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Thursday 12 October 2017

Nux vomica- The magic wand for the Neonatologist! - Dr. K. Abdul Gafar, National Secretary- Administration, IHMA

In our daily practice we come across many an illness belonging to infants. There are three distinct entities for all of which a single medicine can serve you as the remedy and get the child (as well as the mother) out of trouble easily, effectively and permanently as if in a magic! The drug is Nux vomica.

One: Acute gastric troubles.

 
The trouble: The baby presents with restlessness, bloated abdomen, frequent loose stools, less sleep and of course lots of crying. It suckles less and the mother will almost always be wary with sleepless eyes and worried face.


The reason: In our country it’s customary for new moms to have some home remedies to get them rejuvenated after delivery.  This is taken in the form of decoctions like onion, fenugreek etc. and also almost everyone takes a few doses of kashayas, lehyas and arishtas- the routine lasting two to four weeks. Sometimes it can disturb the delicate ecosystem of the baby, especially if the mother is a little anxious and if she herself is a little gastric prone. This leading to the above said symptom complex.


The remedy: Give Nux vomica 200 BiD for three days to the mother. Tell her to have a few extra glasses of water (say like three glasses extra) for one week. Tell her to stop all home remedies for four five days and then re-start them at half the usual quantity for another four five days. Then she can resume those as before. Also the baby can be given pre-boiled water a few drops (say five to ten drops) BiD or Tds for two or three days if the trouble is too much. In worse cases the baby can be given a dose of NV 200 too in much less quantity.
China, Carbo veg, Lycopodium etc. are some of the drugs you  can think of if NV didn’t help, but that happens once in a while only.


The caution: Always be on the lookout for Volulus, Intussuception, Hirschsprung’s disease, Duodinal atresia etc. But those happen in very rare cases only.  So be alert and be ready to intervene in case if the condition does not improve in 48 hours.

Two: Icteric Neonatorum:

 
The trouble:  The baby presents with generalized yeloowness of skin and sclera. Mild raise of temperature and mild resltlessness.
 

The reason: We all know about physiological jaunidice related with fetal RBCs. So, no need to worry. In fact in most cases this is a benign self limiting condition. But sometimes we may need to intervene.
 

The remedy: Give Nux vom 30 one dose a day for three days to the baby. Also expose it to sunlight in moderate amounts as below. Disrobe the baby completely. Cover it’s eyes with a tender banana leaf or mango leaf. If not available use a white cotton cloth for his. Then put the child to sunlight in a open area attached to house like a Varandha. Take care to use the first two hours of morning sun or last two hours of evening sun. Also don’t expose the baby not more than forty minutes at a time- twenty minutes front and twenty minutes back.  Repeat for five or six days. Now a days UV set up is available even in small hospitals and every one go for that. Still sunlight is better than that from my experience as it’s milder than direct UV. Sulphur, Lyco & China are other drugs you can think of.
 

The caution: If the ictericity is more do a serum bilirubin and pay attention to the amount    of direct (conjugated)  and in much higher values do a Coomb’s test. The less common conditions to keep in mind are Rh incompatibility, Neonatal Hepatitis and Biliary Atresia.

Three: Constipation in infants.
 

The Problem: Baby presents with no or scanty stools for several days. Motion only with the help of laxatives in the form of suppository.
 

The reason: Can be less serious or more serious. In most cases it’s because of less consumption of liquids by mother and so less water getting in to baby’s system. Some mothers have deficient milk in their breast that can also be the reason. Another important reason is bottle fed babies especially with milk formulas.
 

The remedy: Give Nux vom 30 or 200 one dose to the baby. In most cases this will bring out motion within 24 hours. Ask mother to have plenty of fluids.  Assess the availability of milk with the mother and also look at her feeding habits to see if there is an error. Surprisingly you will find erroneous feeding habits in more mothers than you think. In worse cases baby needs to be given pre boiled water a few drops three times a day for a few days. In worst cases (if there is a critical deficiency of breast milk) formulas need to be given (even though that itself present a chance for constipation).  The other drugs may vary depending on the c ause.
 

The caution: Be on the lookout for Duodinal atresia, Intussuseption, Volvulus, Hirschsprung’s etc.

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