Hepatitis B treatment in children , hepatitis treatment

Hepatitis B in children

Hepatitis B treatment in children

Causes of hepatitis B in children

Hepatitis B in children is a typical infection; act as a source of infection sick people, and virus carriers. The main pathways of hepatitis B infection in children are transplacental (intrauterine infection), intrapartum (during labor), postnatal (postpartum). Transplacental transmission is realized in 6-8% of all reported cases. Especially often hepatitis B infection of the fetus occurs against placental insufficiency and placental abruption. Intrauterine fetal infection with hepatitis B virus threatened preterm labor. Intrapartum transmission of hepatitis B in children (about 90%) is due to the child's contact with body fluids and blood of an infected mother during the passage through the birth canal.Postnatal infection of the child occurs during breastfeeding or baby care: the violation of the integrity of the skin and mucous membranes of the child, close contact with infected mother viral shedding the blood of cracked nipples. At older ages, children with hepatitis B infection can occur when using shared towels, sponges, toothbrushes and other hygiene items, as well as sexually (adolescents). Not exclude the possibility of infection in children with hepatitis B during blood transfusion, invasive diagnostic and treatment procedures. Risk of hepatitis B increased in children undergoing kidney dialysis. High likelihood of infection among adolescent addicts that share needles and syringes. Immaturity of the immune system in children causes the rapid spread of hepatitis B virus through body fluids and parenchymal liver. Typically, an acute form of hepatitis B in children occurs quickly and ends with the elaboration recovery resistant lifelong immunity to the virus. When latent, asymptomatic hepatitis B in children in adulthood may be inadvertently revealed Scarring of the liver tissue. Children with chronic hepatitis B virus carriers are lifelong .

Symptoms of hepatitis B in children

Cyclic for hepatitis B in children includes incubation (latent) preicteric, jaundice period and the period of convalescence. The incubation period is 2-4 months and is determined by infecting dose, route of infection and the age of the child. In the case of transfusion of infected blood components latent duration of hepatitis B in child reduced to 1.5-2 months, when other routes of infection may be increased up to 4-6 months.The younger the child, the short incubation period. At this stage there are no clinical hepatitis, however, the end of the markers found in the blood of hepatitis B (HBsAg NVeAg, NVsAg anti-IgM) and high activity of the liver enzymes. In period, which lasts from a few hours to 2-3 weeks, dominated the overall infectious asthenia (weakness, lethargy), myalgia and arthralgia, skin rashes, abdominal syndrome, regurgitation, vomiting, loss of appetite, bloating, diarrhea. Sometimes the first clinical signs of hepatitis B in children are dark-colored urine and feces discoloration. In the blood, there is an increased level of transaminases and direct bilirubin, detected viral DNA. Period jaundice hepatitis B in children can last from 7-10 days to 1.5-2 months. Appearance of jaundice in all cases preceded by a change of color of urine and feces.Staining intensity of jaundice skin and visible mucous membranes increases for 7 days and lasts for 1-2 weeks. Unlike hepatitis A, hepatitis B with jaundice general condition does not improve, and the intoxication syndrome, on the contrary, enhanced: the body temperature rises to 38 ° C, increases drowsiness, lethargy, weakness.Children with hepatitis B can be observed occurrence maculopapular skin rash, hypotension, increased liver size, sometimes - spleen. At an altitude of jaundice period recorded maximum levels of transaminases, decrease PTI hypoalbuminemia. With a favorable course of hepatitis B disease in children ends convalescence period, which lasts 3-4 months. Fades jaundice, normal appetite, sleep, activity, blood parameters.Hepatitis B in children can have acute (up to 3 months.), Prolonged (up to 6 months.) And chronic (more than 6 months.) Within. In infants predominate moderate and severe forms of hepatitis B, which can be fatal due to malignant disease course. In the latter case, the children quickly growing pattern of hepatic encephalopathy, hepatic failure, hepatic coma develops .

Diagnosis of hepatitis B in children

Formulation facilitates informed diagnosis examination of the child 's pediatrician and children's infectious diseases, analysis of information on the development and course of the disease (cyclical characteristic symptoms), epidemiological history (prior to transfusion, injections, invasive procedures, operations), etc. The main role in the diagnosis of hepatitis B in children belongs laboratory methods: the detection of markers (HBsAg, HBeAg, anti-HBs, anti-HBe, anti-HBc), change in blood biochemical parameters (increase in bilirubin levels and increased activity of transferases). For suspected hepatitis B in children period should exclude influenza, SARS, foodborne diseases, arthritis, in icteric period - hepatitis A, C, E, yellow fever, infectious mononucleosis, cytomegalovirus infection, Gilbert's syndrome, cholelithiasis, cholangitis, pancreatitis , cirrhosis, etc. In order to further differential diagnosis performed MR cholangiography, ultrasound of the liver and gall bladder, liver scintigraphy, hepatic biopsy

Treatment of hepatitis B in children

Treatment of hepatitis B in children

The question of hospitalization solved individually. Certainly, hospitalized children with severe and very severe forms of hepatitis should also be hospitalized children residing in the team with the children in accordance with the epidemic testimony. Children with moderate and mild can be treated at home. If all the recommendations outcomes of hepatitis B in children in hospital and at home do not differ. It should be remembered that houses the child feels comfortable and relaxed, which is important for the healing process .

Motor mode of hepatitis B patients

Motor mode is in direct proportion to the severity of the disease, ie, the state of health of the patient. In severe forms of the same bed rest should observe the entire period of intoxication and about 2 weeks from the beginning of jaundice period. 

Criteria for the extension motor mode - this health of the child and his or her appetite. Sign of positive dynamics is also a decrease jaundice skin. Optimum driving mode for patients with hepatitis B: bed rest to 3-day 14 jaundice period, up to 20-30th day of the disease. 

Sparing regimen observed approximately 6 weeks after complete recovery. Under gentle mode means exemption from physical education classes and other types of physical activity 6-12 months. Therapeutic nutrition in viral hepatitis B .

Therapy for hepatitis B

Basic treatment of hepatitis B in children is to appoint Cholagogue: magnesium sulfate, flamen, berberine, etc. At an altitude of clinical manifestations can assign drugs, normalizing liver function.

 Always positive effect of vitamin particularly important usages vitamins (B 1, B 2, B 6), and the C and PP inside. In addition to basic therapy in moderate and severe positive effect on yields of interferon 1 million units 1-2 times a day intramuscularly for 15 days.In severe and very severe forms of detoxification therapy shows a 10% glucose solution 500ml per day, and also shows the introduction of glucocorticosteroids. Children who were treated in hospital, discharged on 30-40th day of onset. Herewith, a slight increase in liver size and shift of biochemical parameters. If the child continues to discharge detected antigens of hepatitis B, it shall be registered in the sanitary-epidemiological service. Observation is recovered for children held in an infectious diseases hospital physician. First Inspection - 1 month after discharge, then the survey is carried out on the 3rd, 4th and 6th months. In the absence of complaints and objective abnormalities in two successive normal biochemical tests and the results of tests for hepatitis B antigens of the child is removed from the account, if any continuing monthly medical check-up.If you suspect a chronic form of hepatitis B screening and children are subject to confirmation by chronic process re-hospitalized. Also dispensary observation preventively exposed to all children receiving blood products intravenously. Clinical supervision lasts six months, and if there are signs of viral hepatitis urgently hospitalized children. With a favorable course, children can be admitted to school hours or visit kindergartens and nurseries 2-4 weeks after discharge from hospital. Children are exempt from physical education for 6 months, to participate in competitions and other strenuous exercise - 1 year .

Forecast and Prevention of hepatitis B in children

Forecast and Prevention of hepatitis B in children

Typical forms of hepatitis B in children usually end recovery. Transition to chronic noted in 2-18% of cases. Of childhood hepatitis B accompanied by formation of a stable life-long immunity. 
Complications of hepatitis B in children may be chronic hepatitis or cirrhosis, dramatically increases the risk of hepatocellular carcinoma in adulthood. Malignant course of hepatitis B in children mortality is extremely high (75%). 
The most reliable way to prevent hepatitis B in children is vaccination, which is carried out three times: the first day after birth, 1 and 6 months of life, Hepatitis B vaccination provides 95% protection against infection of 15 years. 
Nonspecific prevention of hepatitis B in children involves the use of disposable medical instruments, careful processing and sterilization of reusable instruments, examination of donors holding transfusion therapy on the strict condition