Epidemiology of infant burn in Eastern Saudi Arabia

Discussion

The paucity of data on burn injuries in infants initiated our 4-year study. A recent publication on infant burns, and literature review by Laitakari et al5 reviewed only 6 previous publications that addressed infant burns. Our review of the literature revealed no previous publications in Saudi Arabia on infant burns except for a publication by Al-Qattan,6 who reported on the treatment of 53 infants with palm burns due to camp fire injures. Our study included 84 infants admitted over a period of 4 years, which constituted 16.5% of all admissions, and 41.4% of pediatric admissions to the Burn Unit. This percentage is higher than Laitakari et al’s review,5 which reported the highest percentage was 30% of pediatric admissions. Laitakari’s own study showed that only 3% of pediatric admissions were infants.5 Scalding was the most common cause of burns at 86.9%. This is consistent with previous studies in which all reported scalding as the most common etiology.5,7,8 Most of these scalds are attributed to the use of hot water during bathing or cleaning. However, a study carried out on infants referred to the emergency department by Lorch et al,8 showed a different pattern of scalding, with the common cause of scalding being hot beverages and soup.8 Unfortunately, in the current study we were unable to determine the common cause of scalding due to inadequate details in the files of reviewed cases.

However, based on the knowledge of Al-Ahsa community habits, hot water from bathing and personal cleaning in toilets in our community is the most likely cause. Water hoses are used for self-cleaning after toilet and they are usually installed low and infants can reach them. Mothers also use water for cleaning their babies after a wet or soiled diaper. Previous studies did not report any perineum burns, however, in our study the perineum (either the only area burned, or part of the burned areas) was involved in 11 infants (13.3%, Table 2).5,8 The differences in cleaning practices within societies is an important factor for burns among infants. The use of an appropriate hot water supply and equipment is important as reveled by Kubilius et al3 who noticed increased scalding burns among pediatrics where hot tap water is not available due to the use of hot water for household duties.

While contact burns were the second most common cause among infants in previous studies, flame burn was second in our study.5,7 Chemical burns were not common, and only reported by Nguyen et al,4 in which flame, chemical, and radiation were the cause in only 5 infants (5%). This difference in pattern may be due to the local practice of using campfires, as reported by Al-Qattan,6 wood and coal for local methods of cooking, and using chemicals for opening blocked sewage lines at homes. The hand was the most common body part affected in previous studies, followed by the trunk.5,8 Our study is consistent with these studies. We classified the body as upper and lower limb, trunk, and perineum. The upper limb was the most affected followed by the trunk. We grouped infants into groups, with and without upper limb burns, and the second with and without trunk burns. When the upper limb was involved the average ± SD age was higher (10.9±2.17 month), compared with infants with no upper limb burns (9.6±2.85 months). This was also reported by Nguyen et al, and can be attributed to mobility and motor development of the older infants, as this may be a risk factor as published by previous studies.4,9 Trunk involvement resulted in a higher stay-days average (11.4 days) compared with 8 days when the trunk was not involved. The trunk association with higher stay days was not reported in previous study. Trunkal involvement is associated with higher TBSA involvement, and thus more stay-days. The peaks of increased burn around the eighth and twelfth month (Figure 4) is only noticed in our study, although Nguyen et al4 reported increased burns with older infants.4 The TBSA involvement varies among all previous studies as reviewed by Laitakari et al.5 Some studies ranged from 0.5-38% as in Nguyen et al’s study,4 and 0.5-40% in Laitakari own study.5 Our range was from 1-25% with the most common involvement being between 5-10%. Nguyen et al4 reported that 94% of contact burns were small and were very small and ranged from 0-1% TBSA. Most of the previous studies reported that they admit infant to the burn unit even with small TBSA, this low threshold to admit low TBSA is that even a 0.5% burn in an infant may require special care and considered a significant injury to an infant, especially if it is on the hand or perineum. There are many limitations to our study. This study addressed infant admissions to the burn unit, but the true number of infants treated for burns in the emergency department and discharged, or those whose parents refused to admit them to the burn unit is unknown. Also, the exact mechanism of the burn, and the place where the burn occurred was not properly recorded in the admission papers. No other data on the socioeconomics of the family, the number of siblings, literacy of parents, and so forth was collected.

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Figure 4

The peaks of increased burn around the eighth and twelfth month in 84 infants admitted to the Burn Unit of King Fahad Hospital, Hofuf, Al-Ahsa, Saudi Arabia.

In conclusion, infant burns should be properly reported and studied, as the etiology of these burns are different from other age groups. Preventive measures should focus on the etiology of these burns based on community habits and behavior, such as the use of campfire and wood or hot water during infant cleaning. Future study should include other important variables that contribute to burns in infants, like socioeconomics and literacy of parents.