Treatment of hepatitis B in children

The general principles of treating hepatitis B in children are the same as for hepatitis A. Nevertheless, it must be taken into account that hepatitis B, unlike hepatitis A, often occurs in severe and malignant form. In addition, the disease can result in the formation of chronic hepatitis and even cirrhosis.

At present, there are no principal objections to the fact that children with mild and moderate forms of hepatitis B are treated at home. The results of treatment of such patients at home are not worse, and in some respects even better than in a hospital.

Specific recommendations for the motor system, therapeutic nutrition and the criteria for their expansion are basically the same as for hepatitis A; one should only take into account that the time of all restrictions for hepatitis B is usually somewhat longer in full accordance with the course of the disease.

In general, with a smooth course of the disease, all restrictions in the motor and nutrition regime should be removed after 6 months from the onset of the disease, and sports can be resolved after 12 months.

Medical treatment of hepatitis B in children is carried out according to the same principles as in hepatitis A. In addition to this basic therapy for moderate and severe forms of hepatitis B, interferon can be administered intramuscularly 1 million units 1-2 times a day for 15 days.

In order to prevent the transition of an acute process into a chronic one, it is advisable to designate an inducer of interferon-cycloferon (from the calculation of 10-15 mg / kg), the duration of the course is 15 receptions.

In severe forms of the disease for the purpose of detoxification, intravenous administration of 1.5% reamberin solution, rheopolyglucin, 10% glucose solution to 500-800 ml / day is indicated, and glucocorticoids are administered at a rate of 2-3 mg / kg per day according to prednisolone for the first 3-4 days (before clinical improvement) followed by a rapid dose reduction (course no more than 7-10 days). In children of the first year of life, moderate-to-severe forms of the disease serve as an indication for the appointment of glucocorticoids.

If there is a suspicion of a malignant form of hepatitis B or if a threat to its development is prescribed:

• glucocorticoids up to 10-15 mg / kg per day by prednisolone intravenously in equal doses in 3-4 hours without a night break;
• albumin, reopolyglucin, 1.5% reamberin solution, 10% glucose solution from the calculation of 100-200 ml / kg per day depending on age and diuresis:
• inhibitor of proteolysis aprotinin (for example: trasilol 500 000, gordoks, kontrikal) in the age-related dose;
• Lasix 2-3 mg / kg and mannitol 0.5-1 g / kg intravenously struino slowly to enhance diuresis;
• by indications (a syndrome of disseminated intravascular coagulation) heparin sodium at 100-300 U / kg intravenously.

To prevent the absorption of toxic metabolites from the intestine resulting from the life of the microbial flora, high purifying enemas, gastric lavage, and broad-spectrum antibiotics (gentamicin, polymyxin) are prescribed.

Report on the positive effect of the polyenzyme drug vobenzim, which has an anti-inflammatory immunomodulatory effect, improves microcirculation.

Taktivin is prescribed for 2-3 ml daily for 10-12 days in order to normalize the quantitative and functional indices of immunity and prevent complications associated with concomitant infectious diseases.

If the complex of therapeutic measures is ineffective, repeated sessions of plasmapheresis should be performed. Repeated sessions of hemosorption and replacement blood transfusions are less effective.

In the complex of pathogenetic agents, it is expedient to include hyperbaric oxygenation (1-2 sessions per day: compression 1.6-1.8 atm, exposure 30-45 min).

The success of therapy for malignant forms mainly depends on the timeliness of the above treatment of hepatitis B in children. In the case of deep hepatic coma, therapy is ineffective.