哺乳期母亲饮食管理对婴儿湿疹的防治作用及其机制研究

背景　湿疹是婴儿时期最常见的过敏性皮肤炎症,药物治疗暂缓症状,仍反复发作,严重影响婴儿的生活质量和健康成长。纯母乳喂养婴儿的湿疹与母亲进食敏感食物相关。目的　探讨哺乳期母亲血清食物特异性IgG抗体水平与婴儿湿疹的关系,哺乳期母亲回避敏感食物对婴儿湿疹的防治作用及可能机制,探索非药物防治婴儿湿疹的方法。方法　2016年3月—2018年9月,采用酶联免疫吸附法（ELISA）对纯母乳喂养的142例湿疹婴儿（观察组）和35例健康婴儿（对照组）的母亲进行血清14种食物特异性IgG抗体水平测定,指导观察组哺乳期母亲依据检测结果回避相应敏感食物,对照组母亲不进行饮食指导,3个月后电话随访湿疹改善情况。结果　观察组母亲血清食物特异性IgG抗体阳性率〔95.7%（132/138）〕明显高于对照组〔82.9%（29/35）〕,二者差异有统计学意义（P<0.05）。观察组115例母亲哺乳期间有不同程度的饮食回避,湿疹缓解的总有效率为93.0%（107/115）,其中完全回避饮食者湿疹缓解率为93.4%（85/91）,不完全回避饮食者湿疹缓解率为91.7%（22/24）。结论　湿疹患儿的母亲血清食物特异性IgG抗体水平升高,提示母亲对相关食物敏感,哺乳期母亲回避敏感食物对婴儿湿疹有防治作用,其机制可能与IgG介导的迟发型变态反应有关。     

孟鲁司特钠颗粒治疗小于6个月纯母乳喂养牛奶蛋白过敏儿临床效果

目的 分析孟鲁司特钠颗粒在单纯母乳喂养小于6个月婴儿中牛奶蛋白过敏的治疗效果,并观察其治疗安全性。方法 对延安大学附属医院106例单纯母乳喂养小于6个月婴儿确诊牛奶蛋白过敏的患儿,随机分为观察组和对照组,对照组在其母亲膳食中回避牛奶和(或)其制品的食物,同时母亲按1000 mg/d,补充钙剂,2次/d。观察组在对照组基础上加用孟鲁司特钠颗粒2 mg/次,1次/d。观察两组患儿临床症状改善情况。从第6周起,其母亲每周重新恢复一种已回避的食物,观察患儿的临床症状、体征加重或再现情况以及不良反应。结果 治疗2周后,观察组总有效率94.6%,对照观察组总有效率72.0%,差异有统计学意义(P＜0.05);母亲逐渐恢复已回避的食物后,患儿临床症状再现或加重出现率观察组47.9%,对照组75.7%,差异有统计学意义(P＜0.05)。结论 孟鲁司特钠颗粒在治疗小于6个月单纯母乳喂养儿牛奶蛋白过敏有显著疗效,且未出现与治疗相关的不良反应。     

喂养方式以及母亲饮食结构对婴儿湿疹发病率的影响

目的探讨1~6个月婴儿母亲饮食结构以及婴儿喂养方式两者与湿疹发病的关系,并观察对进食敏感食物母亲进行饮食干预治疗婴儿湿疹的疗效。方法采用问卷方式调查705例婴儿母亲饮食结构及其婴儿的喂养方式,根据婴儿喂养方式不同分为纯母乳喂养组和纯人工喂养组,对纯母乳喂养组根据母亲哺乳期饮食结构,分为进食大量敏感食物组和进食少量敏感食物组以及非敏感食物组,比较不同喂养方式以及母亲不同饮食结构婴儿湿疹的患病率以及不同组别湿疹发病的相关性分析;并对进食敏感食物组湿疹患儿的母亲进行饮食干预,观察治疗效果。结果广州地区纯母乳喂养婴儿湿疹患病率高于纯人工喂养组(P<0.05),母乳喂养组中母亲进食敏感食物发病率高于非敏感食物(P<0.001),进食敏感食物与湿疹发病率呈正相关关系(r=0.36)。对进食敏感食物母亲进行饮食人工干预后,婴儿湿疹患病率下降(P<0.001)。结论母亲进食敏感食物可能是婴儿湿疹高发的原因,对母亲进行饮食干预可有效减少婴儿湿疹的发病。     

食物回避治疗婴幼儿牛奶蛋白过敏的随访观察研究

目的探讨食物回避治疗婴幼儿牛奶蛋白过敏的随访观察。方法选取我院2018年2月至2019年2月收治的婴幼儿牛奶蛋白过敏患儿共88例,对患儿进行营养学指导与调整喂养方案,采用食物回避的治疗方法在第3个月、6个月时进行随访观察,纪录患儿生长发育及饮食喂养情况。结果食物回避治疗婴幼儿牛奶蛋白过敏在3个月、6个月时患儿临床症状、生长发育情况都得到了显著的改善。治疗3个月后的总有效率为(88.63%),治疗6个月后的总有效率为(98.86%),进行食物回避治疗后第3个月的总有效率低于治疗后6个月时的总有效率,且P0.05,差异具有统计学意义。结论食物回避治疗婴幼儿牛奶蛋白过敏治疗效果显著,具有值得在临床上推广和运用的优越价值。     

母乳性黄疸门诊口服茵栀黄颗粒及复合乳酸菌素疗效观察

目的观察口服茵栀黄颗粒及复合乳酸菌素治疗新生儿母乳性黄疸的临床疗效。方法对就诊新生儿母乳性黄疸126例分为治疗组及对照组,各63例,治疗组给予茵栀黄颗粒及复合乳酸菌素胶囊口服,继续母乳喂养;对照组给予肝酶诱导剂(苯巴比妥)及暂停母乳喂养,比较2组患儿黄疸消退时间及每天胆红素下降速度。结果治疗组较对照组患儿黄疸消退时间及日均胆红素下降值比较,差异均有统计学意义(P<0.05)。结论门诊治疗口服茵栀黄颗粒及复合乳酸菌素胶囊安全,与传统治疗相比,有无需暂停母乳,保证母乳喂养对患儿的营养供给及免疫获得,减轻母亲的心理负担。     

新生儿坏死性小肠结肠炎的临床观察

目的:探讨新生儿坏死性小肠结肠炎的治疗方式以及治疗效果。方法:选选取自2011年4月至2015年5月间来我院就诊的250例新生儿坏死性小肠结肠炎患儿为主要研究对象。所有患儿均采用内科保守治疗方式进行治疗。结果:患儿的发病率与其体重、喂养方式等有着密切联系,且体重较小、以非母乳方式喂养的患儿发病率远远高于体重较大,以母乳方式喂养的患儿(P0.05);治疗的总有效率为86%。结论:提倡母乳治疗,同时做大早发现、早治疗,对降低新生儿坏死性小肠结肠炎的发病率有着重要的意义。     

母乳性黄疸48例临床分析

目的：探讨母乳性黄疸的临床特点、治疗方法及转归。方法：回顾性分析太原市太航医院儿科2003年6月至2006年6月收治的145例黄疸患儿，其中母乳性黄疸48例，占33．1％，48例中男性36例，女性12例，停母乳3d～5d结合辅助治疗1周黄疸消退：结果：48例母乳性黄疸患儿预后良好，无1例发生核黄疸，不必特殊治疗。结论：母乳性黄疸占新生儿黄疸中比例较高，在提倡纯母乳喂养的当今社会，对于母乳性黄疸最重要的诊断、治疗措施是暂停母乳，若经治疗效果不满意尽早考虑联合治疗。     

迟发型母乳性黄疸65例临床分析

母乳性黄疸 (ＢＭＪ)是母乳喂养有关的特发性黄疸 ,近来随着母乳喂养知识普及、母乳喂养率提高而有增多的趋势 ,但报导不多。我院于 1996年至 1998年共观察到 6 5例迟发型母乳性黄疸 ,现分析报告如下。1　临床资料1 1　一般资料　选择 1996年至 1998年在我院出生的健康足月新生儿纯母乳喂养 42 0例 ,经过新生儿访视 ,生后 2ｗｋ生理性黄疸持续不退 ,并除外病理性黄疸的 6 5例患儿 ,其中男 36例、女 2 9例 ;孕周平均 39 4ｗｋ ;第 1产 6 3例 ,第 2产 2例 ;顺产 5 0例 ,剖宫产 15例 ;母亲平均年龄 2 5 3岁 ;母亲健康 (无急、慢性黄疸性肝炎、…     

思密达加10%葡萄糖治疗母乳性黄疸89例临床分析

目的 观察思密达配合10%葡萄糖对母乳性黄疸的治疗效果.方法 对临床诊断母乳性黄疸的89例患儿随机分为思密达治疗组和停母乳喂养对照组,治疗组在不停止母乳喂养的同时加用思密达配合10%葡萄糖20mL,每日2～3次,口服.对照组暂停母乳喂养3天,两组患儿分别于就诊时,治疗第3、5、7天各检测1次血清胆红素.结果 治疗效果及7天治愈率治疗组明显优于对照组,两组比较差异具有非常显著性意义,P＜0.01.结论 思密达配合10%葡萄糖用于治疗母乳性黄疸,能显著降低血清胆红素水平,且不需暂停母乳喂养,值得推荐.     

食物不耐受与儿童慢性皮肤性疾病相关性的临床研究

目的 探讨食物不耐受与儿童慢性皮肤性疾病的相关性.方法 选取本院2009年2月～2011年12月间儿科及皮肤科门诊患有慢性皮肤性疾病的患儿131例.所有患儿均采用酶联免疫吸附法(ELISA)对血清中14种食物特异性IgG抗体水平进行测定,将检测结果呈阳性的患儿随机分为对照组和试验组.两组患儿均给予抗过敏药物治疗.对照组患儿继续正常饮食,试验组患儿回避阳性食物饮食.对两组患儿临床症状改善情况进行对比分析.结果 所有131例慢性皮肤性疾病患儿检测结果血清中食物特异性IgG呈阳性者128例,总阳性率为97.7%;所检测的14种食物中,以虾、蟹、蛋清/蛋黄阳性率为著,患儿对大米、猪肉均耐受;试验组有效率82.8%;对照组有效率9.4%,差异有统计学意义(P<0.05).结论 食物特异性IgG抗体的检测对食物不耐受的诊断、治疗及预防有着重要的临床意义,合理调整饮食对治疗食物不耐受有着显著作用.     

Duration and causes of cessation of breast feeding in working mothers in Ghazvin,Iran

This study determines the duration and reasons for stopping breast feeding among working mothers in the city of Ghazvin near Tehran, Iran, in 1988. The study sample included 259 working mothers who were paramedical and nonmedical personnel, had ended breast feeding, and had one living child aged under 3 years. 100% of mothers had initiated breast feeding at birth. Breast feeding introduction ranged from 0 to 99 hours after delivery. 68.2% received breast milk between 7 and 24 hours after birth. The duration of breast feeding was significantly negatively correlated with the time of introduction of breast milk after delivery. The difference between the mean duration of breast feeding and the first introduction of food was statistically significant. Duration of breast feeding was significantly correlated with the age of introduction of food supplements. Duration of breast feeding was significantly negatively correlated with maternal age at first marriage, at pregnancy and delivery, and at last delivery. Duration of breast feeding was significantly related to insufficient supplies of milk and work outside the home.     

Infant feeding practices among middle income urban Africans and Indians in Kenya

A longitudinal study conducted in Nairobi focused on 70 Africans, 35 Indian vegetarians, and 20 Indian non-vegetarians revealed significant differences between these 3 groups in terms of the choice of milk, breastfeeding duration, age of introduction of other foods to the infant's diet, and the choice of weaning foods. African mothers tended to exclusively breastfeed their infants for longer durations than either of the 2 groups of Indian mothers. At 6 weeks, 42% of African mothers, 19% of Indian vegetarian mothers, and no Indian nonvegetarian mothers were exclusively breastfeeding. Bottle feeding was widespread in all 3 groups; however, African mothers showed a pattern of mixed feeding (at 12 weeks, 68% of African infants were being fed both breast and formula milk), while Indian mothers tended to replace breastfeeding with bottle feeding (at 12 weeks, 10% of the vegetarian mothers and 19% of the non-vegetarian mothers were following this regimen). Indian nonvegetarian mothers made extensive use of formula, while their vegetarian counterparts relied more on cow's milk. All 3 groups introduced foods earlier than the recommended 4-6 months. By 18 weeks, 98% of African infants, 86% of Indian vegetarian infants, and 89% of Indian nonvegetarian infants were receiving semi-solid or solid foods in addition to milk. In all 3 groups, cereals were the most commonly introduced 1st food, followed by fruits and pureed vegetables. The use of commercial cereals was extensive, with 97% of African mothers, 90% of Indian vegetarian mothers, and 82% of Indian nonvegetarian mothers feeding such preparations to their 6-week-old infants. As the children grew older, use of commercial cereals decreased. Despite the differences in feeding practices, the pattern of weight gain was parallel for infants from all 3 study groups. Moreover, the mean energy and protein intakes of all 3 groups were 80% or more of recommended allowances.     

Effectiveness of baby friendly hospital initiative on the promotion of exclusive breast feeding among the Dhaka city dwellers in Bangladesh

To assess the effectiveness of baby friendly hospital initiative on exclusive breast feeding status; this longitudinal study designed to compare the incidence of exclusive breast feeding at 30, 60, 90, 120 and 150 days post partum for mothers who delivered at baby friendly hospital and mothers who delivered at a nearby non-baby friendly hospital. 105 mothers from baby friendly hospital and 104 mothers from non-baby friendly hospital were recruited and followed up for determining duration of exclusive breast-feeding. The median survival time of exclusive breast-feeding was 73.85 days among mothers of baby friendly hospital and 30 days among mothers of non-baby friendly hospital, with a difference of 43.85 days. Life table cumulative surviving proportion for exclusive breast-feeding shows that 82 percent mothers of baby friendly hospital continue at 30 days, compared with 50 percent mothers off non-baby friendly hospital. At 150 days, 16 percent mothers of baby friendly hospital continue exclusive breast-feeding compared with 6 percent mothers of non-baby friendly hospital. Finally 8 percent mothers of baby friendly hospital continue exclusive breast feeding between two hospital was found highly significant (P < 0.001). Duration of exclusive breast-feeding is longer among the mothers who have been delivered in a baby friendly hospital than those mothers who have been delivered in a non-baby friendly hospital.     

乳母膳食和乳汁成分与婴儿生长发育的关系分析

目的：调查吉林省长春市乳母膳食、乳汁成分和婴儿生长发育情况,探讨母乳营养水平与婴儿生长发育的关系,为促进婴儿健康发育提供理论依据。方法：募集138例健康乳母,在产后40~45 d面对面调查研究对象基本信息及婴儿生长发育信息,并采用"二十四小时膳食回顾法"调查乳母膳食情况。提供标准食物图片估算研究对象的膳食品种及数量。应用《金钥匙营养专家系统软件-孕产妇版》分析乳母膳食摄入的能量和营养素水平,并与《中国孕期哺乳期妇女0~6岁儿童膳食指南（2007）》和《中国居民膳食营养素参考摄入量（2013版）》比较,评价乳母的膳食摄入水平。收集母乳并测量婴儿的生长发育指标,采用乳汁成分分析仪测定乳汁宏量营养素水平。分析乳母膳食、乳汁成分与婴儿生长发育之间的关系。结果：乳母平均能量摄入为（1698.74 ±406.23）kcal·d^-1,蛋白质、脂类和碳水化合物提供的能量比例分别为14.06%、33.83%和52.09%。乳汁平均能量为（61.18±13.04）kcal·100g^-1,蛋白质含量为（0.94±0.19）g·100g^-1,脂类含量为（3.55±1.27）g·100g^-1,乳糖含量为（6.38±0.82）g·100g^-1。乳母膳食蛋白质摄入量与乳汁蛋白质含量有关联（r=0.203,P=0.017）。控制喂养方式、乳汁能量、婴儿性别和婴儿年龄的影响,偏相关分析显示乳汁各成分与婴儿身长增量和体质量增量之间均无关联（P>0.05）。结论：乳母膳食营养素摄入量存在不足及不均衡现象;乳母膳食蛋白质摄入量会影响乳汁蛋白质含量,乳汁脂类和乳糖含量与乳母膳食营养素之间无关联,且母乳成分与婴儿生长发育之间也无关联。     

Patterns of breastfeeding practice during the first 6 months of life in Saudi Arabia

OBJECTIVE: To assess the breastfeeding practices in the first 6 months of infants at King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was carried out at KAMC in 2005. Infants who attended the primary care centers and well-baby clinic of the hospital for the 6-month's vaccine were included. Mothers were interviewed to collect information on the mothers, infants, and their breastfeeding practice. World Health Organization definitions were used for classification of infant nutrition patterns. RESULTS: Five hundred seventy eight infants were included in this study. The breastfeeding initiation among the sample was 95%. Most mothers supplemented the infants with milk formula (83.4%) or fluids (94%) during the first 6 months. The percent of exclusive breastfeeding was 1.7% and the partial breastfeeding breast milk with formula was the most common type of feeding (78.8%). Lactation duration dropped to 50% at 6 months of age. Factors favoring the milk formula use were introduction of the formula in the first day of life and maternal reasons of inadequate milk. Lactation duration and formula introduction were found to be significantly associated with mothers' parity, working status, and combined contraceptive pill use. CONCLUSION: Prevalence of exclusive breastfeeding was extremely low in our population. Partial breastfeeding was the trend for feeding in the first 6 months of life, which was accompanied with rapid decline in lactation duration.     

Improving exclusive breast feeding in the first 24 h of life using Plan-Do-Study-Act cycle in a tertiary care hospital

BackgroundBreast milk is the most ideal form of nutrition for neonates, but the rate of early initiation of breast feeding is as low as 41.6% in India. We aimed to improve the proportion of new-borns on exclusive breast feeds in first 24 h after birth in our hospital from a baseline rate of 33% to more than 90% by 6 weeks using concepts of quality improvement (QI) initiative.MethodsWe implemented this QI initiative using Plan-Do-Study-Act (PDSA) cycles and the project was conducted from 07 May 2017 to 17 Jun 2017. All singleton term neonates with birth weight above 2.5 kg were included. Neonates requiring any form of resuscitation at birth, respiratory distress requiring any form of respiratory support, and neonates requiring observation in NICU for any other reason were excluded. We ran PDSA cycles (including educating residents and nurses on breast feeding, initiating skin to skin contact and breast feeding in first hour of birth, demonstrating all mothers face to face about attachment and positioning and restriction on issue of formula milk) to improve breast feeding exclusivity.ResultsA total of 199 neonates were enrolled, over a span of 6 weeks. We could achieve sustained exclusive breast feeding in first 24 h of life in more than 90% of the enrolled neonates by adhering to the QI initiative.ConclusionThis QI project using PDSA methodology has significantly improved the rates of exclusive breast feeding in first 24 h of life in normal neonates roomed in with their mothers.     

Nutrient composition of milk produced by mothers of preterm infants in Nigeria

Nutrient composition was determined in breast milk obtained by manual expression from 12 mothers who delivered prematurely (mean 32 weeks) and 15 mothers who delivered at term (mean 39.4 weeks), on days 3, 7, 14, 21 and 28 postpartum. Complete 24-hour milk expressed by five term mothers and seven preterm mothers on days 7, 14, 21 and 28 lactational ages was also recorded. In both preterm and term mothers' milk, lactose and fact concentrations increased with lactational age, while protein and mineral concentrations decreased. The preterm mothers' milk contained higher concentrations of protein, fat and minerals and lower concentrations of lactose than term mothers's milk. The fat and caloric density of milk of the mothers in this study, who were mostly of low social class, was lower than that reported from Western countries. The implication of this finding for feeding premature infants in developing countries is discussed.     

剖宫产术后母乳喂养的几点体会

目的为了提高剖宫产术后母乳喂养率。方法由专职护士有针对性地对产妇进行合理指导和心理疏导,采用产前健康教育,指导产妇正确的哺乳技巧。结果增进母乳喂养,及时疏通乳腺管等,提高纯母乳喂养率。结论产妇术后乳汁充足达到80％以上．纯母乳喂养率85％以上,比过去产妇乳汁充足和纯母乳喂养有了提高。     

Iron status and infants feeding practice in children with anaemia

A cross sectional study was carried out in the then IPGM&R now (Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh) to detect the pattern of feeding practice among the anemic children who were below 2 years of age and to find out a relationship between feeding practice and iron status. Hemoglobin was measured on finger prick blood samples using Haemoglobinometer. A peripheral blood film, and serum-ferritin was estimated by micro particle enzyme-immonoassay (MEIA). A dietary questionnaire was completed with particular emphasis on the type of feeding, breast and formula and at which age the weaning was introduced. 140 clinically suspected anemic patients were selected randomly for this study. Among them 111 (79.3%) patient had hemoglobin value ranging between 7.2-6.4 gm and their serum-ferritin level at or below 12 ngm/ml. It was observed that female children were predominantly affected and incidentally all patients were malnourished. In this study it was found that babies with an exclusive diet of breast milk were mildly anemic and not deficient in iron. On the contrary infants with mixed feeding habits or prolonged breast-feeding without weaning at all or babies devoid of any breast milk had moderate to severe anaemia and all were deficient in iron.     

Magnitude and determinants of bottle feeding in rural communities

This cross-sectional study assessed the extent of bottle use in child feeding and the factors associated with its use in rural communities. Data were collected from 1536 children aged 0-23 months and their mothers in Addis Ababa, Ethiopia, through house-to-house visits. The overall prevalence of bottle feeding was 11.3%. Only 11 (6.3%) of the 174 children who were bottle fed were on exclusive bottle feeding. After adjusting for parental and child characteristics, factors such as the residence, maternal education and occupation showed a significant association with bottle feeding practice (P 0.05). In general, the extent of bottle feeding in the studied communities was high, with a higher rate among town women. Improvement in maternal and child health services including education on child feeding are recommended.