Assessment of knowledge of pediatric resident doctors about neonatal pain

Infants including newborn babies, experience pain similarly and probably more intensely than older children and adult. They are also at risk of adverse long term effects on behavior and development, through inadequate attention towards pain relief in early life. However, the issue of analgesia in young babies has been largely neglected in most clinical setting, despite subjecting them to painful diagnostic and therapeutic procedures. To assess the knowledge of resident doctors regarding neonatal pain and to compare this with best evidence-based medicine. A survey study questionnaires was distributed to pediatric resident doctors [PRD] in three training hospital centers in Baghdad [A- Al-Kademia teaching Hospital, B- Child central teaching hospital, and C- Children Welfare teaching hospital/ medical city] during the period from first of February to first of May, 2010. The questions were about the doctors` knowledge in treatment of pain in neonates, specifically regarding the perception and the effects of pain, pain assessment tools, and the safety and efficacy of treatments for both procedural and long-term pain. This study included 101 PRD, 29 were females and 72 were males. Doctors generally knew about efficacy of skin to skin contact and massage, breast feeding and oral sucrose during short term procedures, benefit and risk of use of morphine and midazolam, but less agreed that sedation does not necessarily provide adequate pain relief into neonates. Doctors were supporting use of topical anesthetic agents but not supporting the benefit of treating long term pain with opioid analgesic outweigh the risk of neonates. About half of PRD knew the difference in long term effect between neonates and older children. Pain assessment tools were not perceived to be reliable ,valid or routinely used. The knowledge of resident doctors regarding neonatal pain was inadequate when compared with developed countries studies and evidence based medicine, so we recommend to increased the educational programs and training on neonatal pain management

Risk factors of small for gestational age newborn babies

The most common definition of Small for gestational age [SGA] newborns refers to a birth weight below the 10th percentile for gestational age. Intrauterine growth retardation[IUGR] may be caused by maternal, placental, or fetal factors. However, no underlying etiology can be identified in at least 40% of SGA infants. To evaluate the risk factors of SGA births in a sample of Iraqi term newborns. A case control study extended over eight months from Dec. first 2007 to July 31st, 2008. In this study, 100 SGA newborns and 100 control newborns evaluated within the first clay of life. This study was performed in delivery rooms and neonatal special care birth unit in Baghdad Teaching Hospital in Medical City. Data were collected by direct interview of the mothers. Data included different variables related to mothers and neonates. There was a significant relationship between SGA births and maternal urinary tract infections [OR=5.231, P<0.0001] and with antepartum hemorrhage [8.6 time risk, OR=8.609, P=0.0349]. The majority of SGA newborns [15%] occurred in multiple pregnancies [OR=17.471, P0.0003]. SGA newborns were more common among non employed mothers [OR=2. 100, P=0. 0355]. Also SGA newborns had significant relationships with mothers not attended antenatal care [OR=3.648, P=0.0001],those with maternal history of SGA births [OR=15.474, P<0.0001], those mothers with anemia [OR=5 .532, F<0.000 1] and lastly with mothers suffering from hypertension [OR=8.877, P<0.0001]. There was significant relationship between SGA births and Multiple pregnancies and maternal history of SGA births, mothers suffering from hypertension and maternal history of APH and maternal anemia and UTI, mother not attended antenatal clinic and with no employment

Neonatal deaths in neonatal care unit and surgical ward of children welfare teaching hospital medical city-Baghdad [2005-2009]

Neonatal deaths in Iraq account for more than half of under-five children deaths. The rates vary according to causative factors in each area of the world. To have an idea about death rates and major causes of neonatal death in Children Welfare Teaching Hospital[CWTH], Medical City, Baghdad. The medical records of 1074 neonatal deaths in Neonatal Care Unit[NCU] and surgical unit from 2005-2009 in Children Welfare Teaching Hospital, Baghdad, were studied retrospectively, especially for the cause of death as registered in the files. Neonatal deaths relative to admission [15.1%] distributed between Neonatal Care Unit and surgical ward into [11.38%] and [25.5%] respectively. Of 1074 total neonatal deaths, males were 653 [60.8%], 421 [39.2%] were females. Male to female ratio was 1:6. Major causes of death were: congenital anomalies [53.2%], respiratory problems [20%] and neonatal infections [14%]. The results of this study indicate that neonatal death rates are still high, with congenital anomalies being the most common. More researches are needed to know the causes and the need for improvement in neonatal care services

Demographic and clinical presentations of pediatric hydrocephalus in medical city

Hydrocephalus is distension of the ventricular system of the brain related to inadequate passage of cerebrospinal fluid from its points of production within the ventricular system to its points of absorption into the systemic circulation. To study the demographic and clinical presentations of pediatric hydrocephalus in medical city complex, Baghdad. This is a prospective study ,which was carried out on 100 children with a mean age +/- standard deviation [24.3 +/- 16.06]months and median 16 months, who were admitted to Children Welfare Teaching Hospital and neurosurgical department [Surgical Specialties Hospital] / Medical City complex, Baghdad in the period from April first 2009 to October first 2009. A specially designed questionnaires were used to aid the investigators in performing a family interview. General and neurological examinations, and investigations including neuroimaging studies were done. Of 100 patients,[62%]were males and [38%] were females, with male to female ratio of 1.6:1. Family history of congenital anomaly was positive in [26%] of patients, while hydrocephalus was positive in [14%]. Seventy-Two percent of patients had congenital hydrocephalus. Eighty-Seven percent of patients were full term. Fifty-Seven percent of patients were products of NVD ,while [43%] were products of CS,[2%] of them were emergency CS and [41%] were elective. The macrocephaly was diagnosed or noted at birth in [32%] of patients. The study showed that U/S finding of hydrocephalus was positive in [49%]. The majority of the patients had congenital hydrocephalus, but there was delay in the diagnosis of macrocephaly. Prenatal ultrasound diagnosis yield was low in this study. Family history of hydrocephalus and other neural tube defect was important to be elicited

Meatal ulceration in neonates

Meatal ulceration [MU] is a benign problem, commonly fellow neonatal circumcision. It can lead to meatal stenosis and other complications, which can be prevented by proper post circumcision care. This study aims to disclose the different causes of MU in male neonates. Four hundred male neonates attended to Al- Mustansyria primary health care centre PHC/Baghdad for BCG vaccination, were studied cross-sectionally over 5 months period from the 1[st] of March to 10[th] of July, 2007. The parents of neonates were interviewed once by questionnaire and neonates were examined for meatal ulceration as they came for BCG vaccination which was done once weekly in this PHC. Meatal ulcerations were found in 24 out of 400 neonates [6%]. Thirty six neonates were circumcised [9%], 15 of them develop meatal ulceration [41.66%]. Twenty-five neonates were circumcised by doctors [69.45%], nine of them with meatal ulceration [36%], while 11/36 neonates were circumcised by dresser [30.55%], six of them develop meatal ulceration [54.54%]. The incidence of meatal ulceration increase from [2.47%] in non circumcised neonates to [41.66%] in circumcised neonates, [Chi[2] = 115.436, p<0/01]. It was found that 296/400 neonates [74%] used nylon diaper, 20 [6.75%] of them had MU compared to 104/400 used a piece of cloth or cloth diaper, 4 of them develop MU [3.84%]. Circumcision was found to be the most important cause of MU in male neonates, especially when the circumcision was one by not well trained person. Using nylon diaper or a piece of nylon, and not applying cream or cover are accelerating factors for the development of MU. So I recommend that circumcision of neonates to be done by well trained doctor and followed by proper post circumcision care. Also recommend to do further studies of larger sample size and to follow them for long-term bad consequences to give firmer recommendation regarding neonatal circumcision

Long term complications of type 1 diabetes mellitus in children and young adults

Diabetes mellitus is a common chronic metabolic syndrome characterized by impaired metabolism of glucose; morbidity and mortality come from acute metabolic derangement and from long term complications that affect small and large vessels. The assessment of the long term complications of diabetes mellitus in children and young adults. The study included 150 patients with typel diabetes mellitus attending the diabetic clinic of Children Welfare Teaching Hospital who were assessed for the presence of long term complications of diabetes mellitus. The total number of the sample was 150 patients with male to female ratio of 1:1.2 with median age of 12.2 years. Long term complications occurred in 26.7% of patients; [75%] of them had diabetes for more than 5 years. These complications include eye complications [retinopathy and cataract] 12.6%, Renal complications [albuminuria, oedema, and hypertension] 10.6%, peripheral neuropathy 4.6%, limited joint mobility 6.6%, and short stature 17.3%. Long term complications were found in significant number of patients with type I diabetes mellitus which can occur in children with short duration of diabetes, and their frequency increases significantly with increasing duration of diabetes

Early neonatal indirect hyperbilirubinemia in full term newborns and types of feeding

Neonatal jaundice remains the most common and, perhaps, the most controversial problem in full-term newborns during the immediate postnatal period. To evaluate the relationship between types of feeding and neonatal indirect hyperbilirubinemia in full term neonates in the first week of life. In the period from the first of January 2008 to the first of August 2008, populations of 140 full term newborns admitted to the neonatal care unit in Children Welfare teaching Hospital in Medical City-Baghdad were studied. A serum bilirubin level >12.9 mg/dL was considered significant. Of the population studied, most newborns received supplementary feeding 73 [52.1%], followed by breast feeding 50 [35.7%], while only 10 [7.1%] and 7 [5.0%] were on mixed and formula feeding, respectively. Ninety [64.3%] of the jaundiced neonates were males and 50 [35.7%] were females with a male to female ratio of [1.8:1]. This study revealed that, no significant association could be found between different types of feeding and indirect hyperbilirubinemia in full term newborns. Besides, giving water, dextrose water or formula with breastfeeding will adversely affect the volume of milk transferred to the baby and the volume of milk produced by the mother

Respiratory distress in full term newborns

Respiratory distress [RD] is among the most common symptom complexes seen in the newborn infant. It may result from both non-cardiopulmonary and cardiopulmonary causes. This study Aimed to assess the incidence, some possible risk factors, types, and short term out come of RD in full term newborns. A prospective study extending along a 6 months period from 1[st] of October 2006 to 31[st] of march 2007, during which a 50 full term newborns with RD, who were admitted to the NICU of Baghdad Teaching Hospital in Medical City-Baghdad, and enrolled with another 50 full term newborns without RD delivered in the same period, in the same place. For studied groups [cases and controls], a full prenatal and natal history, and complete physical examination were done, including Down's score evaluation of RD. For each patient in the studied group, CXR, CBP, CRP, Bl.C/S were under taken, close observation and out come were recorded. The risk factors that emerged as being significant includes: history of maternal smoking, caesarian section delivery and male sex .The elective caesarian delivery was highly significant risk factor for RD in full term newborns. The incidence of RD in full term newborns to the total live births at that period was [2.16%], TTN was the commonest cause [1.68%], followed by HMD [0.25%], MAS [0.086%], CHD [0.086%] and then C. P [0.001%]. That RD in full term newborns is still an important problem in this NICU, especially due to TTN and following elective CS. These prompt us to recommend the reduction of these risk factors especially elective CS to decrease the incidence of RD in full term newborn babies

Analytic study of congenital malformations in four hospitals in Baghdad

Congenital malformations are responsible for a considerable proportion of perinatal, neonatal and infant mortality in many Eastern Mediterranean countries. So this study aims to find out the incidence, types and probable risk factors of these malformations in Baghdad. One hundred cases of congenital malformations were studied out of 8090 neonates born in 4 hospitals in Baghdad province over 5 months in 2002 [preterm. term]. The incidence, types and risk factors were analysed. The incidence of congenital malformations was 12.36/ 1000 live births, with the central nervous system malformations being the commonest. There is increased risk in consanguineous marriages 27 [27%], mothers not attending antenatal care 25 [25%], mothers of low gravidity 60 [60%], and mothers not taking folic acid during pregnancy [86.7%]. Consanguineous marriages and mothers not taking folic acid during pregnancy are important risk factors for the occurrence of congenital malformations. So I recommend genetic counseling especially for consanguineous marriages, and giving all pregnant women folic acid before and during pregnancy. A multicentre study will give more broad idea about the incidence, types, and risk factors in our country

Respiratory distress syndrome in neonatal care units in medical city

Neonatal Respiratory distress syndrome [RDS] remains one of the major cause's neonatal morbidity and mortality despite advances in perinatal care especially in developed countries. The aims of this study were to find out the risk factors of mothers and newborns [NB] which increase the incidence, morbidity, and mortality of RDS. A prospective descriptive cross-sectional study was conducted on 100 live NR infants born at neonatal care units in Baghdad hospital and private nursing home [medical city complex] / Baghdad in the period from the first of March to the end of June 2006. They were presented with RDS, which was diagnosed clinically and radio-graphically. The study includes preterm and mil term N8 with all birth weights. In this study, there was an increase in the incidence of RDS in preterm NBs 3.5 more than in mil term, and 2.0 times more in small for gestational age [SGA] than in appropriate for gestational age [AGA]. It was found that the risk of death from RDS with air leak was 11 times more than those without air leak, and from RDS with pneumonia 4.0 times more than those without pneumonia. The risk of death among NB delivered by elective Caesarian section [C/S] was 2.4 times more than those born by emergency C/S. and 5.1 times more in NB of diabetic mothers than those without diabetes. We conclude that prematurity and SGA are risk factors for the development of RDS, and air leak and pneumonia are most important complications that increase the risk of death from RDS. So we recommend a proper and regular antenatal care and management of high risk pregnancies to avoid premature delivery and SGA, and proper respiratory care of NB to decrease the complications of RDS especially air leak and pneumonia to decrease the risk of death

Drugs use for diarrhoea in children at home

Children's acute diarrhea is an extensive global problem .It has increased in Iraq seventeen fold after wars and economic sanctions. Proper management is important in saving lives and prevention of complications. We wanted to see what drugs were used, how often and how it compared with oral rehydration use. The mothers of 175 children who presented with diarrhoea of acute onset and admitted to the Children Welfare Hospital, Baghdad, over a period of 8 months were interviewed. Apart from 39 children, who had parenteral infections, two had celiac disease and one accidentally ingested a laxative, the others were diagnosed as gastroenteritis at hospital. Of the 102 children diagnosed as gastroenteritis before admission, 29[28%] had their stools microscopically examined and a parasite was found in 12. Seventy: three [75%] of those who did not have stools examined, and [59%] of those who had no parasites demonstrated in stool were given antibacterial [metronidazole, gentamicin, amoxycilin,+1-cloxacilin, co-trimoxazole]. Many had antiemetics and anti spasmodics. Oral rehydration solution [ORS-WHO] was given to [46%] of patients. Seventy-Four [73%] of children with gastroenteritis were given anti bacterials at home and less than half had ORS