Treatment of hepatitis B in children

General principles of treating hepatitis B in children are the same as for hepatitis A. However, it is necessary to take into account that hepatitis B, unlike hepatitis A, often occurs in a severe and malignant form. In addition, the disease can end with the formation of chronic hepatitis and even cirrhosis.

At present, there are no fundamental objections to children with mild and moderate forms of hepatitis B being treated at home. The results of treating such patients at home are no worse, and in some respects even better, than in a hospital.

Specific recommendations regarding physical activity, therapeutic nutrition and criteria for their expansion are basically the same as for hepatitis A; it should only be taken into account that the duration of all restrictions for hepatitis B is usually somewhat longer, in full accordance with the course of the disease.

In general, it can be said that if the disease progresses smoothly, all restrictions on physical activity and nutrition should be lifted 6 months after the onset of the disease, and sports activities can be allowed after 12 months.

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

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

In severe forms of the disease, intravenous administration of a 1.5% solution of reamberin, rheopolyglucin, 10% glucose solution up to 500-800 ml/day is indicated for detoxification purposes, and glucocorticoids are prescribed at a rate of 2-3 mg/kg per day for prednisolone during the first 3-4 days (until clinical improvement) with subsequent rapid reduction of the dose (a course of no more than 7-10 days). In children of the 1st year of life, moderate forms of the disease are also an indication for the prescription of glucocorticoids.

If a malignant form of hepatitis B is suspected or there is a risk of its development, the following is prescribed:

• glucocorticoids up to 10-15 mg/kg per day of prednisolone intravenously in equal doses every 3-4 hours without a night break;
• albumin, rheopolyglucin, 1.5% reamberin solution, 10% glucose solution at the rate of 100-200 ml/kg per day depending on age and diuresis:
• proteolysis inhibitor aprotinin (eg: trasylol 500,000, gordox, contrikal) in an age-appropriate dose;
• lasix 2-3 mg/kg and mannitol 0.5-1 g/kg intravenously by slow jet stream to enhance diuresis;
• according to indications (disseminated intravascular coagulation syndrome) sodium heparin 100-300 U/kg intravenously.

To prevent the absorption of toxic metabolites from the intestines, formed as a result of the vital activity of microbial flora, high cleansing enemas, gastric lavage are prescribed, and broad-spectrum antibiotics (gentamicin, polymyxin) are administered.

They report a positive effect of the polyenzyme drug Wobenzym, which has an anti-inflammatory immunomodulatory effect and improves microcirculation.

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

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

It is advisable to include hyperbaric oxygenation in the complex of pathogenetic agents (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 for hepatitis B in children. In the case of deep hepatic coma, therapy is ineffective.