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

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Salting NewbornsPickling 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

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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 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.

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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
  didnt reveal a focus of infection.

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Traditional Practice of Salting Newborns 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 AnalysisWBC 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 didnt respond to
  conventional anticonvulsant.
• Brain CT revealed brain edema, intraventricular
  and subarachnoid hemorrhage.

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Traditional Practice of Salting Newborns 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.

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Traditional Practice of Salting Newborns Case 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 AnalysisWBC 1440,RBC 576,Bil 2,Prn
  1,Sug Nil .
• Urine CultureMixed 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.

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Traditional Practice of Salting Newborns 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
  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.

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Traditional Practice of Salting Newborns Case 4
- Sultan

• Sultan was admitted to J H at the age of 5 days
  
• Presented with fever , hypoactivity, and
  jaundice.
• ExaminationJaundicepoor 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 AnalysisWBC 54,RBC 8,PrnSug
  Nil.RepeatedWBC 4.
• Urine CSKlebsiella Pneumoniae.
• Serum Na 142mmol/l.
• Sultan was salted by rubbing skin with salt
  and oil.

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Traditional Practice of Salting Newborns Methods
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

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Traditional Practice of Salting Newborns Methods
Subjects - 3

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Traditional Practice of Salting Newborns
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.

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Traditional Practice of Salting Newborns Methods
Subjects - 5

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Traditional Practice of Salting Newborns
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.

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Traditional Practice of Salting Newborns
Preliminary Results 2 Advantages of Salting

• Six (16) didnt 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.

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Traditional Practice of Salting Newborns
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).

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Traditional Practice of Salting Newborns
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.

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Traditional Practice of Salting Newborns
Observations 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
  .

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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.

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Traditional Practice of Salting Newborns
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.