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Case Study

Neonatal Jaundice
Dr Mrs Sagira Chimthanawala
'Nux-v / Cicuta / Opium / Syph

A premature 8½ m female child, born out of a consanguineous marriage, second of her parents, was born at our hospital in the wee hours of 2nd June 2001, to a 35 yr old mother. Birth weight was 1.8 kg. Her mother was 'B'Rh Negative and father ‘O’Rh Positive. The mother had PIH since the 2nd trimester. 2 days after birth the child started presenting with

  1. Yellow discoloration of skin- gradually progressing
  2. Listlessness
  3. Weak cry
  4. Refusal to suck milk
  5. Stools - soft, watery, golden yellow, 7-8 times/d

Past Obstetric History

  1. H/o PIH +. Delivered a FTN Male at a rural Hospital. No reported complications. Was not administered Rh Anti D immunoglobulin.
  2. Two abortions -spontaneous after the first delivery in a span of 4 years - Bad Obst History.
  3. During the present pregnancy, following investigations were done -

a.   Hb - 11 gm% (Dec, 2000); 10.2gm% (Mar 2001), 10 gm% (May 2001)

b.   Blood grouping -‘B’Rh Negative. Husband ‘O’Rh Positive.

c.   Bld Sugar (R)-88 mg/dl-Jan 2001,105 mg/dl(June 2001)

d.   VDRL NR

e.   TORCH - all components Neg.

  1. Since the patient was undergoing ANC Checkup at the rural hospital, and presented to us only for delivery, no homoeopathic medications were administered. But on admission she reported -
    O/E Baby Listless,
    Resp: dyspnoeic
    HR 128 / min, reg
    Icterus +, Pallor +
    No cyanosis/ caput
    Ant Font - Normal. No separation of sutures
    Head Circumference - 34 cms.
    Macroglossia +, Low set ears, Hypertelorism +
    Simian crease Lt palm +
    Anal excoriations +
    RS chest clear
    CVS HS pure
    P/A soft, Liver - Just palp, Spleen / Kidneys - NP
    Neonatal Reflexes - rooting present, sucking absent

She was kept in the incubator with IV Fluids. On the 6th day of birth she started having Convulsions - generalized tonic, 3-4 episodes at 4-6-hrs interval. Following were the investigations

·         Hb = 12gm%, PCV = 30%, Blood group = ‘O’ Rh +ve.

·         S. Total Bilirubin = 16 mg/dl, Direct = 0.8 mg/dl, Indirect 15.2 mg/dl

·         Blood Sugar (R) = 64 mg/dL

·         S TSH = 3 mU/L, T4 = 8 microg/dL, T3 = 119 ng/dL

·         S Calcium = 9.8 mg/dL, S. Magnesium = 1 mg/dL, S Na = 138 mEq/L

·         S.K+ = 3.9 mEq/L

·         Arterial Blood Gases: pH = 7.36, pO2 saturation = 92%, CO2 tension 46 mmHg






8.40 am


NV 0/3 5 drops 3 hrly
IV Fluids ct.


2 pm

E/o Convulsion gen tonic 1 hr ago. Jaundice ++ Refusal to feed.

ct all


7 pm

Cry weak. No convulsion since 6 hrs.

ct all


6.10 am

Convulsions with drawing of head backwards Extremities rigidly straightened during attacks could not  be bent. 3 episodes at night. Cry still weak. Refusal to feed Icterus / Pallor ++

Omit NV
Cicuta-vir 200 1 dr ½ cup water, ½ tsf x 1hrly
Phototherapy / IV Fluids ct


11 am

S Bil = 15 mg/dL, Indirect = 14.3 mg/dL

ct all


9 pm

Stools loose but qty less. 4-6 times/d, skin warm, yellow Cry still weak. Convulsions 1 episode. No e/o dehydration
RS/CVS - NAD, P/A - mild distention. Liver +, Spleen NP

ct all


10 am

Convulsions twice /24hrs, diarrhoea increased to 5-7 stools/ 24 h; Watery, blackish frothy, Cry weak  S.Bil = 13.6 mg/dl, D = 0.7 mg /dL, I= 12.9 mg/dL

Cicuta-vir 200 x 4 hrly
IV Fluids ct
Phototherapy ct.



GC same. Listlessness ++, Cry weak, refusal to feed Skin warm, HR 128/min, R/R 32/min

Exchange transfusion SOS
Rest ct all



GC Not fair. Not responding to painful stimuli,
Resp intermittent deep, skin warm to touch & yellow. Pupils sluggishly reacting Convulsive twitching esp face & limbs. Cry weak, Stools watery blackish, frothy.

Omit Cicuta-vir, O2 inhalation
Opium 200 2 drops in½ cup water, ¼ tsf x ½ hrly IV Fluids/ Phototherapy ct.


11.30 am

Normothermic, HR 110/min, Icterus /Pallor +, Rest same

Opium 200 x 3 hrly


 9 pm

No convulsions. Pt >>. Listlessness >, Cry weak. Stools watery 2 times / 12 hrs, golden yellow.  S. Bili =8.8 gm/dL, Indirect = 8gm/dL

Phototherapy ct
IV Fluids ct.
Opium 200 ¼ tsf tds


9.10 am

Baby active, started to suck breast milk. No convulsions since 24 hrs. Cry good. Skin warm, Pupils NSRL S. Bil 4.4 mg/dL, Indirect = 4 mg/dL

Shifted out of incubator
Opium 200 ¼ tsf BD
Phototherapy ct


7 pm

 Baby well. Icterus less. Good cry. Feeding well

Omit Opium / IV fluids
Ct Breast feeding



No complaints. Feeding well. Neonatal reflexes - normal

Ct all



Discharge on request.
Adv follow-up. No vaccinations
Posted for detail case-taking x 1 week

Syphilinum 1M 1 dose


  1. Nux-vom was given in milisimal potency as a first prescription for Jaundice, drowsiness , refusal to suck milk with convulsions (Kernicterus) and to counter the effects of antihypertensive administered to the mother during pregnancy (pt was an unregistered hospital case presented only for delivery).
  2. Cuprum-met, Cicuta-vir, and Secale-cor were thought of when Nux-vom failed to show the desirable effects, for convulsions. But Cicuta was chosen to control convulsions which were generalized, with drawing of head backwards. Rigid extremities which could not be bent - a characteristic symptom of Cicuta. Cicuta controlled the convulsions to a great extent but listlessness and twitching still persisted.
  3. The symptom complex changed from bad to worse on the 9th postnatal day. Again several remedies came up at the altar viz Opium, Verat-alb, Carbo-veg, Camphor. But Opium took care of the Muscular twitching, Diarrhoea, listlessness, baby unresponsive to pain, intermittent respiration, warm yellow skin, Pupils sluggish, bloated abdomen, and extreme prostration with weak cry. Fractional doses of 200 potency were stimulant enough to rouse the vitality of the baby. It acted as a life saver.
  4. Initially Exchange transfusion was planned to counter the Kernicterus and the pallor but since the Serum Bilirubin levels showed regression, this procedure was kept at bay. Although Phototherapy and IV Fluids were continued till the jaundice regressed completely.
  5. Syphilinum was given as a deep acting miasmatic remedy to slow the symptomatic progress of Down's syndrome. The parents were advised developmental follow-up for at least 2 years age along with genetic studies for Down's Syndrome.

Co-ordinating Editor comments: It is a case of sheer callousness on part of the drs who investigated this patient. They had the mind to ask for TORCH but not Anti Rh antibody. If this investigation had been done in time, it could have prevented this problem.