Integrated Traditional Chinese Medicine Nursing Interventions Combined with Phototherapy for Damp-Heat Type Neonatal Jaundice

Summary

This protocol describes standard phototherapy and an integrated Traditional Chinese Medicine (TCM) nursing approach—including herbal bathing, acupoint massage, and touch therapy—in neonates with damp-heat type jaundice. The protocol demonstrates reduction in bilirubin, liver enzymes, and inflammatory markers, while maintaining comparable safety and efficacy.

Abstract

Neonatal jaundice is one of the most frequently occurring conditions in newborns. This protocol describes the clinical implementation of two common care interventions, including standard phototherapy and clear water bathing or a Traditional Chinese Medicine (TCM)-integrated nursing care, on the serum and inflammatory indicators in neonates with damp-heat type jaundice. This protocol was demonstrated using anonymized medical records of 120 neonates who received treatment between 2022 and 2023. Clinical outcome measures included total bilirubin (TBIL), indirect bilirubin (IBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (γ-GT), lactate dehydrogenase (LDH), and C-reactive protein (CRP). Significant reductions in these serum and inflammatory markers were observed in both treatment groups (p < 0.001). The effect sizes on total bilirubin are large: Cohen d = 5.31 (clear water) and 5.37 (TCM-integrated). Similarly, marked reductions were observed in indirect bilirubin with d = 4.41 and d = 4.07, respectively. Improvements were also observed in ALT, AST, γ-GT, LDH, and CRP levels (AST: d = 3.31-3.73). CRP reductions were observed in both groups (d = 2.72 versus 2.24). Mixed ANOVA demonstrated significant main effects of time across all markers (TBIL F = 3427.51, p < 0.001). Multivariate regression analysis showed that ΔCRP was significantly associated with treatment effectiveness, suggesting a possible association between reduced systemic inflammation and clinical improvement (β = -1.771, p = 0.010). The adverse events are comparable between groups (incidence of rash: 10% vs. 15%, p = 0.581). Integrated TCM nursing interventions combined with standard phototherapy demonstrated treatment outcomes comparable to clear water bathing combined with phototherapy in improving clinical and biochemical parameters associated with neonatal jaundice.

Introduction

Neonatal jaundice is a prevalent condition caused by the immaturity of bilirubin metabolism in newborns, manifesting as elevated serum bilirubin levels. This physiological jaundice typically arises from increased red blood cell turnover, immature hepatic uptake and conjugation processes, and enhanced enterohepatic circulation¹. The accelerated destruction of red blood cells—whose lifespan is approximately 80 days in neonates compared with 120 in adults—contributes significantly to bilirubin accumulation². In addition, hepatic immaturity is characterized by deficient Y and Z protein receptors and reduced uridi....

Protocol

Ethics statement:

This retrospective analytical and clinical nursing protocol was conducted using anonymized neonatal clinical records collected in accordance with institutional ethical standards and applicable clinical regulations. Patient-identifiable information was removed prior to analysis. The requirement for formal ethics committee approval and informed consent was waived because the study involved retrospective analysis of fully de-identified data collected during routine clinical care and did not involve direct patient contact or intervention.

This protocol describes the standardized clini....

Results

Descriptive Statistics and Baseline Characteristics

Descriptive analysis of continuous variables demonstrated clear trends before and after treatment, as summarized in Table 1. A total of two study groups were included in the retrospective analysis: a clear water bathing group receiving standard phototherapy-based care and an integrated TCM nursing intervention group receiving herbal bathing, acupoint massage, touch therapy, and phototherapy. Each group includ.......

Discussion

The present findings demonstrate that integrated TCM nursing interventions administered alongside standard phototherapy produced laboratory outcome trends comparable to those observed with clear water bathing combined with phototherapy. These outcomes are consistent with findings from prior clinical evaluations of TCM interventions in neonatal jaundice. A meta-analysis conducted in China by Wang et al. (2017), which included multiple neonatal clinical studies evaluating TCM washing combined with massage therapy, demonstr.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Artemisia capillaris (Yinchen)	Tongrentang Pharmaceutical Co., Ltd., Beijing, China	Herbal raw material grade	Herbal component used for damp-heat-clearing herbal bath decoction
Clinical chemistry analyzer	Beckman Coulter Inc., Brea, CA, USA	AU5800 Clinical Chemistry Analyzer	Used for measurement of total bilirubin (TBIL), indirect bilirubin (IBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (γ-GT), and lactate dehydrogenase (LDH)
CRP assay kit	Beckman Coulter Inc., Brea, CA, USA	hs-CRP Reagent Kit OSR6147	Used for quantitative measurement of C-reactive protein (CRP)
Digital water thermometer	Omron Healthcare Co., Ltd., Kyoto, Japan	TH-100 Digital Thermometer	Used to monitor bath water temperature (37–39 °C)
Gardenia jasminoides (Zhizi)	Tongrentang Pharmaceutical Co., Ltd., Beijing, China	Herbal raw material grade	Anti-inflammatory herb used in herbal bath preparation
Honeysuckle (Lonicera japonica)	Tongrentang Pharmaceutical Co., Ltd., Beijing, China	Herbal raw material grade	Anti-inflammatory herbal component used in bath decoction
Newborn bathtub	Hengkang Medical Equipment Co., Ltd., Jiangsu, China	HKN-NB01 Infant Bath Tub	Used for clear water bathing or herbal bathing of neonates
Phototherapy unit (blue/green LED light)	Dräger Medical GmbH, Lübeck, Germany	BiliLux LED Phototherapy Unit	Used for phototherapy treatment of neonatal jaundice (blue light wavelength 425–475 nm)
Scutellaria baicalensis (Huangqin)	Tongrentang Pharmaceutical Co., Ltd., Beijing, China	Herbal raw material grade	Used for heat-clearing and detoxification in TCM decoction
Serum separator blood collection tubes	Becton Dickinson (BD), Franklin Lakes, NJ, USA	SST™ II Advance Tube 367953	Used for neonatal blood sample collection and serum separation
SPSS Statistics software	IBM Corp., Armonk, NY, USA	Version 19.0	Statistical analysis software used for data processing and analysis
Sterile medical gauze	Winner Medical Co., Ltd., Shenzhen, China	300-G Sterile Gauze Pads	Used for drying neonates and maintaining hygiene after bathing
Waterproof umbilical patch	3M Health Care, St. Paul, MN, USA	3M Tegaderm Transparent Dressing 1624W	Applied to protect the umbilical stump during bathing procedures