Normal Saline Instillation at Neonatal Intensive Care Units: A Descriptive Study of Neonatal Nurses' Knowledge and Practice

Background: Instillation of normal saline (NS) during endotracheal suctioning is a common practice in neonatal intensive care units in Jordan, while in most developed countries, this is not a standard of care Objectives: The objective of the present study was to examine the suctioning practice of NICU nurses in six hospitals in Jordan, with particular attention to the use of NS. The present study aimed to determine why NICU nurses continue to instil normal saline during suctioning. The study also explored current NSI instillation and suctioning techniques in selected settings. Methods: A cross-sectional descriptive approach was used to collect data from 136 NICU nurses using a 29-question, self-administered questionnaire. The participants were from seven NICUs of seven governmental hospitals in Jordan. The questionnaire addressed tracheal suctioning practices within the NICU. Results: Findings show a higher frequency of use of NS in NICU. Most nurses (79.41%) believed that NS is beneficial for loosening secretions, stimulating cough response (57.8%), promoting neonate comfort (57%), and helping to reduce bacterial growth (41.5%). Most nurses (94.8%) instilled not more than 0.5 ml of NS during the suctioning procedure. Most nurses (80%) used open suctioning rather than closed suctioning, and 80.5% of nurses instilled the NSI in the endotracheal tube rather than the in-line suction adapter. The NICU nurses' level of knowledge and their practices regarding acceptable suction pressure varied. The vast majority (82%) believed it should be less than 80 mmHg of intermittent suctioning. More than half of participants (53.7%) reported that they suction mechanically ventilated premature neonates more frequently than is necessary. Participants indicated that a significant complication associated with NS use included increased pulmonary infection (41.6%) and decreased oxygen saturation (42.1%). Conclusion: This is the first study that explored neonatal nurses' knowledge and practice of NS use during endotracheal suctioning in premature neonates in a developing country. Instillation of NS during suctioning could be detrimental to the health of premature neonates. Jordanian NICU nurses should be educated on best endotracheal suction practices, particularly NS instillation. Evidence-based practice guidelines should be updated to facilitate safe suctioning practice in Jordanian NICUs

Sweet Solution Analgesia

Mammals’ first tasting experience is usually sweet solution. Whether it is milk (breast or formula), sugar water as in some cultures or even dates as advocated by Prophet Mohammed to his followers. Thus, it is no wonder the soothing, calming and even pain relieving effects of oral sweet solutions. Nevertheless, using sweet solution purposely for its pain-relieving effects for infants in the clinical setting is relatively recent; however, the discussion concerning sweet solution effectiveness, mechanism of actions and adverse long-term effects are still ongoing. In this chapter, we present an account of studies on both humans and animals that explored and examined the use of several sweet solutions for analgesia

Fathers And Breastfeeding Process: Determining Their Role And Attitudes

Breastfeeding is a vital for infants during their early stage of life and it is considered that fathers have an important role to make this process succeed; this study was done to determine father’s attitudes and involvement in the breastfeeding process. A study survey instrument designed to measure father’s attitudes regarding breastfeeding process, the degree of their involvement and fathers` surrounded cultural effect on their involvement. Instrument were piloted with 22 fathers who met the inclusion criteria and Cronbach's alpha was 0.73 for both measures : fathers` attitudes regarding breastfeeding and fathers` involvement in the process. Then a total of 198 fathers in King Abdullah University Hospital (KAUH) in Jordan completed a self-administered questionnaire. Means and standard deviations were calculated for the measures of fathers` breastfeeding attitudes and involvement, then Pearson’s correlation analysis was conducted with an alpha level of 0.05 between the measure of fathers` involvement in breastfeeding process and surrounded cultural effect on their involvement. Result shows that fathers in had a negative attitudes and poor involvement in the breastfeeding process, and a significant correlation found between fathers` involvement in the breastfeeding process and surrounded cultural effect regarding this role (P- value = 0.01). Father may play an important role to positively influence a mother's decision to initiate and continue breastfeeding. Therefore, efforts to increase breastfeeding rates should focus on involving fathers in interventions and programs to change their attitudes and make them aware regarding their role in the breastfeeding process

Testing Effect of the National Basic Newborn Resuscitation Educational Program on Midwives’ Knowledge and Skills: Observational Quasi-experimental Study

ABSTRACT Background: Although being a crucial strategy to improve newborn outcomes, many midwives must prepare to perform basic newborn resuscitation (BNR).  Objectives: We assessed the midwives' knowledge and the quality of skills performance regarding BNR and the effectiveness of the educational program in improving midwives' knowledge and skills during the process of BNR.  Methods: an observational quasi-experimental pretest-post test design was conducted. BNR educational program was adapted from the American Academy of Paediatrics (AAP) Neonatal Resuscitation Program (NRP). It was conducted through three days of workshops, including An overview lecture, Interactive video modules, and extensive hands-on teaching of basic resuscitation techniques. After that, assessments (pre- and post-tests) were performed. Data were analyzed using the t-test, way ANOVA, The Relative Importance Index analysis (RII), and the linear regression test, Findings:100 midwives attended the workshop. Their mean scores were: knowledge score before the program (M=68.40, SD= 13.4) to after (M=78.72, SD=10.3). Overall mean prioritization before was 2.71(out of 3) to after 2.9. The mean quality performance of skills (out of 4 points) before and after the educational program, respectively, were (M=2.2, SD=0.8), (3.64, SD=0.5).  Discussion and Conclusions: The study results showed the significant impact of the BNR educational program, followed immediately by significant improvement in the midwives' knowledge and skills performance

A Meta-analysis to Assess the Effectiveness of a Procedural Scale to Measure Pain in a Child Aged 0-1 Year

Background: The burden of pain in newborns has been investigated in several studies, but little is known about the appropriateness and effectiveness of using pain scales according to the specific type of pain or the condition of the infant. Our purpose was to conduct a meta-analysis to assess and report on the effectiveness of the used procedural pain scale to measure pain in a child over 0-1years reflecting that by using the non-pharmacological interventions in pain reduction in randomized trials. Methods: A systematic search was performed up to October 2021 in PubMed and Cochrane Library The current review enrolled randomized clinical trials (RCTs). It was also conducted according to PRISMA guidelines. Cochrane's risk of bias assessment was used to assess the studies' quality and risk of bias. Meta-analyses were performed by calculating the standardized mean difference (SMD) at a 95% confidence interval (CI) using Review Manager Software Results: 50 trials were found 8 trials were included in this meta-analysis. Most of the studies related to procedural pain (heel lance and vaccination), Three validated pain scales were used in all trials (neonatal infant pain scale NIPS, premature infant pain profile PIPP, AND neonatal pain, agitation, and sedation scale NPASS. The Meta-analysis showed significant effect of non- pharmacological interventions (swaddling, mother holding, sucrose) in pain reduction compared with control group (SMD 1.2, 95% CI -1.88 to -.52, P =0.0005), I` = 95%, P> 0.00001. The 8 studies with 918 infant’s participants entered into analysis used effective pain scales (NIPS, PIPP, and NPASS) to measure procedural pain effectively Conclusions: overall the non-pharmacological interventions show positively effect in pain reduction, these mean the pain scales that are used in studies appropriate to assess pain when measure procedural pain (heel lice, vaccination), however, there is no consistency about the best tool to use in children related to several factors

Evaluation of Intervention Programs for Children with Autism

The present study reviewed the literature about intervention programs for Autism Spectrum Disorder (ASD) among children. ASD is a long-term neurodevelopment disorder that is identified as impairment in the context of social communication and interaction, and the predominance of restricted and repetitive patterns of behavior, interests or activities. Intervention programs have objectives such as to help individuals with ASD, particularly at the early developmental stage. Another objective is to involve the parents of the children with ASD to improve the effectiveness of implementing these interventions. Reviewing the literature showed that the involvement of parents reduced their stress level

HEMATOLOGICAL CHANGES IN PRISONERS WITH HIGHER BLOOD LEAD LEVELS COMPARED WITH GENERAL POPULATION

Lead (Pb) is one of the major environmental health hazards. From a biological point of view, lead is considered as anon-essential trace element and has no any biological function. The aims of the present study were to study blood lead levels among prisoners in the Northern of Jordan. Two prisons in the northern of Jordan were visited. Blood samples were collected and evaluated for hematological parameters and blood lead level. The study included 73 participants (46 prisoners and 27 participants as control). Study findings revealed low exposure of lead among study participants. The mean blood lead level among prisoners was 0.924 μg/dl, and 0.57μg/dl among control group. Hematological parameters under study were less in prisoners compared control group. Study findings revealed significant relationships between blood lead level and hematological parameters among prisoners. Taken together, the present study evaluated the effects of lead exposure on prisoners through studying these effects on some hematological parameters. The findings of the present study indicated that even prisoners had more blood lead levels compared with control group; the exposure variations were not statistically significant, but able to induce changes on studied hematological parameters

Blood lead level and correlation with pregnancy-associated anaemia

BackgroundThe most common reason that leads to anaemia is related to the reduction in certain trace elements such as Fe. However, it has been found that an elevation in some other heavy metals such as Pb could also lead to anaemia.AimsThis research aims to assess the Correlation between Pb blood levels and Fe, Haemoglobin levels during pregnancy among Jordanian women.Methods A cross-sectional study was conducted in the Northern area of Jordan. Venous blood samples collected from 167 pregnant women for the determination of haemoglobin (Hb), Fe and Pb levels of which 17 in the first trimester, 19 in second trimesters, 131 in third trimesters. Women were classified into two groups, the first group included cases with blood Pb Levels ≥10µg/dL (high blood Pb level group, n=118) and the second with blood Lead levels less than 10µg/dL (low blood Lead level group, n=49).Results About 71.4 per cent of women had anaemia (n=120; Hb>10.5g/dl) and 70.7 per cent of women had a high blood Pb level of ≥10µg/dL). Pb blood levels ranged from 6.45 to 28.0μg/dL. The mean (SD) of blood Pb level was 12.1 (4.1) µg/dL. The mean haemoglobin and Fe levels did not differ significantly between women with low and high levels of Pb. Blood Pb levels were not significantly correlated with haemoglobin levels (r=-0.025; P=0.747) nor with iron levels (r=0.099; P=0.241). After adjusting for important variables, Pb was not significantly associated with haemoglobin (P=0.223) and with iron (P=0.116).Conclusion The level of Pb in the blood of pregnant women has no any association with haemoglobin and Fe levels during pregnancy

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The impact of consanguinity on children health in Jordan Valley

Consanguineous unions have been associated with an increased susceptibility to various forms of inherited recessive disease in many parts of the world, including Arab populations. First cousin unions where the individuals share 1/8 of their genes are very common in Middle East cultures and could affect disease risk. Although consanguinity is known to contribute to hereditary and congenital diseases, the incidence of such diseases is still not clear in Jordan population. This study was performed to determine the prevalence of genetic, congenital/mental disorders (ex. Congenital Heart Diseases (CHD), cleft lip, mental and sensory handicap) and chromosomal aberration disorders and their association with parental consanguinity in a selected sample of children in Jordan Valley. The present study was undertaken to determine the prevalence of and their association with parental consanguinity in a sample of children selected from Jordan Valley. The study also explored incidence of children with hereditary diseases, congenital abnormalities and handicaps in Jordan valley in relation to other factors such as sex and mode of transmission. A descriptive analysis of all children with hereditary and congenital diseases among 100 affected children ages 6 months - 15 years was conducted. The study consisted of a 100 children-parents of children whom were having a child affected by a genetic abnormalities and/ or congenital malformations/ diseases. Families-children dyads were approached through local health centres and school. Data were collected through questionnaire which was adopted from health centre. The questionnaire provided information on consanguinity status and date of marriage among two generations: the affected children, and their parents. Data on consanguinity status among 100 children was obtained. Descriptive quantitative analysis was used to analyse data. The overall consanguinity of parents was 74% and the inbreeding coefficient was (0.025). Consanguineous marriages remain an important factor associated with hereditary abnormalities in northern Jordan. The closer the relationship of mates, the greater genetic effect and its associated abnormalities were found. This result is similar to other places with similar social features