REPORTING GUIDELINES IN RESEARCH – An Introduction by Dr Suhana P Azis

“Reporting research is as important a part of a study as its design or analysis.” Poorly conducted trials are a waste of time, effort, and money. The most dangerous risk associated with poor-quality reporting is an overestimate of the advantages of a given treatment.  Whatever the outcome of a study, it is really hard for the average reader to interpret and verify the reliability of a poorly reported clinical trial . In turn, this problem could result in changes in clinical practice that are based on false evidence and that may harm patients. Research related to the health of humans should have the potential to advance scientific understanding or improve the treatment or prevention of disease. The expectation is that an account of the research will be published, communicating the results of the research to other interested parties. Publication is generally in the form of articles in scientific journals, which should describe what was done and what was found. Reports of clinical research are important to many groups, especially other researchers, clinicians, systematic reviewers, and patients. 1
Scientific publications are one of the most important outputs of any research, as they are the primary means of sharing the findings with the broader research community. The quality and relevance of research is mostly judged through the published report, which is often the only public record that the research was done. Unclear reporting of a study’s methodology and findings prevents critical appraisal of the study and limits effective dissemination. Inadequate reporting of medical research carries with it an additional risk of inadequate and misleading study results being used by patients and health care providers. Patients may be harmed and scarce health care resources may be expended on ineffective health care treatments through such inadequate reporting. There is a wealth of evidence that much of published medical research is reported poorly . Yet a good report is an essential component of good research. Reporting guidelines, such as the CONSORT(Consolidated Standards of Reporting Trials) Statement for reporting the findings of randomised controlled trials  can lead to important improvements in the quality and reliability of published research. Since the development of the CONSORT Statement in 1996, several other guidelines have been developed relating to other types of research studies.. At present, no coordination or focused collaboration in the development of reporting guidelines exists as there is in, for example, the clinical practice guidelines field. Guideline development methods vary greatly. Dissemination and implementation of reporting guidelines relies mostly on passive publication of the guidelines, occasionally accompanied by editorials. Reporting guidelines are not routinely used on a large scale, and their potential is not being fully realised. To remedy this situation, the National Knowledge Service of the UK National Health Service provided funds to set up the EQUATOR Network (Enhancing the Quality and Transparency of Health Research; http://www.equatornetwork.org/). This new initiative seeks to improve the quality of scientific publications by promoting transparent and accurate reporting. The Network provides resources and training relating to the reporting of health research and assists in the development, dissemination, and implementation of reporting guidelines.2
Homoeopathy with it’s strong presence in the national health scenario of India has  a vast pool of untapped clinical data in the hands of  medical practitioner’s. A systematic effort to streamline the data through proper reporting as through the HOMCASE guidelines or through development of new guidelines catering to the unique principles of homoeopathy will result in a huge database of this modality of treatment which is the need of the hour.
The following are the reporting guidelines for main study types3 -

    Study Types    Reporting guidelines    Expansions

1.    Randomised Trials
    CONSORT    Consolidated Standards of Reporting Trials
2.    Observational studies
    STROBE    Strengthening the Reporting of Observational studies in Epidemiology
3.    Case Reports
    CARE    Consensus-based Clinical Case Reporting Guideline Development
    HOMCASE   
Homeopathic clinical case reports-Development of a supplement to the CARE clinical case reporting guideline
4.    Qualitative research
    SRQR    Standards for Reporting Qualitative Research
5.    Diagnostic/Prognostic Study
    STARD     Standards for Reporting Diagnostic accuracy studies
6.    Systematic Reviews
    PRISMA    Preferred reporting items for systematic review and meta-analysis protocols
7.    Quality Improvement studies
    SQUIRE   Standards for Quality Improvement Reporting Excellence
8.    Economic evaluations
    CHEERS    Consolidated Health Economic Evaluation Reporting Standards
9.    Animal pre clinical studies
    ARRIVE    Animal Research-Reporting In Vivo Experiments
10.    Study Protocols
    SPIRIT    Standard Protocol Items: Recommendations for Interventional Trials

REFERENCES-
Guidelines for Reporting Health Research: A User’sManual, First Edition. Edited by David Moher,
Douglas G. Altman, Kenneth F. Schulz, Iveta Simera and Elizabeth Wager Published 2014 by John Wiley & Sons, Ltd.
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050139 ( last accessed on 05.09.2017)
http://www.equator-network.org/ (last accessed on 05.09.2017)


Dr.Suhana P Azis is Research Officer (Homoeopathy), Central Council for Research in Homoeopathy(CCRH), Janakpuri, NewDelhi under the Ministry of AYUSH, Government of India

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HMP Vol 22 Issue 1

https://drive.google.com/open?id=0BxR24sq3gqQTM19tQ1BXNlJjLW5EV0VvMXZtQWJxX1ozVG1r

Common Illnesses of Neonates And Their Pointers - Dr Sreekumar A MD (Hom)

SCREAMING

WITH COLIC

•   CHAMOMILLA
•   MAG P HOS
•   NUX VOM

WITH URGING FOR STOOL

•   RHEUM

URINATION BEFORE

•   SARSAPARILLA
•   BORAX

WHEN TOUCHED

•   ANT TART

AVERSION TO  MOTHERS MILK

CALC PHOS

• CHILD DEMANDS ATTENTION, NEEDS TO BE CARRIED
• ABDOMINAL COLIC

SILICEA

• < FROM MOTHERS MILK

BORAX

• PAIN BEFORE PASSING STOOL OR URINE
• APHTHAE

ANT CRUD

• VOMITS IN CURDLED FORM
• REFUSES NURSING
• WHITE COATED TONGUE
• AVERSION TO COLD BATHING

VOMITS MILK AFTER NURSING

ANT CRUD

• VOMITS IN CURDLED FORM
• REFUSES NURSING
• WHITE COATED TONGUE
• AVERSION TO COLD BATHING

VALERIANA

• < WHEN MOTHER IS ANGRY
• VOMITS MILK IN LARGE LUMPS

CANNOT HOLD UP HEAD

• CUPRUM MET
• ABROTANUM

NOSE BLEEDING

• FERR PHOS
• PHOS
• HAMAMELIS

INGUINAL HERNIA

• AUR MET
• CALC CARB
• NUX VOM
• NIT ACID
• SILICEA
• LYCOPOD
• SULPH

HYDROCOELE

• PULSATILLA
• SILICEA
• RHODODENDRON
• ABROTANUM
• AURUM MET
• CALCAREA CARB

ICTERUS NEONATORUM

• CHELIDONIUM
• MERC SOL
• NUX V

INTUSSUSCEPTION

OPIUM

• STOOL ROUND HARD BLACK BALLS
• CONSTIPATION OF NEW BORNS

PLUMBUM MET

• STOOL LIKE SHEEP DUNG
• FAECAL VOMITING
• LARGE AND HARD ABDOMEN
• STRANGE POSITION DURING SLEEP

FRETFUL AT NIGHT , LIVELY NEXT DAY

• PSORINUM

IRRITABLE DAY TIME AND HAPPY AT NIGHT

• LYCOPODIUM

DISTURBED SLEEP AT NIGHT , MUST BE ROCKED

CARCINOSIN

• SLEEPS IN KNEE ELBOW POSITION
• SLEEPLESSNESS FROM BIRTH

CHAM

• SLEEPLESSNESS FROM PAIN
• DROWSY AT DAY TIME , BUT CANNOT SLEEP

CINA

• CHILD LYING ON BACK STRIKES WITH HANDS AND FEET ON BED
• SCREAMS AT NIGHT
• STARTS FROM SLEEP
• CANNOT SLEEP UNTIL ROCKED
• BRUXISM

STICTA

• FROM COUGH
• AFTER SURGERIES

DIAPER RASHES

WITH SORENESS AROUND ANUS
BORAX

• APHTHOUS INFLAMMATIONS
• SENSITIVE TO NOISES
• FEAR OF FALLING
• CHILD SCREAMS BEFORE PASSING STOOL OR URINE
• INFLAMMATORY STRICTURE OF RECTUM

MERC SOL

• ULCERATIONS WITH TENDENCY TO SPREAD
• MOIST, CRUSTY , OFFENSIVE LESIONS
• PROFUSE SWEAT

SULPHUR

• < AFTER WASHING
• EASILY SUPPURATES
• DUE TO LACK OF HYGIENE
• DISAGREEABLE ODOR, CANNOT BE REMOVED BY WASHING
• ERUPTIONS COMING IN CROPS

WITH EXCORIATION BETWEEN BUTTOCKS

GRAPHITES

• WITH MOIST , STICKY DISCHARGES
• WITH CRACKS
• WITH DRY ROUGH SKIN
• WITH CRUSTS
• MORE IN FLEXURES AND BEHIND EARS

KREOSOTE

• WITH OFFENSIVE DISCHARGES
• WEAKNESS
• DENTAL CARIES AND SPONGY BLEEDING GUMS

SEPIA

• MILK CAUSES DIARRHEA
• SIGHT OF FOOD SICKENS
• ERUPTIONS CIRCULAR IN SPOTS
• RAW AND CRACKED SKIN IN FLEXURES

ECZEMA

GRAPHITES

• WITH MOIST , STICKY DISCHARGES
• WITH CRACKS
• WITH DRY ROUGH SKIN
• WITH CRUSTS
• MORE IN FLEXURES AND BEHIND EARS

CARCINOSIN

• NUMEROUS MOLES

NATRUM MUR

• CRUSTY LESIONS ON BENDS OF LIMBS
• ERUPTION ALONG MARGINS OF SCALP, BEHIND EARS
• OILY SKIN
• MAPPED TONGUE

SULPHUR

• < AFTER WASHING
• EASILY SUPPURATES
• DUE TO LACK OF HYGIENE
• DISAGREEABLE ODOR, CANNOT BE REMOVED BY WASHING
• ERUPTIONS COMING IN CROPS

VIOLA TRICOLOR

• OFFENSIVE URINE
• RECURRENT URINARY COMPLAINTS

CRUSTA LACTEA ( CRADLE CAP )

STAPHYSAGRIA

• LOSS OF HAIR
• MORE ON OCCIPUT
• YELLOW DISCHARGE
• THICK SCABS

HMP VOL 21 ISSUE 4

https://drive.google.com/open?id=0BxR24sq3gqQTUVc0bHBweldEdmdLYW5qLTFMblVINGhiOGNN

Pearls - Dr.T K Harindranath

# Infantile colic with flatulence
A dose of Chamomilla  followed by Senna 3x half hourly depending on the severity

# Iodine 3x in aqueous solution can be used to clean the mouth of infant in oral candidiasis.
Five drops in ten ml distilled water

# Add one drop of Sambucus Q in 10ml N S. This solution can be used to relieve nasal congestion in infants. To relieve nasal obstruction immediately put 2 drops in each nostril.
Solution should be used within 12 hours after preparation

Nux vomica- The magic wand for the Neonatologist! - Dr. K. Abdul Gafar, National Secretary- Administration, IHMA

In our daily practice we come across many an illness belonging to infants. There are three distinct entities for all of which a single medicine can serve you as the remedy and get the child (as well as the mother) out of trouble easily, effectively and permanently as if in a magic! The drug is Nux vomica.

One: Acute gastric troubles.
 
The trouble: The baby presents with restlessness, bloated abdomen, frequent loose stools, less sleep and of course lots of crying. It suckles less and the mother will almost always be wary with sleepless eyes and worried face.

The reason: In our country it’s customary for new moms to have some home remedies to get them rejuvenated after delivery.  This is taken in the form of decoctions like onion, fenugreek etc. and also almost everyone takes a few doses of kashayas, lehyas and arishtas- the routine lasting two to four weeks. Sometimes it can disturb the delicate ecosystem of the baby, especially if the mother is a little anxious and if she herself is a little gastric prone. This leading to the above said symptom complex.

The remedy: Give Nux vomica 200 BiD for three days to the mother. Tell her to have a few extra glasses of water (say like three glasses extra) for one week. Tell her to stop all home remedies for four five days and then re-start them at half the usual quantity for another four five days. Then she can resume those as before. Also the baby can be given pre-boiled water a few drops (say five to ten drops) BiD or Tds for two or three days if the trouble is too much. In worse cases the baby can be given a dose of NV 200 too in much less quantity.
China, Carbo veg, Lycopodium etc. are some of the drugs you  can think of if NV didn’t help, but that happens once in a while only.

The caution: Always be on the lookout for Volulus, Intussuception, Hirschsprung’s disease, Duodinal atresia etc. But those happen in very rare cases only.  So be alert and be ready to intervene in case if the condition does not improve in 48 hours.

Two: Icteric Neonatorum:
 
The trouble:  The baby presents with generalized yeloowness of skin and sclera. Mild raise of temperature and mild resltlessness.
 
The reason: We all know about physiological jaunidice related with fetal RBCs. So, no need to worry. In fact in most cases this is a benign self limiting condition. But sometimes we may need to intervene.
 
The remedy: Give Nux vom 30 one dose a day for three days to the baby. Also expose it to sunlight in moderate amounts as below. Disrobe the baby completely. Cover it’s eyes with a tender banana leaf or mango leaf. If not available use a white cotton cloth for his. Then put the child to sunlight in a open area attached to house like a Varandha. Take care to use the first two hours of morning sun or last two hours of evening sun. Also don’t expose the baby not more than forty minutes at a time- twenty minutes front and twenty minutes back.  Repeat for five or six days. Now a days UV set up is available even in small hospitals and every one go for that. Still sunlight is better than that from my experience as it’s milder than direct UV. Sulphur, Lyco & China are other drugs you can think of.
 
The caution: If the ictericity is more do a serum bilirubin and pay attention to the amount    of direct (conjugated)  and in much higher values do a Coomb’s test. The less common conditions to keep in mind are Rh incompatibility, Neonatal Hepatitis and Biliary Atresia.

Three: Constipation in infants.
 
The Problem: Baby presents with no or scanty stools for several days. Motion only with the help of laxatives in the form of suppository.
 
The reason: Can be less serious or more serious. In most cases it’s because of less consumption of liquids by mother and so less water getting in to baby’s system. Some mothers have deficient milk in their breast that can also be the reason. Another important reason is bottle fed babies especially with milk formulas.
 
The remedy: Give Nux vom 30 or 200 one dose to the baby. In most cases this will bring out motion within 24 hours. Ask mother to have plenty of fluids.  Assess the availability of milk with the mother and also look at her feeding habits to see if there is an error. Surprisingly you will find erroneous feeding habits in more mothers than you think. In worse cases baby needs to be given pre boiled water a few drops three times a day for a few days. In worst cases (if there is a critical deficiency of breast milk) formulas need to be given (even though that itself present a chance for constipation).  The other drugs may vary depending on the c ause.
 
The caution: Be on the lookout for Duodinal atresia, Intussuseption, Volvulus, Hirschsprung’s etc.

Exercise during Pregnancy - Pramod C K

Exercise during pregnancy can have a positive impact on both baby and mom. You need to be physically active during pregnancy.
Woman with normal pregnancies should get at least 30 minutes of moderate exercise on most days. More women than ever are taking that advice, making fitness a part of their daily-or almost daily-routine.There are plenty of health perks to exercising for two.

Most exercises are safe to perform during pregnancy, as long as you exercise with caution and do not overdo it. Do everything in moderation, never exercise to the point of exhaustion. The safest and productive exercises are swimming, brisk walking, stationary cycling, elliptical , pranayama (breathing exercises), light weight training, kegel exercise etc. Drink water before, after and during exercise to avoid dehydration. Any exercise or environment that raises a pregnant woman's temperature more than 1.5° should be avoided since it causes blood to be shunted away from the uterus to the skin as the body attempts to cool off.

Practising yoga while pregnant is one of the best ways to keep your body feeling good and your mind in balance. If you have never practised yoga before, start with prenatal yoga for a while, you should be able to continue your regular yoga practice with a few modifications.

Exercises like Squat can open your pelvic outlet by 10%. When you squat to induce labor, it creates more room for the baby to move down into the birth canal. Strong legs are a must when it comes to labor and the final push to give birth. Squats are fine, but avoid lunges and deep knee bends because your joints will be more prone to injury.

Jumping and running while pregnant can hurt the baby. Use lighter weights with more reps during pregnancy to avoid overloading joints already loosened by increased levels of hormone Relaxin during pregnancy.
Kegel exercise helps strengthen your pelvic floor, the muscle group that controls all the flow of urine and the contraction of the vagina and anal sphincter. One of the many benefits of doing your Kegels is that they prevent urinary incontinence, a pretty common complaint late in pregnancy and during postpartum.
The benefits of exercise for mom:

Exercise may prevent gestational diabetes, a growing problem among pregnant woman. It causes your brain to release Endorphins, those happy chemicals that give you a natural high-improving your mood, diminishing stress and anxiety. A strong set of abs is the best defence against back pain, which plagues many pregnant woman. But even exercise that is not directly targeting the tummy can also relieve back pain and pressure . An active body encourages active bowels. Moms who exercise tend to have shorter labors and delivery interventions, including C-sections. The more fit you stay during pregnancy, the faster you will recover physically after childbirth. Many pregnant women have a hard time falling asleep, but those who exercise consistently often sleep better and wake up feeling more rested. A little exercise can go a long way when it comes to giving your energy level the boost it needs.

The benefits of exercise for Babies:

Babies are also stimulated by the sounds and vibrations they experience in the womb during workouts. Babies of moms who exercise during pregnancy are born at a healthier weights, are better able to weather labor and delivery and recover from the stresses of birth more quickly. Research shows that babies of moms who exercise throughout pregnancy score higher, on average, on general intelligence tests by 5. Also they tend to sleep through the night sooner, are less prone to colic, and are better able to soothe themselves.

Stretching:

 A pregnant body is more prone to muscle cramps in the legs. Stretching can help you uncover little pockets of tension, warding off sore muscles. Plus you can do it anywhere, anytime-even if you spend most of your day sitting down.

Precautions:

If you are abstaining from exercise on your doctor's orders, you are helping your baby and yourself. Your doctor will almost certainly restrict exercise if you have a history of miscarriages or of premature labor, or if you have an incompetent cervix, bleeding or persistent spotting in the second or third trimester, heart disease, high blood pressure, anaemia etc.

Always check with your doctor for your pregnancy exercise protocol.

Pramod is a top trainer in Bengaluru offering personalized fitness solution. Pramod can be contacted at +91 9611219889

HMP Vol 21 issue 3

https://drive.google.com/open?id=0BxR24sq3gqQTTnJsZmcxS3FONFBRWDB2eHJEQmdrWnVZc2tn

HMP Vol 23 Issue 2

https://drive.google.com/open?id=0BxR24sq3gqQTWG42MDhxR0VuLWM

HMP Vol 23 Issue 3

https://drive.google.com/open?id=0BxR24sq3gqQTZWN2TFA0Z1NSLXc

Of the Neonate - Dr.Mayarani Senan BHMS, MSc (Psy), MPhil (Counselling and Guidance), MBA (Self-Management and Crisis Management)

“Sent straight from heaven up above
Came an angel for me to love
To hold and rock and kiss goodnight
To wrap my arms around real tight”


A newborn is a bundle of joy and surprises. The union of single celled sperm and ovum, creating a life is truly amazing. Equally mind-blowing is the maturational process –a biological unfolding of an individual according to a plan contained in its genes.
The term “infant” is derived form Latin means “unable to talk” .Medically a neonate or new-born is only hours, days or a month old. This period is a time of extensive and ongoing system of transition from uterine environment to the external world. It is obvious that the development does not stop with birth, in fact many systems cardiovascular system, respiratory system, gastrointestinal system and all undergo significant changes. Some changes especially neural changes are incomplete.
Neonatology has developed in the past decade bringing together the knowledge and experience of medical professionals, health professionals, psychologists and mothers to improve the quality of physical and psychological care of the infant.
Various Theories of Development:
Jean Piaget’s Cognitive Development Theory proposes sensorimotor stage: a period of time between birth and age two during which an infant's knowledge of the world is limited to his or her sensory perceptions and motor activities. Behaviours are limited to simple motor responses caused by sensory stimuli.
Attachment theory
Attachment behaviour in adults towards the child includes responding sensitively and appropriately to the child’s needs. Such behaviour appears universal across cultures. Attachment theory provides an explanation of how the parent-child relationship emerges and influences subsequent development proposed that attachment can be understood within an evolutionary context in that the caregiver provides safety and security for the infant.

Psychologists have proposed two main theories that are believed to be important in forming attachments.
The Learning / Behaviourist Theory of Attachment (e.g. Dollard & miller, 1950) suggest that attachment is a set of learned behaviours.  The basis for the learning of attachments is the provision of food.  An infant will initially form an attachment to whoever feeds it.
They learn to associate the feeder (usually the mother) with the comfort of being fed and through the process of classical conditioning, come to find contact with the mother comforting. They also find that certain behaviours (e.g. crying, smiling) bring desirable responses from others (e.g. attention, comfort), and through the process of operant conditioning learn to repeat these behaviours in order to get the things they want.
The Evolutionary Theory of attachment Bowlby, suggests that children come into the world biologically pre-programmed to form attachments with others, because this will help them to survive.  The infant produces innate ‘social releaser’ behaviours such as crying and smiling that stimulate innate caregiving responses from adults. The determinant of attachment is not food, but care and responsiveness.
Bowlby suggested that a child would initially form only one primary attachment (monotropy) and that the attachment figure acted as a secure base for exploring the world. The attachment relationship acts as a prototype for all future social relationships so disrupting it can have severe consequences. This theory also suggests that there is a critical period for developing an attachment (about 0 -5 years).  If an attachment has not developed during this period, then the child will suffer from irreversible developmental consequences, such as reduced intelligence and increased aggression.
                                   Newborn's sense of touch may be as acute as his ability to taste and smell. Touch -- mostly MOTHER’S -- stimulates everything from deeper breathing to immune development to emotional well-being. Studies have shown that under conditions of extreme neglect, new-borns that are hardly held or cuddled experience emotional and developmental problems. By contrast, extra Touch can have remarkable results: lots of physical contact gives babies a developmental boost (reminds of the oil massage suggested for little ones). Touch, it turns out, doesn't just stimulate a physiological reaction. It's a form of communication. And how you handle your baby makes a difference. While hesitant touch conveys uncertainty, fear and unease, firm consistent contact signals safety, protection, and love, says Tiffany Field, Ph.D., director of the Touch Research Institutes at the University of Miami School of Medicine.
                                    Research shows that when a parent responds quickly to comfort a crying infant, the baby cries less often overall. Picking up the baby while crying conveys the message to the child that he/she is safe and the parent is caring. Longitudinal research has shown that having a ‘loving’ primary caregiver and developing ‘organized and secure’ attachment to a primary caregiver acts as a protective factor against social and emotional maladjustment for infants and children. Attachment insecurity (avoidant and resistant) has been proven to be a risk factor for later development, but its high base rate in the normal population (approximately 40%) has reduced its predictive value for psychopathology.

Common diseases of neonates - Dr.Nisha Gopinath

Abstract:most common diseases of neonates which causes discomfort to the newborn.How can we assess the crying baby.The most common diseases are preterm birth,hemolytic diseases of newborns,infant respiratory distress syndrome,neonatal jaundice,broncho pulmonary dysplasia,neonatal infection,neonatal sepsis,perinatal asphyxia.

Neonatal mortality rate: it refers to the number of deaths occurring at less than 28days after the birth per thousand live births. This accounts for 67%of the infant death. 50%of the neonatal death can be attributed to low birth waight, acute perinatal asphyxia, congenital anomalies,perinatal infections, difficult labour,respiratory distress syndrome and gastroenteritis.

INTRODUCTION
Neonatology means knowledge of the human newborn, Neonatal period starts from the 7th day of life to 28th day of life.
The first 24hours of life is a very significant and a highly vulnerable time due to critical transition from intra uterine to extra uterine life.
Crying is a normal physiological behaviour in young infants. At 6 to 8 weeks age a baby cries on average 2-3times/24hours.infant with colic are well and thriving.

Assessment of a crying infant: 
Crying develops in the early weeks of life and peaks around 6 to 8 weeks of age. Colic is the term used to describe infants who cry excessively for no apparent reason during the first three months of life. Colic is one of the most distressing problems of infancy. It is distressing for the infant, the parents, and for the health care provider. The cause of colic is not well understood, but it resolves in most infants by three to four months of age. Even though it usually goes away on its own, it can be helpful to learn more about colic in order to gain a better understanding of this difficult stage of baby's life.Usually worse in late afternoon or evening but may occur at any time.may last for several hours.
Infant may draw up legs as if in pain ,but there is no evidence that is colic is attributable to an intestinal problems or wind.it usually improves by 3 to 4 months of age. Colic is defined as "excessive crying." An infant with colic usually cries for more than three hours per day on more than three days per week.
Colic is extremely common and occurs in up to 40 percent of all infants. It usually starts sometime between the third and sixth week after birth and ends when a baby is three to four months of age. Colic occurs with equal frequency in the following groups:
●Males and females
●Breast- and bottle-fed infants
●Full-term and preterm infants
●The first and second child (and other siblings as well)

Common non pathological causes of crying include,
⦁    Excessive tiredness – suspect if the infants total sleep duration per 24hours falls more than an hour short of the average for their age.
Average sleep requirements: At birth -16 hours
                                                  At 2-3months- 15hours.
A 6 week old baby generally becomes tired after being awake for 1.5hours.
⦁    Hunger – this is more likely if a mother repors her baby has frequent feeds(<3hourly),poor weight gain and inadequate milk supply.
⦁    Gastro –oesophageal reflex disease may exist if there is frequent vomiting or if the body has feeding difficulties.
⦁    Lactose overload/malabsorption- primary lactose intolerance is extremely rare,suspect if there is frothy watery diarrhea with perianal excoriation.

Most common diseases of neonates

-hemolytic diseases of newborn
-infant respiratory distress syndrome
-neonatal jaundice
-broncho pulmonary dysplasia
-neonatal infection
-neonatal sepsis
-perinatal asphyxia
-necrotizing entrocolitis
-meconium aspiration syndrome

Hemolytic disease of newborn:its also known as erythroblastosis fetalis,isoimmunization,or blood group incompatibility,occurs when fetal red blood cells,which possess an antigen that the mother lacks,cross the placenta into the maternal circulation,where they stimulate antibody production.the antibodies return to the fetal circulation and result in RBC destruction.
Infant respiratory distress syndrome: its also known as hyaline membrane disease,is inadequate pulmonary surfactant due to preterm birth .the manifestation of disease are caused by the resultant diffuse alveolar atlectasis,odema,and cell injury.
Risk factors-prematurity,maternal diabetismellitus,and genetic factors,thoracic malformations
Infants delivered before labour starts do not benefit from the adrenergic and steroid hormones released during labour,which increase surfactant production and release.assessment of fetal lung maturity –prenatal prediction of lung maturity can be made by testing amniotic fluid obtained by amniocentesis.

Neonatal jaundice: Newborn appear jaundiced when it is >7mg/dl between 25% and 50% of all term newborns and a higher percentage of premature infants develop clinical jaundice.
causes of neonatal jaundice-
overproduction-fetomaternal blood group

                              -heriditary spherocytosis
                              -eliptocytosis,somatocytosis
                               -G6PD deficiency and drugs
                              -pyruvate kinase deficiency
                              -alpha thalassemia,beta thalassemia
                               -acquired hemolysis due to vit K
Undersecreation- metabolic and endocrine conditions
                                        -gilbert disease,galactosemia
                                        -hypothyroidism,lucy-driscoll syndrome                     
                                         -prematurity,hypopitutarisam
                                         -hypopituarisam,anencephaly
                                         -obstructive disorders,biliary atresia
Bronchopulmonary dysplasia:
 Is a form of chronic lung diseases that develops in preterm neonates treated with oxygen and positive pressure ventilation.infants born with bronchopulmonary dysplasia shows the symptoms of respiratory distress syndrome.
Neonatal infections:
Vertically transmitted(mother to child)viral infections of the fetus and newborn can generally divided into two major categories
Congenital infections-which are transmitted to the fetus in utero.
Perinatal infections- which are acquired intrapartum or in the postpartum period.congenital infections can have clinical manifestations that are apparent antenataly by ultrasonography or when the patient is born.classically the congenital infections are Toxoplasmosis,Rubella,Cytomegalo virus,Herpes simplex virus.where as perinatal infections may not become clinically apparent until after the firat few days or weeks of life .
Neonatal sepsis:
Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns,particularly in low birth weight infants.several studies report the incidence of Early onset sepsis(EOS)to vary from one to four cases per 1000live births.the most common causative organism is Group B streptococcus.The clinical signs of EOS are usually apperent in the first hours of life.90% of infants are asymptomatic by 24hours of age .Respiratory distress is the most common presenting symptom.
Meconium aspiration syndrome:
Is the aspiration of stained amniotic fluid,which can occur before ,during,or immediately after birth.meconium is rarely found in the amniotic fluid prior to 34weeks of gestation,meconium aspiration primarily affects infants born at term and postterm.intra uterine distress can cause passage of meconium into the amniotic fluid.factors that promote the passage of meconium in utero include placental insufficiency,maternal hypertension,preeclampsia,oligohydramnios,infection and maternal drug abuse.


REFERENCES

1.Nelson text book of pediatrics,20th edition
2.oxford hand book of pediatrics.
3.Pearls in clinical pediatrics
4.Manual of neonatal care 7th edition
5.Rennie and Robertson’s text book of neonatology 5th edition.
6.www.uptodate.com

HMP Vol 23 Issue 4

 https://drive.google.com/file/d/0BxR24sq3gqQTeU9EOE01TldKNm8/view?usp=sharing