mentioned the following disadvantages :

 Dryness, cracking and redness of skin.

 Irritation of eyes and mucus membranes.

 Increases the salt content in the body,

(mentioned by 2 nurses).

Preliminary Results – 4: Methods of Salting

The mother or mother-in-law does one of the

following:

 Bathing and washing with salted water: 23 mothers (29%).

 Rubbing skin with salt and olive oil: 29 mothers (37%).

 Putting salt into the mouth / rubbing the tongue: 1 mother (2.7%).

 25 mothers (30%) heard about it but do not know how.

Traditional Practice of Salting Newborns Conclusions

 Salting newborns should be stopped to eliminate its possible morbidity and mortality.  Adequate education of all mothers regarding the proper care of newborns is a must in all sectors.  A multi-center campaign in collaboration with the Ministry of Health should be started to educate all the delivering women about salting and many other harmful practices like Kohl.

Recommendations

A National Campaign Against Salting Babies:

Pickling Babies Is Killing Babies

 Educational campaign in the schools, colleges and universities.

 Educational campaign using all the news media: newspapers, TV and radio.  Posters in the public places.  Educational pamphlets with simple information.