Icterus Neonatorum.
Synonym:—Infantile jaundice.
Some writers make a distinction between the icterus with which an infant is born, and that which occurs a few days after birth, from some obstruction of the bile duct, from some inherited dyscrasia; or icterus due to infection, which may be quite severe from the first and result in death.
Etiology:—This condition is not uncommon in new born babes. In some localities more than half of the infants develop a yellowish discoloration of the skin and conjunctivae during the first week of life.
It occurs more frequently in boys than in girls, and in those infants whose mothers have been in previous poor health or who suffer from some dyscrasia. Some writers have thought it occurred more frequently when chloroform was used in parturition. The condition is caused probably by faults in the portal circulation, the influence of the tension upon the portal vessels permitting portal blood which contains bile to enter the general circulation. Another theory is that there are deficient red corpuscles in the blood, with an excess of bile pigment.
Symptomatology:—The discoloration may be present at birth or it may appear on the second or third day quite conspicuously and increase rapidly. The temperature is apt to be abnormal; the child is drowsy, difficult to arouse, the urine highly colored and staining the linen, and the feces are gray or grayish white—clay colored. in the milder cases no constitutional symptoms may appear and the icterus will disappear after two or three days. In the severer cases there may be hemorrhage from the cord, impairment of nutrition, and gradual failure of the vital powers of the child, with a persistent whining or feeble cry, and no inclination to nurse. in these cases there is often enlargement of the liver and occasionally of the spleen.
Treatment:—These patients should have the utmost care, and attention should be paid to the character of the milk of the mother, to be sure that it is sufficiently nutritious from the first. But little, if any, medicine will be needed in ordinary cases. If there is elevated temperature the patient should have very small doses of aconite, or of aconite and bryonia. Later a very small portion of chionanthus may be added, although I have succeeded best with sodium phosphate. All remedies should be administered at frequent intervals and in very small doses. It is an excellent plan to pour a quantity of warmed sweet oil over the entire abdomen and especially over the hepatic area, and rub the liver with gentle massage for a period of from five to ten minutes at a time, three or four times each day. Other conditions may be met with indicated treatment.
