1. Dr.Zarkesh Neonatologist

2. Crying:  Is the last sign of hunger.  Is the main route of communication between infants and their parents.  Is the most common reason for seeking medical attention in the first 3 months of life.  It may distort parental infant relationship.

3. The most common causes:  Colic :“Rule of Three”  Acute Otitis Media  UTI  Milk allergy  Opium withdrawal  Gastroesophageal reflux  Napkin dermatitis  Other Infectious diseases  Smoking

4. Colic: Overall prevalence rates of colic varies between 1.5 to 11.9 percent of infants. Recurrence of excessive crying increases the likelihood of colic. A cry of colic is described as urgent,piercing,arousing and sad by parents. Presents later in preterm infants. There are studies showing that the problem may persist longer than 3 months.

5. Kangaroo Mother Care (KMC) & Massage Therapy : may use as a simple and safe method for treatment.

6. Acute Otitis Media:  It develops in 0.6% of all live births during the first month of life, the rate may reach 2% to 3% in premature infants.  It occurs more often in: male,bottle-fed infants,infants with cleft palate,prolonged intubation.  In the first 2 W of life : a combination of ampicillin and an aminoglycoside for 10d provides effective initial treatment.

7. UTI:  Its incidence varies from 0.1% to 1% of all infants.  Symptoms referable to the GU system are rare.  U/A is normal in 50% of cases.  Isolation of any bacteria from a bladder aspirate or counts of 10oo or higher colony/ml of cathetrized urine are meaningful.  Empirical therapy includes a combination ampicillin and an aminoglycoside for 10d.

8. Milk Allergy: The usual age of presentation is around 66D,but is seen as early as 2 D of life. It has prompt resolution of symptom after elimination of the Ag from the diet. Infants with cows milk protein allergy have a 30% to 40% chance of being allergic to soy protein.

9. Opium Withdrawal:  The onset of neonatal withdrawal from narcotics generally begins in the first 2 D,but may occur as late as 6 W.  Supportive care : providing a quiet environment,loose swaddling,adherence to supine position.  Pharmacotherapy :Diluted morphine (0.4 mg/ml) 2 drops/kg with feeding every 4 h.  After stabilization for 3 to 5 d, the dose may be tapered gradually without altering interval.

10. Gastroesophageal reflux (GER): It is normally seen in neonates. GERD should be considered only when : Crying persists beyond 4 m There is no diurnal variation Infant has poor weight gain Crying is prolonged and extreme

11. Diaper Dermatitis: Candidiasis in the first 4 w of life is usually benign and is localized most often to the oral cavity or the diaper area. It is usually restricted to the groin,but can be noted in any warm,moist area. The peak incidence occurs at 3 to 4 months of age. Topical antifungal agents 3 times daily for 7 to 10d is usually effective, and combined with a corticosteroid can be useful in severe cases.

12. Diagnosis:  Physical examination led to the diagnosis in 61% of cases.  The history and physical examination provide the diagnosis in 86% of cases.  U/A and U/C are the most helpful tests.  Ultrasound is the most useful imaging study.