晚发性维生素K缺乏致颅内出血的预防

通过６６例晚发性维生素Ｋ缺乏致颅内出血病历分析，此病多发性于生后１－３月婴儿（８７．７９％）。由于母乳中维不Ｋ含量仅为牛乳的１／４及产后乳母很少进食绿叶蔬菜和水果，使维生素Ｋ摄取不足，故母乳喂养儿的发病（７５．７６％）高于人工喂养儿及混合喂养儿。另外小年龄组婴儿在患有腹泻乳儿肝炎，反复感染等疾患时，由于影响了维生素Ｋ在体内的吸收、利用及合成，更易发生维生素Ｋ缺乏引起的颅内出血，因此预防采取综合措施     

高原地区晚发性维生素K缺乏合并低钙血症41例临床分析

目的:探讨晚发性维生素K缺乏与低钙血症致颅内出血的相关性。方法:回顾性分析41例病例,年龄1～3个月;其中男26例,女15例;单纯母乳喂养37例,混合喂养4例。41例均无外伤史及出血性疾病家族史。结果:41例均证实既有颅内出血又有血钙降低,且凝血酶原时间均延长。结论:维生素K缺乏合并血钙低时更易导致自发性出血,所以对于母乳喂养、低钙惊厥的小婴儿应常规给予维生素K预防量,并积极补钙治疗,以防止诱发颅内出血。     

母乳喂养中的维生素K缺乏及预防

最近维生素K缺乏及预防再度引起国际学术界的重视,并开展了相应的研究,因为由于维生素K缺乏造成出血在纯母乳喂养儿中占极大比例,此种出血致死率高,后遗症棘手,不仅影响存活儿的生理健康,而且累及日后智力发育和行为发展,引发一系列社会问题,所以,这也是推广母乳喂养、创建爱婴医院必需加以解决的问题.生后2周至1岁的婴儿由于维生素K(Vk)缺乏而致出血称为晚发性Vk缺乏症,1980年日本报告了晚发性婴儿Vk缺乏出血病发生率为1/4000,其中87％的患儿为单纯母乳喂养儿.国内近些年来也有大量病历报道此病.发展中国家此病发生率估计为0.6～3/1000,其中单纯母乳喂养儿占87～98％.     

母亲口服维生素K_1预防婴儿维生素K缺乏出血症的研究

[目的 ]探讨乳母口服维生素K1 预防婴儿维生素K缺乏出血症 (VKDB)的效果。 [方法 ]干预组 9871名乳母自分娩后每 1 0天口服维生素K1 片 1 0mg直到满 3个月 ,未干预组 1 0 0 1 0人不服 ,均观察婴儿 6个月内的出血情况 ;同时小样本采集乳母初乳、1月乳、2月乳汁和婴儿的脐血、1个月、2个月静脉血分别测定维生素K1 和维生素K缺乏诱导蛋白 (PIVKA Ⅱ )含量。 [结果 ]干预组发生 1例VKDB ,未干预组发生 2 2例VKDB ;干预组母亲 1个月乳汁和 2个月乳汁中维生素K1 含量分别是未干预组的 3 5倍和 3倍 ,干预组婴儿 1个月外周血PIVKA Ⅱ阳性率和未干预组比较未表现出统计学差异。 [结论 ]母亲口服维生素K1 可明显提高母乳维生素K1 的含量 ,有效减少母乳喂养儿VKDB的发生     

母亲口服维生素Kl预防婴儿维生素K缺乏出血症的研究

[目的]探讨乳母口服维生素K1预防婴儿维生素K缺乏出血症(VKDB)的效果。[方法]干预组9871名乳母自分娩后每10天口服维生素K1片10mg直到满3个月，未干预组10010人不服，均观察婴儿6个月内的出血情况；同时小样本采集乳母韧乳、1月乳、2月乳汁和婴儿的脐血、1个月、2个月静脉血分别测定维生素K1和维生素K缺乏诱导蛋白(PIVKA-Ⅱ)含量。[结果]干预组发生1例VKDB，未干预组发生22例VKDB；干预组母亲1个月乳汁和2个月乳汁中维生素K1含量分别是未干预组的3．5倍和3倍，干预组婴儿1个月外周血PIVKA-Ⅱ阳性率和未干预组比较未表现出统计学差异。[结论]母亲口服维生素K1可明显提高母乳维生素K1的含量，有效减少母乳喂养儿VKDB的发生。     

6月龄婴儿维生素A缺乏症的影响因素研究

目的调查深圳市龙岗区6月龄婴儿维生素A水平,分析维生素A缺乏症的影响因素,为维生素A缺乏症的防控提供依据。方法以2019年1—12月在龙岗区妇幼保健院儿保门诊接受健康体检的1638例6月龄婴儿为研究对象,检测婴儿血清维生素A水平,并分析维生素A缺乏症可能的影响因素。1638例婴儿根据喂养方式分为母乳喂养组(n=1005)、混合喂养组(n=228)和配方奶喂养组(n=405);根据维生素AD补充情况分为持续补充组(n=183)、交替补充组(n=420)及单独补充组(n=1035)。结果6月龄婴儿血清维生素A平均水平为(0.30±0.07)mg/L。维生素A缺乏的婴儿882例(53.84%),维生素A平均水平为(0.24±0.03)mg/L,其中边缘型维生素A缺乏795例(48.53%),亚临床型维生素A缺乏87例(5.31%);维生素A正常的婴儿756例,维生素A平均水平为(0.36±0.06)mg/L。持续补充组维生素A缺乏症检出率明显低于交替补充组及单独补充组,差异均有统计学意义(χ²值分别为26.818、36.050,均P<0.05)。母乳喂养组及混合喂养组维生素A缺乏症检出率均高于配方奶喂养组,差异均有统计学意义(χ²值分别为113.482、47.534,均P<0.05)。早产的婴儿维生素A缺乏症检出率高于足月的(χ²=16.957,P<0.05)。多因素二分类Logistic回归分析显示母乳喂养(OR=4.196)、混合喂养(OR=3.466)增加了婴儿维生素A缺乏症的发生风险(均P<0.05);持续补充维生素AD(OR=0.361)、足月(OR=0.326)、6月龄时未患营养不良(OR=0.257)、6月龄内未患呼吸道感染(OR=0.675)降低了维生素A缺乏症的发生风险(均P<0.05)。结论深圳市龙岗区6月龄婴儿维生素A缺乏症检出率较高,母乳喂养儿、混合喂养儿及早产儿出生后6月龄内应及时、合理地补充推荐摄入量的维生素AD。     

迟发型维生素K缺乏症42例治疗体会

目的探讨迟发型维生素K缺乏症的发病因素,预防措施,提高婴儿的生存质量.方法对收治的42例迟发型维生素K缺乏症的病例进行临床分析.结果本组42例中,单纯母乳喂养占37例(88.1%),混合喂养5例(11.9%);未进行过维生素K预防39例(92.9%),已进行过一次维生素K预防3例(7.1%);农村患儿40例(95.2%),城镇患儿2例(4.8%).结论单纯母乳喂养婴儿本病发生率高(86.8%),单纯进行1次维生素K预防,不能完全阻止晚发维生素K缺乏症发生,提示对所有新生儿生后常规补充维生素K一次后,生后1～3个月定期补充维生素K1可预防本病的发生.     

晚发型维生素K缺乏性出血中文文献报告病例20年(1989—2008)综合分析

【目的】综合分析中文期刊晚发型维生素K缺乏性出血病例报告资料,了解我国晚发型维生素K缺乏性出血的病例特征、发病趋势、地区分布和高危因素等。【方法】"维生素K缺乏"为主题词,1989年1月—2008年8月为检索时段,检索中文期刊全文数据库、维普、万方、中国生物医学文献数据库上涉及维生素K缺乏的全部文献,逐篇甄别,遴选出"晚发型维生素K缺乏性出血"的病例报告一次文献,建立excel数据库。【结果】晚发型维生素K缺乏性出血文献1 448篇,其中792篇文献不适合做病例分析,剔除,656篇文献用于分析。656篇文献所涉及的晚发型维生素K缺乏性出血病例数21 894例,遍及30个省市自治区。母乳喂养占90.1%;男女之比为2.22∶1;4周以内发病占6%,4~8周占73%,8周以上占21%。高危因素包括:乳母用药、肝胆疾患、呼吸道感染、腹泻、应用抗生素、发热等。出血部位以颅内出血为主,高达90.4%。后遗症发生率为20%,以运动障碍或智力障碍多见。【结论】我国晚发型维生素K缺乏性出血发病形势严峻;母乳喂养儿多见,男童易患,4~8周为高发年龄。颅内出血发生率极高。高危因素为乳母用药,小儿使用抗生素、患腹泻、呼吸道感染等、肝胆疾病等。     

迟发型维生素K缺乏致颅内出血54例临床分析

目的:探讨迟发型维生素K缺乏致颅内出血的发病原因。方法:对54例迟发型维生素K缺乏致颅内出血患儿的临床资料进行回顾性分析。结果:该病患儿年龄2周～3个月,均为母乳喂养史后未及时给予维生素K,突然发病呈进行性加重,面色苍白、甚至抽搐乃至昏迷,严重者可出现脑疝表现,头部CT显示颅内出血。轻者给予维生素K1后出血停止,并辅以止痉、降颅压等对症治疗预后良好。重者因并发多脏器功能衰竭死亡,幸存者遗留后遗症。结论 :维生素K缺乏症是由于维生素K缺乏而引起的凝血障碍性疾病,迟发型维生素K缺乏症所致的颅内出血症状重,死亡率高,幸存者遗留神经系统后遗症(脑发育不良,癫痫、语言落后等)。     

迟发性维生素K缺乏症致颅内出血28例临床分析

迟发性维生素K缺乏症是指新生儿晚期 (出生 2周后 )到乳儿期因缺乏维生素K而引起的出血性疾病 ,所致颅内出血发病急 ,病情重 ,病死率和后遗症率高 ,且易误诊。我院儿科于 1992年 6月～ 2 0 0 2年 6月共收住维生素K缺乏致颅内出血 2 8例 ,现分析如下。1　临床资料1 1　一般资料　男 19例 ,女 9例。年龄 2 0d～ 1个月 2例 ,～ 2个月 2 4例 ,～ 3个月 1例 ,～ 6个月 1例 ;早产儿 1例 ,剖宫产儿1例 ,余均为足月正常分娩儿。喂养方式 :母乳喂养 2 3例 ,混合喂养 5例 ;病前有腹泻史 5例 ,上感 1例 ,全部病例均无窒息史、外伤史及出血性疾病家族…     

Association of infant feeding practices in the general population with infant growth and stool characteristics

This was a prospective cohort study of 976 infants from birth to 12 months of age. Infants were fed breast milk, goat infant formula, cow infant formula, or a combination of formula and breast milk during the first 4 months of age. Data on type of milk feeding and infant growth (weight and height) were collected at birth and at 4, 8, and 12 months during routine clinical assessment. The number and consistency of bowel motions per day were recorded based on observational data supplied by the mothers. Infants fed breast milk or goat or cow infant formula during the first 4 months displayed similar growth outcomes. More of the infants fed cow infant formula had fewer and more well-formed bowel motions compared with breast-fed infants. The stool characteristics of infants fed goat formula resembled those of infants fed breast milk.     

Vitamin A status of preterm infants: the influence of feeding and vitamin supplements

Consecutive weekly determinations of plasma retinol, alpha-tocopherol, retinol-binding protein, prealbumin, and zinc were performed on a group of 58 infants weighing less than 2000 g at birth in an intensive-care nursery. Data were classified by the feeding regimen of the preceding week: parenteral, premature formula, or own mother's milk. Mean plasma-retinol values were less than 20 mcg/dl, the lower limit of normal for adults, with the highest values in the formula-fed group. Retinol-binding protein and prealbumin values were lowest in the parenterally-fed group. Alpha-tocopherol concentrations were consistently maintained at levels higher than 500 mcg/dl only in infants fed their own mother's milk. Mean zinc concentrations above 70 mcg/dl, the lower limit of normal for adults, occurred only in parenterally fed infants. Doubling the recommended vitamin supplement in formula-fed infants did not produce a significant increase in plasma retinol or tocopherol.     

Vitamin C nutrition during prolonged lactation: optimal in infants while marginal in some mothers

Prolonged breast-feeding is practiced by mothers in the hope of improving their infants' health and preventing diseases. In this study of the nutritional adequacy of breast-feeding, 200 mothers with healthy, full term newborns were encouraged to breast-feed exclusively. At age 6 months 116 infants and at age 9 months 36 infants remained exclusively breast-fed. The control infants were weaned early and they received vitamin C through a supplemented milk formula and solid food. The exclusively breast-fed infants were able to maintain their plasma vitamin C concentration at the same or a higher concentration than the vitamin C-supplemented controls. Their plasma concentration was about 2-fold compared with the maternal concentration. It was relatively independent of maternal nutrition and of vitamin C concentration in milk. The mother's intake of vitamin C influenced their plasma and milk concentrations. About 6% of the mothers had subnormal plasma concentrations without symptoms. The lowest concentrations occurred 2 months postpartum and during the spring. Thus, exclusively breast-fed infants are well protected against vitamin C deficiency, but marginal intake in lactating mothers is more common than assumed for a well-nourished population.     

Evaluation of the evidence to support current recommendations to meet the needs of premature infants: the role of human milk

The beneficial effects of human milk extend to the feeding of premature infants, because their nutrition support must be designed to compensate for metabolic and gastrointestinal immaturity, immunologic compromise, and maternal psychosocial conditions. Significant effects on the recipient host, such as reduction in sepsis and necrotizing enterocolitis, have been reported for premature infants fed their mothers' milk. However, nutritional concerns arise because the quantity of nutrients in breast milk may not meet the great nutrient needs of premature infants born weighing <1500 g. Human milk supplements, or fortifiers, are available to augment the nutrient content of unfortified breast milk. Host defense benefits observed in infants fed unfortified human milk also are found in premature infants fed fortified human milk. Availability of milk is an issue for mothers delivering prematurely. Donor pasteurized human milk has been suggested as a proxy for the mother's own milk.     

Phenylalanine kinetics differ between formula-fed and human milk-fed preterm infants

Infants fed casein-dominant formulas have higher plasma phenylalanine and tyrosine concentrations than those fed mother's milk. Conversely, elevated plasma threonine concentrations are observed in infants fed whey-dominant formulas. We recently showed that formula-fed preterm infants have a lower capacity to degrade threonine than do preterm infants fed mother's milk. We hypothesized that these same infants (n = 18) would differ in their catabolism of phenylalanine in response to phenylalanine loads provided by formulas with increasing casein content of formulas (whey:casein 60:40, 40:60, and 20:80) compared with preterm infants fed mother's milk. Plasma phenylalanine concentrations significantly rose (49, 46, 79 micromol . L(-1) for whey:casein 60:40, 40:60, and 20:80, respectively, pooled SD 8, P < 0.05); and plasma phenylalanine concentrations in infants fed mother's milk were low (40 +/- 4 micromol . L(-1)). Using [1-(13)C]phenylalanine tracer and (13)CO(2) production in breath we found that although there was a significant positive relation between phenylalanine oxidation and phenylalanine intake in formula-fed infants (r(2) = 0.43, P = 0.03), these infants were not able to increase their oxidation of phenylalanine enough to prevent a significant rise in plasma phenylalanine when fed the 20:80 formula. Compared to infants fed mother's milk, formula-fed infants had significantly lower phenylalanine oxidation (39.1 vs. 30.7% of phenylalanine intake, respectively, P < 0.05). We conclude that one of the mechanisms for the differences in plasma amino acid concentration between formula-fed and mother's milk-fed preterm infants may be in vivo down-regulated catabolism of 2 important essential amino acids (phenylalanine in addition to threonine) in formula-fed preterm infants.     

Randomized diet in the neonatal period and growth performance until 7.5-8 y of age in preterm children

BACKGROUND: Preterm children are at high risk of poor growth performance. In 2 randomized trials, preterm infants fed preterm formula grew better in the neonatal period than those fed banked donor breast milk or standard term formula. OBJECTIVE: Our objective was to test the hypothesis that for preterm infants, the neonatal period is a critical one for programming growth performance and that early diet influences long-term growth. DESIGN: A total of 926 preterm infants were recruited into 2 parallel, randomized trials of neonatal diet. In trial 1, infants were fed either banked donor breast milk or preterm formula whereas in trial 2, infants were fed either standard term formula or preterm formula. Within each trial, the allocated milk was the sole diet for some infants (study A), whereas for others it was a supplement to maternal breast milk, given when not enough expressed breast milk was available (study B). We followed up 781 of 833 survivors (94%) to age 7.5-8 y. Trained assessors obtained anthropometric measurements according to a standard protocol. RESULTS: Despite significantly better neonatal growth performance in infants fed preterm formula (compared with either banked donor breast milk or standard formula), early diet had no influence on weight, height, head circumference, or skinfold thicknesses at 9 or 18 mo postterm or at age 7.5-8 y. CONCLUSIONS: These findings suggest that the preterm period is not a critical window for nutritional programming of growth, which contrasts with evidence from these trials showing that early diet influences later neurodevelopment.     

Vitamin requirements of very low birth weight infants: a review

This review of the nutritional needs of very low birth weight infants (VLBW) concluded that vitamin supplementation was indicated for vitamins A, D, C, and folic acid. With breast feeding or other circumstances, there may be marginal needs for vitamin E, K, B1, B2, and B6. Supplementation of VLBW depends upon the gestation age, which is related to the placental transfer and body stores at birth, and vitamin content of breast milk or formula (feeds), and volume and micronutrient composition of feeds. The infant's vitamin stores at birth are dependent on the nutritional status of the mother, particularly lipid soluble vitamins, which have been found to be higher in fetal cord blood than in maternal blood. The exception is B6, which crosses the placental barrier with difficulty. Preterm infants and infants of undernourished mothers usually have reduced levels of water soluble vitamins at birth. There is some variability in nutrients of feeds. Breast milk, for instance, has lower levels of vitamins D and K than recommended levels. Needs will also very with the presence of particular nutrients. For example, B6 requirements will vary with protein intake. Vitamin E requirements will depend on the amount of linoleic acid or polyunsaturated fatty acids in the diet. Tryptophan in the presence of B6 allows the synthesis of niacin. Volume of feeding affects nutritional needs. The recommended daily allowance (RDA) of specific nutrients for an infant up to 6 month of age and weighing 3-8 kg requires consumption of 500-1000 ml of breast milk or formula per day. A full term infant can receive sufficient nutrients with 450-750 ml, but below 400 would result in a deficit of vitamins. Unfortunately, the volume of feeds for VLBWs is too low in the first two weeks of life or until the body weight of 2000 g is reached; thus supplementation was recommended. Late anemia due to vitamin E deficiency may be prevented when the alpha tocopherol per gram of polyunsaturated fatty acids ratio is equal to or higher than the recommended levels. When intake of vitamin K at birth is insufficient, deficiencies may appear later; the recommendation was .2 to 1.0 mg at birth as a preventive regimen. Vitamin D was also recommended for both breast and formula fed infants. Pyridoxine/ g protein intake, folic acid, and vitamin C should be provided VLBW infants as indicated.     

不同喂养方式对早产小于胎龄儿骨密度的影响

目的 研究不同喂养方式对早产小于胎龄儿（ SGA）骨密度的影响。方法 将215例小于胎龄儿按照喂养方式分为5组：早产儿出院后配方奶喂养组、母乳喂养组、足月儿配方奶喂养组、母乳＋早产儿出院后配方奶喂养组、母乳＋足月儿配方奶喂养组,比较各组在生后第6月、12月骨密度值。结果 5组小于胎龄儿的骨密度数值从高到低依次为：母乳＋早产儿出院后配方奶喂养组、母乳喂养组、早产儿出院后配方奶喂养组、母乳＋足月儿配方奶组、足月儿配方奶喂养组,差异具有统计学意义（6月龄时：F男＝2．845,F女＝2．570;12月龄时：F男＝2．737,F女＝7．461,均P＜0．05）。结论 对早产小于胎龄儿童进行母乳喂养或强化母乳喂养能改善其骨密度情况,适用于早产儿。     

Plasma vitamin A and E in preterm babies fed on breast milk or formula milk with or without long-chain polyunsaturated fatty acids

Plasma vitamin A and E, the antioxidant nutrients copper and zinc, and magnesium were investigated in preterm babies. They were fed on their own mother's breast milk, or a formula with, or without, AA and DHA. Vitamin A (2.4 mg/d) and E (15 mg/d) supplements were also given. Vitamin A and E levels of most of the babies were sub-optimal at birth. The mean concentrations of vitamin E increased in all the groups by the expected date of delivery (EDD) (p < 0.001). Those fed on their mother's breast milk had the highest value compared with the other groups (p < 0.001). There was an increase in the mean level of vitamin A (p > 0.05) and copper (p < 0.05) and a decrease in zinc (p < 0.05) between birth and EDD. Concentrations of the two vitamins were not different (p > 0.05) between the babies fed on the formula with, and without, AA and DHA. It is concluded that the amount of AA and DHA incorporated in the formula milk did not adversely influence the plasma vitamin A and E of the babies.     

Traditional nutritional and surgical practices and their effects on the growth of infants in south-west Ethiopia

A 1-year birth cohort of 1563 infants was seen bi-monthly for the first year of life. They comprised all identified infants born in Jimma town, south-west Ethiopia, in the year starting 1 Meskren 1985 in the Ethiopian calendar (11 September 1992). Growth in infancy is poor in this town, as it is in Ethiopia more generally: mean z-scores for both weight and length were more than 1.5 SD below the median of the NCHS/WHO reference population by 1 year of age, and infant mortality was 115/1000. In this paper we examine the weight gain of singletons in relation to background variables and to traditional nutritional and surgical practices in the families.
   Confirming work in other areas, sanitation, water supply, the income of the family and the mother's literacy were important determinants of weight gain. Almost all the infants were initially breast fed, and about 80% were still breast fed at 1 year. Many were also given cows' milk from 4 months onwards. Breast feeding had beneficial effects up to 8 months of age, and cows'milk had beneficial effects after 6 months of age. Supplementary feeds of solids and semi-solids were given at appropriate ages, but had no detectable benefit. Water was given inappropriately early, but did no detectable harm.
   Episodes of diarrhoea, fever or persistent cough each reduced weight gain. Catch-up in weight then took up to 8 months, probably because of the poor nutritional quality of supplementary feeds. The incidences of local traditional operations in the first year were: circumcision 63% in males and 4% in females, uvulectomy 35% and the extraction of milk teeth 38%. Although circumcision had no detectable adverse effect on weight, uvulectomy and milk teeth extraction both reduced weight gain.