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Editorial Note

Editorial Team Editor: Dr. Biji Thomas George Associate Editor: Dr. Yousef Abdel Mohsin El Qabbany Issue Manager: Shyju Joseph

It has been said that “having a baby changes the way you view your in-laws. You love it when they come to visit now. They can hold the baby and you can go out!� Indeed, having a baby can be a joy and a stress. The joy and stress

Magazine Coordinator: Anu Joseph

start not just when the baby is born, but during the pregnancy as

Design & Layout Dantis Mathew

There are a lot of myths and legends surrounding what to do and


what not during a pregnancy. Our consultant Obstetrician Dr. Bernd Wittman gives us an oversight on the care mothers need to take during a pregnancy. After the delivery, a common worry, especially for new mothers, is when the baby keeps crying unstoppably. When is it something serious and when is it something simple like a wet nappy? Dr. Achini De Silva, our Senior Paediatrician tells us of the various causes why babies cry incessantly. We also carry an article on how to avoid muscle strains and injuries during sports and work outs.

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Dr. Biji George Editor

So You Are Dr. Bernd K. Wittmann Sr. Consultant MD, FRCSC You probably missed a period, had a home pregnancy test, and it was positive - what now? The best approach is to see your physician, who will check out your medical history for any problems, and will order an ultrasound examination (US) after 7 weeks, to confirm the dates and make sure that there is a baby with a heartbeat. Of course, you have been taking Folic Acid before you conceived, and your life style is healthy. If all is well, and you have neither bleeding nor cramps, then you have a better than 90% chance of a successful pregnancy. However, every couple at this stage is worried if the baby is normal. With the advent of ultrasound in obstetrics 50 years ago, there has been an ongoing search for ways to identify and document normal features of the baby. Severe anomalies can sometimes already be seen between 10 - 12 weeks, however

the fluid at the neck of the baby (nuchal = neck translucency

most problems are recognized later. In an attempt to try to

- NT) can disappear after 14 weeks.

confirm early on that the baby is normal, scientists have

Should all be normal, then you should see your physician or

recognized that between 11 - 14 weeks, specific ultrasound

midwife every 4 weeks until 6 months, and then more

features combined with blood tests can provide a very

frequently. At around 20 weeks, an ultrasound examination

accurate assessment of the risk of some major chromosome

will be booked, and the baby will receive a full examination of

anomalies. This test is called First Trimester Screen, and many

all the anatomic features which can be recognized at this

professional organizations have recommended that this test

time. This examination is also used to show you and your

is being made available to all pregnant women. The

husband all the beautiful features of your baby. Four to six

ultrasound examination at this time will already provide a lot

weeks later is the best time to perform a 3D/4D ultrasound

of detailed structural information of the baby, and help

examination, if you are interested in seeing real life features of

confirm that all is well. This test is available at Starcare Hospi-

your baby. The last formal ultrasound examination is usually

tal, should be booked between 11 - 14 weeks, and results are

performed at around 32 weeks, to evaluate growth and

available one week later. If the dates are uncertain, an earlier

development of the baby. Of course, if you have medical

visit is necessary to establish dates and book the appointment

problems, or there are concerns about the baby, the placenta

for the FTS at the correct time. After 14 weeks, the test

or the fluid around the baby, then ongoing monitoring of the

cannot be performed, as the most important ultrasound sign,

pregnancy by ultrasound is required.

Excessive Crying

IN A NEWBORN Dr. Achini Nirosha Kumari De Silva MBBS, DCH, MD (Paed), MRCPCH(UK) Consultant Paediatrician

overload occur in a baby when breastfeeds consistently contain inadequate amounts of fat (lipid). Foremilk (which is released within the first 5-10 minutes) is more “sugary and

It definitely is a nerve wracking experience when you have a

watery” compared to hind milk which has more fat (lipid)

screaming un-pacifiable newborn to deal with. We cannot

and proteins. Higher fat levels in breast milk causes babies to

blame the baby, as his only way of communication. The

feel full and satisfied after a breastfeed. Lipid also slows down

parents, especially new ones, naturally become anxious when

the time taken by the intestine to digest the milk. A breast-

their baby cries too much. However, parents must try to avoid

feed that has too little “cream” or fat content results the baby

anxiety on such occasions. A new born can feel your anxiety;

not feeling full or satisfied by the breast feed and also causes

in turn he will become more agitated resulting in a vicious

fast and improper digestion of the milk so that the milk

cycle. Parents and other caregivers should remain calm and

ferments in the colon, causing low-grade inflammation and

try to analyze the reasons behind the incessant crying.


The common reasons for a baby to get agitated are hunger,

Babies who don’t feel full after a feed, due to inadequate lipid

wet or dirty nappy, abdominal discomfort before passing

intake, may quickly want more milk. In older breastfed babies,

stools or urine, insect bites, itchy rashes especially irritating

this can result in a cycle of overproduction. The baby feeds

nappy rashes, feeling excessively hot due to over wrapping or

very frequently, stimulating the breast to produce more milk.

cold due to exposure, nasal congestion and nose block.

This milk will be even more sugary and watery and lacking fat

There are conditions for which you need to take medical aid

or “cream”. The baby will then feel hungrier and the cycle

without a delay. For example if you see a lump in the groin

becomes unmanageable.

area which could be a hernia, any redness in the scrotum, ear

There are ways that mothers can increase the fat content in

infection or discharge. If any new born baby has fever, or a

their breast milk so that their babies feel full and satisfied after

pulsation/ bulging soft spot on the head (fontanelle) you

each breastfeed.

have to rush to the hospital.

1. Discontinue “comfort suckling” (when the baby makes

“Functional lactose overload” is another common condition

frequent rhythmic flutter-like sucks and only periodic

which leads to unsettled babies. Signs of functional lactose

swallows toward the end of a feed). 2. Allow only “twenty minutes a side”–or similar instructions to limit the feed. 3. Always offer the fuller side first. 4. Always feed from both sides. 5. Avoid Breast Pumps: Because a breast pump acts as a vacuum but does not extract much of the low volume, lipid-rich milk, babies receiving significant amounts of expressed breast milk may also develop functional lactose overload. Properly taught breast massage may have a role, to help mobilize the lipid fraction. So the next time your baby cries a lot, remember to look for the simple signs and watch out for the dangerous signs so that you can be sure that your baby will always be healthy and happy.

HEALTH& WELLNESS Muscle strains are common. They can occur when you stretch or reach out past your normal range while running, playing sport, gardening etc. A muscle tear is more serious as some of the muscle fibres will be broken. Treatment Initial treatment for both injuries involves RICED. R Rest - stop the activity you are doing to avoid further damage I Ice - place crushed ice wrapped in a damp towel on the injured area for 20 minutes every 2 hours for the first 48 hours. C Compression - firm bandaging helps reduce swelling and bleeding E Elevation - keep the affected area raised as much as possible


D Diagnosis - it is very important to see your doctor or

Following an injury, your physiotherapist can help your

physiotherapist if the pain and swelling gets worse or you

rehabilitation. The earlier you get help, the faster your injury is

have not improved after a couple of days

likely to heal. Treatment will include an exercise programme,


possibly with the use of some gym equipment to increase

The best way to prevent muscle strains and tears is to include

your strength and co-ordination and restore any movement

a warm-up programme before starting any exercise, and then

lost in the joint.

cool down and stretch when you have finished the activity.

If you are a keen sportsperson your physiotherapist can help

Advice on warm-up programmes and cool-down activities

you with your training programme to decrease the chance of

can be obtained from your local gym trainer.


Starcare in the


Starcare Hospital celebrates 2 magical years of healthcare with many festivites

Win your Gift QUIZ CORNER

Answer the below questions

1. What can you put in a wooden box that would make it lighter? The more of them you put in the lighter it becomes, yet the box stays empty?

2. A man built a rectangular house, each side having a southern view. He spotted a bear. What colour was the bear ?

3. Near the beach there is a floating ship. Over the board is hauled down a rope ladder with 10 steps. The distance between every two steps is 30cm. The lowest step lays on the water surface. The tide is coming and every hour the water rises with 15cm. When will the water get to the third step of the ladder ? a) b) c) d)

After 2 hours After 4 hours Never After 14 hours

Send in your answers at and the winner will get a GIFT VOUCHER.

*Conditions apply

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For more information on our hospital

Visit:, E-mail: Contact: +968 24557200, GSM: +968 98252030, P.O.Box: 198, PC 101, As Seeb, Sultanate of Oman

Disclaimer This magazine does not attempt to endorse or promote any information presented. Please keep in mind that information about health matters changes constantly as new studies are performed and new treatments are discovered. Consult your physician or other health professional for your health related advice.


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