Neonatal Jaundice
NATIONAL JOURNAL OF HOMOEOPATHY 2001 May / Jun VOL III NO 3.
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.

4. 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,
   Normothermic
   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

Discussion

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.