Patient's question:
My child was born prematurely and stayed in the incubator for forty-six days. On the first day of check-up, the direct bilirubin was 5.7 (normal), while the indirect bilirubin was 78.6 (high). On the forty-sixth day, the direct bilirubin was 85.7 (increased) and the indirect bilirubin was 52.2 (increased). The hepatitis B surface antigen has always been negative (all hepatitis B tests were negative before my pregnancy). More than ten days after discharge, I had another check-up at a different hospital, where the direct bilirubin was 114.5 and the indirect bilirubin was 48.3. The doctor diagnosed the baby with neonatal hepatitis syndrome. The doctors in the incubator used medications that could affect the liver, and now my child is taking traditional Chinese medicine. A few days ago, the baby's stool was always yellow, but since last Wednesday, I noticed the stool was a bit lighter in color. Is this due to the traditional Chinese medicine or the illness?Doctor's answer:
The treatment mainly involves three aspects: etiological treatment, symptomatic management, and nutritional supplementation:1. Etiological Treatment: This is relatively difficult. For viral infections, specific medications are often lacking. For CMV infections, ganciclovir may be tried, but its toxic side effects, such as bone marrow suppression, must be monitored. In cases of metabolic disorders like galactosemia, lactose-containing diets should be discontinued. For intrahepatic biliary developmental abnormalities, etiological treatment is challenging. Therefore, symptomatic management is primarily adopted.
2. Symptomatic Management:
(1) Phototherapy: The newborn is placed naked in a phototherapy box, with both eyes and testes covered with black paper. Monochromatic light (20W blue fluorescent tubes arranged in an arc, with a 2.5 cm distance between tubes, at a distance of 35–50 cm from the child) or bichromatic light (6 tubes above and 6 below, with the lower tubes at a distance of 25–35 cm from the child) is used for 24–48 hours. Treatment is stopped once bilirubin drops below 120 μmol/L.
(2) Enzyme Inducers: Phenobarbital (Rumina) is commonly used. It is administered in the first week of life at a dose of 4–8 mg/kg/day for 4 consecutive days, with effects appearing within 3–7 days. Alternatively, a high initial dose (8 mg/kg/day) can be given, followed by a maintenance dose (4 mg/kg/day). Adding nikethamide (Koramine) at 100 mg/kg/day can enhance efficacy.
(3) Traditional Chinese Medicine for Bile Promotion:
① Yinzhihuang Injection: 5–10 ml is added to 50–100 ml of glucose solution for intravenous drip, once daily.
② Shengdahuang: Boiled in water and taken at 0.5 g/kg/day.
(4) Liver Enzyme Reduction: Bifendate: 1–2 pills, 2–3 times daily.
(5) Promoting Hepatocyte Regeneration: Hepatocyte Growth Stimulating Factor, Albumin (1 g/kg).
(6) Corticosteroids: These can cause secondary infections and other side effects, so they should be used cautiously. However, they remain a valuable option for jaundice detoxification in severe cases.
3. Nutritional Supplementation: Breastfeeding should be continued. For severe cases, the amount may be reduced or temporarily suspended based on the severity of the condition. Fat-soluble vitamins A, D, E, and K should be supplemented, especially for cholestasis.
- VitA: 100,000 IU IM every 2 months.
- VitD: 300,000–600,000 IU IM every 2 months (calcium should be supplemented simultaneously).
- VitE: 10 mg/kg IM, maximum 200 mg every 2 weeks.
- VitK: 10 mg IV every 2 weeks.
(7) Prognosis: It depends on the etiology, severity of the condition, and complications. For metabolic liver disease and cholestasis, without addressing the underlying cause, improvement is difficult.
Herbal Formula Composition:
- Yinchen: 10g
- Chishao: 10g
- Jinjincao: 6g
- Yujin: 6g
- Danshen: 6g
- Banlangen: 6g
- Jibugcao: 6g
- Sheshengcao: 6g
- Jiaosanzixian: 12g
- Gancao: 3g
Preparation and Usage:
The above herbs are decocted with 200 ml of water to produce 100 ml of liquid, which is divided into 4–5 doses for oral administration daily.
Indications: Infant Hepatitis Syndrome.
Symptoms: Jaundice, abdominal distension, vomiting, hepatomegaly or hepatosplenomegaly, pale or white stools, and dark yellow urine.
Case Study:
A female infant named Ouyang, 50 days old. At 20 days of age, jaundice of the sclera and skin was observed, accompanied by milk vomiting that worsened daily, poor, decreased urine output, dark yellow urine, and white stools. The tongue was yellow, and the pulse was slightly rapid.
Physical Examination: Jaundice of the sclera and skin, no abnormalities in heart or lung auscultation, mild abdominal distension, liver palpable 4 cm below the costal margin, spleen palpable 2 cm below the costal margin, soft in texture.
Laboratory Tests: Hemoglobin 120 g/L, red blood cells 4.2 × 10^12/L, white blood cells 7.2 × 10^9/L (neutrophils 0.6), normal stool routine, clear yellow urine, negative urine protein, bilirubin (++) in urine, urobilinogen (++) in urine. Ultrasound revealed hepatocellular jaundice.
Liver Function Tests: Total bilirubin 94 μmol/L, direct bilirubin 37.6 μmol/L, ALT 236 U, HBsAg (+).
Diagnosis: Infant Hepatitis Syndrome.
Pattern Differentiation: Damp-heat accumulation type.
Treatment Principle: Clearing damp-heat and promoting blood circulation to remove stasis.
Prescription: Modified Yingang Decoction. After 15 doses, the jaundice resolved, milk intake increased, urine turned light yellow, stools returned to normal, and improved. Liver function tests were normal, but HBsAg remained positive. After another month of treatment, liver function tests returned to normal, and HBsAg became negative.
Follow-up: One year later, the child showed normal growth and development.