Paediatricians’ awareness of children’s oral health: Knowledge,training, attitudes and practices among Turkish paediatricians

BACKGROUND:

In Turkey, 74.1% of children between three and six years of age develop dental caries.

OBJECTIVE:

To assess the depth of oral health and dental knowledge among paediatricians in Turkey, to determine their level of oral health education and to determine factors that were associated with higher knowledge scores.

METHODS:

A cross-sectional survey of demographics that assessed the participants’ knowledge of oral and dental health, attitudes regarding oral health during well-child visits and opinions regarding infant oral health care visits was conducted. The outcome variables were the proportions of paediatricians who adhered to good clinical practice guidelines, recommended dental visits for children younger than one year of age, and having a knowledge score >50%.

RESULTS:

The participant characteristics that were significantly associated with a greater mean number of correct answers were female sex, good clinical practice, confidence in detecting dental caries and the presence of a dentistry department in their hospital (P=0.001, P<0.001, P<0.001 and P=0.02, respectively). Only 13.9% of paediatricians referred children younger than one year of age to a dentist. After adjusting for the level of oral health education received during residency training, sex and having children, only the knowledge score was significantly associated with referring patients younger than one year of age to a dentist (P=0.01).

CONCLUSIONS:

Some paediatricians’ knowledge was found to be associated with practices that were in accordance with professional society recommendations. The lack of dental knowledge and training in residency limits the paediatricians’ role in promoting children’s oral health in daily practice.     

Childhood exposure to ionizing radiation from computed tomography imaging in Nova Scotia

BACKGROUND:

Examining radiation dose in the paediatric population is particularly important due to the vulnerability of paediatric patients (increased radiosensitive tissues and postexposure life-years) and risk for future radiogenic malignancy.

OBJECTIVES:

To evaluate trends in paediatric computed tomography (CT) use and ionizing radiation exposure using population-based data from Nova Scotia.

METHODS:

A retrospective, population-based cohort study of CT use in patients <20 years of age, from January 1, 2004 to December 31, 2011, was performed in Nova Scotia. CT examination data were retrieved from a provincial imaging repository. Trends in CT use were described, and both annual and cumulative effective dose exposures were calculated.

RESULTS:

In total, 29,452 CT events, involving up to 22,867 individuals were retrieved. Overall annual paediatric CT examination rates remained static (range 17.4 to 18.8 per 1000 per year). However, use in children <10 years of age decreased by >50% (P<0.001); this was counterbalanced by a steady increase among 15- to 19-year-olds (P<0.0001). Overall, 15.4% of scanned patients underwent ≥2 examinations, of which 58 patients (1.6%) exceeded 50 mSv of exposure.

CONCLUSIONS:

Despite a static rate in CT imaging among the entire cohort, children <15 years of age and, particularly, those <10 years of age displayed marked reductions in CT use. This may reflect increased awareness of campaigns emphasizing judicious CT use, revised clinical practice guidelines and increased availability of alternative modalities. A small subgroup demonstrated high-dose exposure (>50 mSv), and rates in individuals >15 years of age steadily increased, suggesting further exposure reduction efforts are necessary.     

Risk factors for positional plagiocephaly and appropriate time frames for prevention messaging

OBJECTIVE:

To determine potential risk factors for developing positional plagiocephaly in infants seven to 12 weeks of age in Calgary, Alberta.

METHODS:

A prospective cohort design was used. Healthy term infants (n=440), seven to 12 weeks of age, from well-child clinics at four community health centres in Calgary, Alberta were assessed by the primary author and a registered nurse research assistant using Argenta’s plagiocephaly assessment tool. Parents completed a questionnaire surveying risk factors.

RESULTS:

The incidence of positional plagiocephaly was estimated to be 46.6%. The following risk factors were identified using multiple logistic regression: right-sided head positional preference (OR 4.66 [95% CI 2.85 to 7.58]; P<0.001), left-sided head positional preference (OR 4.21 [95% CI 2.45 to 7.25]; P<0.001), supine sleep position (OR 2.67 [95% CI 1.58 to 4.51]; P<0.001), vacuum/forceps assisted delivery (OR 1.88 [95% CI 1.02 to 3.49]; P=0.04) and male sex (OR 1.55 [95% CI 1.00 to 2.38]; P=0.05).

CONCLUSION:

Advice to vary infants’ head positions needs to be communicated to parents/guardians well before the two-month well-child clinic visit. This could occur in the prenatal period by prenatal care providers or educators, or during the neonatal period by postpartum and public health nurses. Prevention education may be emphasized for parents/guardians of male infants and infants who have had assisted deliveries.     

The association between urinary continence and quality of life in paediatric patients with spina bifida and tethered cord

OBJECTIVE:

To determine the association between urinary continence and quality of life (QoL) in a paediatric spina bifida population.

METHODS:

After appropriate ethics approval, a prospective study was initiated using multiple validated QoL instruments that were distributed to patients as they presented for their annual appointment at the Northern Alberta Spina Bifida Clinic (Edmonton, Alberta). General demographic information was collected and validated questionnaires were used. The survey package included two instruments to assess overall QoL: Global Pediatric QoL (PedsQL 4.0) and Health Specific QoL-Spina Bifida (HRQoL-SB). Two instruments were also included to quantify urinary symptoms and assess urinary specific QoL: the Urinary Incontinence Severity Index – Pediatric (ISI-P) and Urinary Specific QoL (PinQ).

RESULTS:

A total of 71 patients were enrolled in the study. The general QoL (PedsQL 4.0) and health-specific QoL (HRQoL-SB) scores for the population indicated an overall QoL of 66% (n=69) and 83% (n=67), respectively. Approximately 46% (33 of 71) reported >1 episode of urinary incontinence per week. Urinary continence was associated with a significantly higher urinary-specific QoL (PinQ; P<0.001), general QoL (PedsQL 4.0; P<0.05) and health-specific QoL (HRQoL-SB; P<0.05). Furthermore, urinary incontinence and its effect on QoL was not influenced by the presence of a shunt, level of the lesion or manner of dysraphism.

CONCLUSION:

These data suggest that QoL in patients with spina bifida is related to urinary continence. This effect appears to be independent of the type and level of the spinal dysraphism and the presence or absence of a shunt.     

Development and validation of a self-efficacy scale for clinical decision-making in general paediatrics

BACKGROUND:

Success in a task is not only related to skill, but it is also related to ‘self-efficacy’, or belief in one’s capability to perform that task. No tool currently exists to measure self-efficacy in clinical decision-making in general paediatrics.

OBJECTIVE:

To develop and provide validity evidence for the General Pediatrics-specific Self-Efficacy (GPedsSE) scale.

METHODS:

The five-item GPedsSE scale, developed using an expert panel, was matched to the New General Self-Efficacy (NGSE) scale’s structure for validity analysis purposes. Thirty-six postgraduate year 1 to postgraduate year 5 paediatric residents of the Montreal Children’s Hospital (Montreal, Quebec) completed the GPedsSE and NGSE scales, with items interspersed.

RESULTS:

The mean (± SD) GPedsSE score was 18.6±2.6 of 25. Total GPedsSE and NGSE scores were moderately correlated (r=0.54, P<0.005). On planned comparison, the GPedsSE score increased with training year (F[1.3]=6.62; P<0.001), while the NGSE score did not (F<0.37). Exploratory factor analysis showed two components, each aligning with a scale.

CONCLUSION:

The GPedsSE scale contextualizes an existing tool to general paediatrics, a novel concurrent validity approach.     

Quality of referral of short children to the paediatric endocrinologist and impact of a fax communication system

BACKGROUND/OBJECTIVES:

In 2001, a chart review of children referred to the authors’ endocrine clinic because of short stature revealed that many were referred with insufficient baseline data, had normal height velocity and were within genetic target height. Therefore, a two-way fax communication system was implemented between referring physicians and the authors’ service before the first visit. Aspects that were assessed included whether this system increased the information accompanying the patient at referral, resulted in children with nonpathological shortness not being seen in the clinic, and was used differently by paediatricians and general practitioners.

STUDY DESIGN:

Between January and December 2006, 138 referrals for short stature, diagnosed with familial short stature, constitutional delay or idiopathic short stature, were audited (69 with and 69 without previous fax communication). Data collected included source of referral, clinical information provided, available growth measurements, and results from laboratory and imaging studies.

RESULTS:

Fax communication resulted in growth curves being provided more often (95.6% of cases versus 40.5% of cases without fax communication [P<0.001]) and more investigations being performed by the referring physician (median [range]: six [zero to 13] investigations versus one [zero to 11]; P<0.001), as well as a diagnosis of nonpathological short stature being given to 31 children based on the growth curve, laboratory and imaging results, without the children being seen in the endocrine clinic. Fax communication was also used more frequently by paediatricians (84%) than by general practitioners (15%).

CONCLUSION:

The fax communication system resulted in a more complete evaluation of referred patients by their physicians and reduced the number of unnecessary visits to the authors’ specialty clinic while promoting medical education.     

Success with lifestyle monotherapy in youth with new-onset type 2 diabetes

BACKGROUND:

Evidence is lacking to support the efficacy of lifestyle modification as first-line therapy in the clinical management of type 2 diabetes mellitus (T2DM) in adolescents.

METHODS:

A retrospective chart review of youth diagnosed with T2DM between 1999 and 2008 was conducted. The authors describe the percentage of youth presenting with glycosylated hemoglobin (HbA_1c) of <9% who achieved/maintained target glycemic control (HbA_1c ≤7.0%) with lifestyle monotherapy during the year following diagnosis.

RESULTS:

Among the 275 youth with T2DM, 38% (n=104) presented with an HbA_1c <9% and were prescribed lifestyle monotherapy at diagnosis. Of the 80 youth who had sufficient follow-up data over 12 months, 54% successfully maintained target glycemic control solely with lifestyle management. The mean HbA_1c score at diagnosis was lower in youth who where successful on lifestlye monotherapy compared with those who were not successful.

CONCLUSIONS:

A significant proportion of youth newly diagnosed with T2DM presenting with an HbA_1c <9% effectively achieved/maintained target glycemic control with lifestyle recommendations alone for 12 months.     

Implementation of a new clinical practice guideline regarding pain management during childhood vaccine injections

OBJECTIVE:

To determine the impact of a multifaceted knowledge translation strategy for a new vaccination pain management guideline on public health immunizers’ attitudes, beliefs and use of pain-relieving strategies during childhood vaccination.

METHOD:

Using a randomized controlled pre-post study design, public health nurses (PHNs) at intervention sites received a multifaceted knowledge translation intervention about new pain management guidelines incorporated in the British Columbia Immunization Program Manual, including education, supplies and online support. Attitudes and beliefs of PHNs toward immunization pain and pain management, and use of pain-relieving strategies were compared for the intervention sites between the pre- and postimplementation phases.

RESULTS:

A total of 516 children were immunized by 31 PHNs pre- and postimplementation in the intervention sites. Postimplementation, satisfaction and confidence with ability to manage pain and willingness to use newly recommended strategies were significantly more positive (P<0.05) in the intervention sites, and overall use of at least one newly recommended strategy increased from 49.8% preintervention to 77.6% postimplementation (P<0.001).

CONCLUSION:

The knowledge translation intervention improved PHN immunizers’ attitudes, beliefs and practices regarding paediatric vaccination pain management. Reducing pain may result in a better immunization experience for children, caregivers and immunizers.     

A simulation-based intervention teaching seizure management to caregivers: A randomized controlled pilot study

OBJECTIVES:

To examine the effect of simulation-based seizure management teaching on improving caregiver competence and reported confidence with managing seizures. The authors hypothesized that simulation-based education would lead to a higher level of demonstrated competence and reported confidence in family members and caregivers. Simulation has not been previously studied in this context.

METHODS:

A two-group pre- and post-test experimental research design involving a total of 61 caregivers was used. The intervention was a simulation-based seizure curriculum delivered as a supplement to traditional seizure discharge teaching. Caregiver performance was analyzed using a seizure management checklist. Caregivers’ perception of self-efficacy was captured using a self-efficacy questionnaire.

RESULTS:

Caregivers in the experimental group achieved significantly higher postintervention performance scores than caregivers in the control group in both premedication and postmedication seizure management (P<0.01). Additionally, they achieved significantly higher scores on the self-efficacy questionnaire including items reflecting confidence managing the seizure at home (P<0.05).

CONCLUSION:

Caregivers receiving the supplemental simulation-based curriculum achieved significantly higher levels of competence and reported confidence, supporting a positive relationship between simulation-based seizure discharge education, and caregiver competence and confidence in managing seizures. Simulation sessions provided insight into caregiver knowledge but, more importantly, insight into the caregiver’s ability to apply knowledge under stressful conditions, allowing tailoring of curriculum to meet individual needs. These findings may have applications and relevance for management of other acute or chronic medical conditions.     

Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools

OBJECTIVES:

To examine rates of sport participation, sport injury, risk factors and sport safety practices in young adolescents.

DESIGN:

Cross-sectional.

SETTING:

Calgary and area junior high schools.

PARTICIPANTS:

A random sample of 1466 students (aged 12 to 15 years).

OUTCOME MEASURES:

Sport injury within one year prior to completing the survey.

RESULTS:

Ninety-three per cent of students participated in sports in the previous year. The injury rate was 60.85 injuries/100 students/year (95% CI 58.29 to 63.35) for students reporting at least one sport injury, 29.4 injuries/100 students/year (95% CI 27.08 to 31.81) for medically treated injuries, and 12.28 injuries/100 students/year (95% CI 10.64 to 14.07) for injuries presenting to a hospital emergency department. The greatest proportion of injuries occurred in basketball (14%), soccer (12%), hockey (8.6%) and snowboarding/skiing (7.1%).

CONCLUSIONS:

The rates of participation and injury in sports are high in junior high school students. Future research should focus on prevention strategies in sports with high participation and injury rates to have the greatest population health impact.     

Accuracy of parents and health care professionals at estimating infant emesis volume

OBJECTIVE

To quantify visual estimation inaccuracies of infant emesis by parents and caregivers (P/Cs) and health care professionals (HCPs).

METHODS:

A single-blinded survey was performed in which P/Cs and HCPs visually estimated predetermined volumes of simulated emesis spilled on receiving blankets or pyjamas.

RESULTS:

HCPs’ estimations of volumes 1 and 3 were 150.4% and 145.1%, respectively, of the actual volumes, and their estimations of volumes 2 and 4 were 81.9% and 85.8%, respectively, of the actual volumes. This was, on average, significantly more accurate than the P/Cs’ estimations (P<0.001 to P=0.002), which ranged from 130.4% to 275.7% of the actual volumes.

CONCLUSION:

P/Cs and HCPs were, on average, highly inaccurate at visually estimating simulated emesis volume, an important consideration when making clinical judgments based on these estimations. In addition, HCPs now have an evidence-based tool to use in their practice when reassuring and counselling anxious parents.     

Parents' compliance with specific medical instructions in newborn discharge letters

BACKGROUND:

Due to decreased hospital stay, follow-up of unresolved medical problems of babies with uncomplicated postpartum course is relegated to outpatient clinics.

OBJECTIVE:

To identify factors in discharge letters that influence parent compliance.

METHODS:

Telephone contact with parents three months after discharge queried compliance with routine and special instructions as written in discharge letters. Statistical analyses compared responses of compliant versus less compliant parents. P<0.05 was considered to be statistically significant. The present study was approved by the Institutional Ethical Review Board Committee.

RESULTS:

Of the 2000 discharge letters, 319 (16%) included special instructions. Parents of 252 infants (79%) who received discharge letters containing 332 special instructions were interviewed by telephone. Compliance was greater for noninvasive instructions (86%) relative to others (57.8%) (P<0.001). Initiation of follow-up visits was correlated with parity (P<0.001) and maternal age (P<0.001).

CONCLUSION:

Discharge letters should be read and discussed with parents before infants are discharged, and the relevance of specific medical instructions should be emphasized.     

Evaluation of a practice guideline for the management of respiratory distress syndrome in preterm infants: A quality improvement initiative

BACKGROUND:

The use of mechanical ventilation to treat respiratory distress syndrome in preterm infants has been associated with the development of bronchopulmonary dysplasia. As part of a quality improvement initiative to reduce the incidence of bronchopulmonary dysplasia in preterm infants, a new practice guideline for the management of respiratory distress syndrome was developed and adopted into practice in a neonatal intensive care unit in February 2012.

OBJECTIVE:

To evaluate the effects of implementing the new guideline in regard to the use of mechanical ventilation and surfactant, and the incidence of bronchopulmonary dypslasia.

METHODS:

An historical cohort of very preterm infants (gestational age 26⁰ to 32⁶ weeks) born one year before guideline implementation was compared with a similar cohort of infants born one year following guideline implementation. Data were collected retrospectively from the local neonatal intensive care unit database.

RESULTS:

A total of 272 preterm infants were included in the study: 129 in the preguideline cohort and 143 in the postguideline cohort. Following the implementation of the guideline, the proportion of infants treated with ongoing mechanical ventilation was reduced from 49% to 26% (P<0.001) and there was a trend toward a reduction in bronchopulmonary dysplasia (27% versus 18%; P=0.07). There was no difference in the proportion of infants treated with surfactant (54% versus 50%).

CONCLUSION:

The implementation of the practice guideline helped to minimize the use of ongoing mechanical ventilation in preterm infants.     

Regional Disparities in Sedentary Behaviors and Meal Frequency in Iranian Adolescents: The CASPIAN-III Study

Background:

The prevalence of obesity is increasing among Iranian youngsters like other developing countries.

Objectives:

This study was conducted to assess regional disparities in sedentary behaviors and meal frequency in Iranian adolescents.

Patients and Methods:

In this national survey, 5682 students aged 10 - 18 years from urban and rural districts of 27 provinces of Iran were selected via stratified multi-stage sampling method. The country was classified into four sub-national regions, based on criteria of the combination of geography and socioeconomic status (SES). Mean of meal frequency and physical activity levels as well as prevalence of omitting meals and sedentary behavior were compared across regions with different SES after stratifying with sex and age group.

Results:

Meal frequency in lower socio-economic regions was significantly higher than two other regions in 10 - 13 and 10 - 18 years old groups (P trend < 0.001). However, the mean of working hours with computer was linearly increased with increasing the SES in studied regions (P trend < 0.001), whereas the corresponding figure was not significant for the mean of watching TV (P trend > 0.05). Frequency of adolescents omitting their meals was higher in higher SES regions especially in West Iran (P < 0.001) in 10 - 13 years old age group. Having personal computer and working with it more than two hours per day mainly was observed in central Iran which ranked as the highest SES group.

Conclusions:

Efforts to ensure Iranian youth meet healthy food habits and screen time guidelines include limiting access to screen technologies and encouraging parents to monitor their own screen time is required.     

Community-acquired urinary tract pathogens and their resistance patterns in hospitalized children in southeastern Ontario between 2002 and 2006

BACKGROUND:

The purpose of the present study was to assess the epidemiology and resistance patterns of bacteria causing urinary tract infections in children who were admitted to Kingston General Hospital (Kingston, Ontario) – the regional tertiary care hospital of southeastern Ontario.

METHODS:

A retrospective chart review of patients one to 18 years of age who were admitted to Kingston General Hospital with a discharge diagnosis of urinary tract infection between 2002 and early 2006 was undertaken.

RESULTS:

One hundred forty-two patient charts were reviewed, of which 56.3% of patients were female. The mean age of the patients was 12.3 months. The most common bacteria identified on urine culture over a five-year period were Escherichia coli (71.6%), Enterococcus species (5.7%) and Klebsiella species (5.0%). Bacteria were frequently resistant to ampicillin (54.4%) and trimethoprim-sulfamethoxazole (TMP-SMX) (40.4%). During the three months before admission, bacteria resistant to ampicillin were cultured from the urine of 75.6% of patients who were receiving some antibiotic, compared with 44% of children with no documented use of antibiotics (P<0.0001). Resistance to TMP-SMX in those with pre-existing genitourinary disease was 72.2% versus 31.8% in those without (P<0.0001). Patients who had previous admissions for urinary tract infections also showed greater resistance to TMP-SMX (70.6% versus 32.7%; P<0.005), cefazolin (64.7% versus 20.0%; P<0.0001) and nitrofurantoin (58.8% versus 18.2%; P<0.0001).

CONCLUSIONS:

There was a high resistance to ampicillin. Risk factors for resistant bacteria included the use of antibiotics three months before admission, previous genitourinary disease and previous admissions for urinary tract infections. In the presence of these risk factors, a third-generation cephalosporin as first-line antimicrobial therapy is recommended. However, the combination of ampicillin plus gentamicin can be considered for empirical therapy in low-risk patients.     

Exposure to alcohol in utero: Influence on cognitive function and learning in a northern elementary school population

OBJECTIVES:

To establish the prevalence of fetal alcohol exposure; to compare physical, behavioural and learning patterns of children with significant alcohol exposure in utero with those of a group of children exposed to minimal alcohol; to assess the usefulness of a fetal alcohol syndrome (FAS)/fetal alcohol effect (FAE) score; and to provide feedback to parents, schools and communities.

DESIGN:

Parent questionnaire, complete physical examinations of children, psychometric tests of the children using elements of the Pediatric Early Elementary Examination (PEEX) and the Pediatric Examination of Educational Readiness (PEER), ADD-H comprehensive teachers rating scale (ACTeRS) score, the newly developed FAS/FAE Score, and the Brigance Comprehensive Inventory of Basic Skills to assess language and mathematical achievement. Testers were blinded to the results of the assessments and questionnaires.

SETTING:

Grades 1 to 3 at Sir Alexander MacKenzie School in Inuvik, Northwest Territories.

RESULTS:

Twenty-four per cent of mothers reported frequent or binge drinking, and 76% of mothers reported abstinence or moderate alcohol intake. There were significant ethnic differences; none of the Caucasian mothers reported frequent or binge drinking during pregnancy compared with 40% of Inuvialuit and 33% of Indian mothers. Children with exposure to frequent or binge drinking in utero had smaller palpebral fissures (2.3±0.1 cm versus 2.5±0.3 cm, P<0.01), smaller palpebral fissure to intercanthal distance ratios (0.77±0.05 versus 0.86±0.10, P<0.01) and smaller head circumferences (52.1±1.6 cm versus 53.6±1.6 cm, P<0.01) than those exposed to moderate drinking or abstinence. Children exposed to frequent or binge drinking in utero also demonstrated poorer coordination (P<0.005) and cortical function (P<0.01), attention problems, hyperactivity (ACTeRS), and poorer scholastic achievement in language (P<0.001) and mathematics (P<0.01) than their minimally exposed counterparts. In children in grades 2 and 3, a significant negative correlation was found between FAS/FAE scores and language (r=–0.55, P<0.001) and mathematical achievement (r=–0.28, P=0.20).

CONCLUSIONS:

The prevalence of drinking during pregnancy in the northern population studied was high, and exposure in utero was associated with physical abnormalities, difficulties with coordination and cortical function, and significant delays in language and mathematical achievement. The FAS/FAE score may be useful in predicting success or failure in language development.     

Gentamicin in neonates at risk for sepsis – peak serum concentrations are not necessary

BACKGROUND:

Serum gentamicin concentrations (GSCs) are frequently obtained before and after gentamicin administration to newborns with, or at high risk for, sepsis.

OBJECTIVE:

To determine whether performing a peak GSC assay when the trough GSC is within the guidelines for care would add clinically relevant information for health care workers.

METHODS:

A retrospective review of the IWK Health Centre (Halifax, Nova Scotia) laboratory database for peak and trough GSC for infants <28 days after birth was performed.

RESULTS:

Of 5253 paired samples of trough and peak GSCs, 3001 (57%) had trough GSCs ≤2 μg/mL. Of these, only nine (0.3%) had a peak GSC >10 μg/mL.

CONCLUSIONS:

Performing a peak GSC measurement does not provide further clinically important data and increases patient morbidity and hospital costs.     

The Effect of Traditional Remedies (Camel's Thorn,Flixweed and Sugar Water) on Idiopathic Neonatal Jaundice

Objective

Jaundice is the most common reason of newborn''s admission to neonatal ward. Many Iranian families give traditional remedies like sugar water, camel''s thorn and flixweed extracts to breast-fed babies for reducing jaundice. This study investigated the effect of traditional remedies on idiopathic neonatal jaundice.

Methods

This prospective study has been performed on 336 babies with idiopathic jaundice in a four year period (2005-2009) at Ghaem hospital, Mashhad, Iran. The babies were divided into two groups. In case group (n=234) breast-fed babies received no remedy and in control group (n=102), traditional remedies were given additional to breast milk and the results recorded and compared.

Findings

In the present study significant differences were observed between the two groups in age of admission (6.8±3.2 vs 9.2±3.7 day, P<0.001), serum bilirubin values (17.8 vs 21.3 mg/dl, P<0.001) and percent of weight loss (P<0.01). There were no significant differences between the two groups in birth weight, sex, gestational age and duration of hospitalization, age at jaundice remission, hematocrit value and maternal factors (age, gestational order, pregnancy and labor problems)(P>0.05).

Conclusion

Traditional remedies (camel''s thorn, flixweed and sugar water) cause more weight loss and delayed reexamination of newborns leading to increased hyperbilirubinemia. These remedies may raise pseudo confidence in parents, which postpones reexamination and follow up of the newborns.