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Salting Newborns: Pickling Them Or Killing Them? A Practice That Should Be Stopped

Salting Newborns: Pickling Them Or Killing Them? A Practice That Should Be Stopped. Y. K. Abu-Osba MD., R. A. Jarad MD., K. H. Zainedeen MD., A.Y. Khmour MD. Neonatal Intensive Care Unit Jordan Hospital, Amman, Jordan. Traditional Practice of Salting Newborns Introduction.

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Salting Newborns: Pickling Them Or Killing Them? A Practice That Should Be Stopped

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  1. Salting Newborns:Pickling Them Or Killing Them?A Practice That Should Be Stopped Y. K. Abu-Osba MD., R. A. Jarad MD., K. H. Zainedeen MD., A.Y. Khmour MD. Neonatal Intensive Care Unit Jordan Hospital, Amman, Jordan

  2. Traditional Practice of Salting NewbornsIntroduction Some traditional practices regarding newborn care, had been followed since few thousands of years, generation after generation. Some of these practices areuseful, some arepotentially harmful, and some arekilling . 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.

  3. Traditional Practice of Salting NewbornsCase 1: Ghofran Ghofran was a product of c/s, 3rd part of triplet, b.w. 2.2 kg, and Apgar score 8/9/9. • Presentation: Presented at age of 6 days with parents complain of: fever, poor sucking, cyanosis, jaundice and hypoactivity. • P. examination: Temp 39.5 C, BP 68/22, HR 168, RR 52, weight 1.8 kg , head circumference 32 cm. She was sick looking, toxic, and severely dehydrated with acidotic breathing. Severe mottling of the skin with peripheral cyanosis. She had absent reflexes. General examination didn’t reveal a focus of infection.

  4. Traditional Practice of Salting NewbornsCase 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 380/693 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.

  5. Traditional Practice of Salting NewbornsCase 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.

  6. Traditional Practice of Salting NewbornsCase 2 - Abdallah Abdallah presented to Jordan Hospital at age of 8 days with parents complain of sever jaundice, poor sucking with decrease in urination, and decreased activity.B.Wt : 2.5 kg. On examination: HR 140,Temp 36.5, RR 40, BP 85/45. Severely dehydrated and severely jaundiced baby. Hypoactive with poor reflexes. Head circumference 32 cm, 50th centile. Investigations: • Severe hyperbilirubinemia, T- bilirubin 27.7 mg/dl ,Direct Bil 1.65 mg/dl . • Na 164 mmol/l, Urea 50 mg/dl,Creatinine 1.21 mg/dl • Urine Analysis:WBC 1440,RBC 576,Bil +2,Prn +1,Sug Nil . • Urine Culture:Mixed Growth.Repitetion showed no growth. Management: • Double volume exchange transfusion and phototherapy. • He was started on I.V. antibiotics and I.V. fluids till his condition improved then fed orally. • Brain MRI: Normal. • Head circumference at one month of age 33.5 cm dropping between 25 and 50th centile. Abdallah was salted by rubbing the skin with salt & oil.

  7. Traditional Practice of Salting NewbornsCase 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 50th centile at birth. • At age of 6 months head circumference is 42.5 cm , on 10th centile. • Brain CT not done because of financial reasons.

  8. Traditional Practice of Salting NewbornsCase 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.

  9. Traditional Practice of Salting NewbornsMethods & Subjects -1 • To explore the magnitude of this problem in the population we serve. • To find the reasons behind this practice. • To find the person who actually do the salting. • To educate the mothers and relatives about the possible complications of salting. We constructed the following questionnaire and interviewed the mothers delivered at Jordan Hospital during the study period

  10. Traditional Practice of Salting NewbornsMethods & Subjects - 3 استبيان تمليح المواليد إسم المريض: ………………………………….………... رقم الملف : …………………..…………… عمر الأم/ الأب: ........ التعليم: بدون ....... ابتدائي.……... إعدادي: ……..... ثانوي: …….... جامعي:...…….……... المهنة:.................. السكن: ............………...........هاتف:.……………........عدد الأطفال:...………..…….... هل سمعت عن تمليح الطفل: نعم ……. لا: …………… المصدر: ……………………..………………..….… هل تنوين تمليح طفلك؟......………... هل تملحت الام نفسها؟..……………....…….................……….............. فائدة التمليح: ............................................……………….………………………………………............ ضرر التمليح: …………......……………………………………………..…………………..….………. هل سبق أن ملحت أحد أطفالك: ……………..… عدد المرات : ..……............. المدة: .………….….…............ هل حدثت مضاعفات: .....................................................…………………………………….…................. من يقوم بالتمليح: ……………………………………………………………….………………..……… كيف تجري عملية التمليح: فرك الجلد بالملح:… …………..…… فرك الجلد بالملح والزيت: ………………..…… حمام بماء مملح:……….....……………….….... وضع ملح بالفم :..........………………......….......... ملاحظات:…………………………………………………………………..…………………………… هل ما زلت تنوين تمليح طفلك؟………………………………………………………………………….......

  11. Traditional Practice of Salting NewbornsMethods & 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.

  12. Traditional Practice of Salting NewbornsMethods & Subjects - 5 خطر تمليح المواليد  جرت عادة بعض الأهل القيام بما يعرف بتمليح الطفل الوليد وذلك بفرك جلده بالملح أو بتغسيله بماء مملح لظنهم بأنه جرت العادة على ذلك أو لاعتقادهم بوجود فوائد أو ضرورة لذلك. إن لمثل هذه العادة مخاطر جمة على الوليد. نتيجة لذلك يحدث الآتي: • إن بشرة الوليد خاصة الطفل الخديج رقيقة ويمكن من خلالها امتصاص الملح وبذلك تزداد نسبة الأملاح في الدم بدرجة عالية جدا. • يمكن أن يبلع الطفل خلال الحمام كمية كبيرة من الماء المملح، كما أن الملح الذي يفرك به فم الطفل يذوب ويمتص في الجسم وبذلك تزداد نسبة الأملاح في الدم بدرجة عالية جدا. •  ومما يدعو للأسف استمرار بعض الأهالي بالقيام بذلك مما أدى إلى حدوث وفيات أو مضاعفات شديدة عند بعض المواليد الذين تعرضوا لهذه العادة الضارة. وفيما يلي بعض المضاعفات التي قد تحدث نتيجة لذلك: • حدوث التهابات في الجلد. • حدوث التهابات في الفم واللثة والغشاء المخاطي للجهاز الهضمي. • ارتفاع خطير وحاد في نسبة الأملاح (الصوديوم والكلور) في الدم مما يؤدي الى اختلالات خطيرة في الوظائف الفسيولوجية للجسم. • حدوث تكسر حاد في الكريات الحمراء في الدم مما يؤدي إلى نقص شديد في قوة الدم (نسبة الهيموجلوبين). • حدوث ارتفاع حاد في نسبة البيلوروبين ( الصفار) في الدم ومختلف أعضاء الجسم خاصة الدماغ مما قد يؤدي إلى تلف في خلايا الدماغ وبالتالي تأثر السمع والبصر وحدوث تخلف عقلي وحركي. • حدوث جفاف شديد وفقدان الجسم للسوائل مما يؤدي إلى مضاعفات خطيرة. • تأثر الكلى بسبب زيادة الأملاح والجفاف مما قد يؤدي إلى قصور شديد مؤقت أو دائم لوظائف الكلى. • حدوث مضاعفات أخرى عديدة. • إذا كان لديك أية استفسارات أخرى يمكن الاتصال بمقيم طب الأطفال بمستشفى الأردن أو طبيبك الخاص.

  13. Traditional Practice of Salting NewbornsPreliminary 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.

  14. Traditional Practice of Salting NewbornsPreliminary Results – 2:Advantages of Salting • Six (16%) didn’t know any advantage but salted their babies as a traditional practice. • Fifty six mothers (50%) thought that there are some advantages including: • Decreases sweating. • Strengthens muscles and bones. • Improves immunity. • Improves wound healing. • Disinfects,softens and protects skin from allergies.

  15. Traditional Practice of Salting NewbornsPreliminary 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).

  16. Traditional Practice of Salting NewbornsPreliminary 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.

  17. Traditional Practice of Salting NewbornsObservations on the Results • The sample does not represent the whole population, although the mothers came from various social and educational backgrounds. • Neither age, education, social background; nor financial abilities influenced their practice of salting. • Complications depend on the way, duration and frequency of salting. • Maternal influence is great (one mother refused salting her baby while her mother in law insisted on doing it). • In spite of our explanation to the mothers, four mothers insisted on salting their babies at home .

  18. Traditional Practice of Salting NewbornsConclusions • 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.

  19. Traditional Practice of Salting NewbornsRecommendations 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.

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