早期新生儿乳糖吸收不良与乳糖不耐受筛查及影响因素探讨

为了解乳糖吸收不良在新生儿早期的分布状况,本文采用醋酸铅半定量法测定了86例早期新生儿(足月儿74例、早产儿12例)的粪便乳糖及粪便pH值,结果提示LM(乳糖吸收不良)在早期新生儿中发生率较高,达39.5%,而LI(乳糖不耐受)发生率为5.8%,说明大部分乳糖吸收不良的新生儿不伴有消化道症状.进一步分析,LM/LI的发生与分娩方式、围产期缺氧史、孕周、喂养史及性别均无关.本文随访了全部5例LI患儿,虽未经治疗,腹泻、腹胀症状多在2～3周内消失,最长1例症状持续至6周,生后3～4个月时复查粪便乳糖均转阴,同时生长发育良好.故新生儿早期的LM/LI系一个暂时性的缺乏,发育性的过程,考虑与肠粘膜发育不够成熟有关.     

婴儿乳糖不耐受的诊治研究

婴儿乳糖不耐受(LI)最常见的症状为腹泻,约占婴儿腹泻的46%～70%。LI的腹泻无特异性,单凭临床难以确诊。确诊LI必须有乳糖吸收不良(LM)的客观指标。呼气氢试验、肠黏膜活检、双糖酶测定等方法在国外已开展较多,但均需要一定的仪器设备。最简单的方法为测定粪便中的还原糖。国际上已公认,用Clinitest试剂测定粪糖可作为婴儿LI的粗筛试验。由于Clinitest试剂必须进口,购买不便,国内又先后推出了醋酸铅法、改良班氏试剂法。笔者近年来试用了普通班氏试剂检测婴儿粪糖并与Clinitest试剂进行对照,结果相似。班氏试剂价格低廉,易买易配,各基层单位均能采用,可作为Clinitest试剂的代用品。LI一旦确诊,不论原发、继发均应采用去乳糖饮食疗法。     

新生儿乳糖吸收不良与不耐受的临床探讨

乳糖吸收不良与不耐受症是糖源性腹泻最常见的一种，在婴幼儿腹泻中占有一定数量，但尚末见新生儿乳糖吸收不良与不耐受的资料报道。我院于1992年5月至1993年12月采用醋酸铅法直接检测142例新生儿腹泻的粪便乳糖含量，发现粪乳糖含量＞（＋）者60例，随机分治疗组给去乳糖饮食疗法；对照组只给助消化对症治疗，两组疗效对比，有显著性差异，特报告如下。临床资料一、临床诊断指标1．临床表坎特征腹泻伴有腹胀、肠呜音增强等，典型粪便水分多、粪质少、有泡沫、酸臭气味，每日3～10次不等。应用抗生素与消化止泻药无效，但给去乳糖饮食治疗，…     

新生儿乳糖不耐受研究进展

乳糖不耐受是指因乳糖酶数量不足或活性低下引起乳糖吸收不良,引发一系列消化道系统症状,严重影响患儿的生长发育。由于乳糖不耐受与胃肠道疾病症状有相似之处,且缺乏简便有效的检测方法,新生儿乳糖不耐受常被忽视或与其他胃肠道疾病混淆,易漏诊、误诊,导致抗生素、氨基酸配方奶的过度使用。因此,对新生儿乳糖不耐受的早期识别、诊断及治疗...     

粪便乳糖检测法诊断乳糖吸收不良与不耐受

本文报道用醋酸铅加氢氧化铵检查粪便乳糖的研究结果,并论证了其可靠性及实用性。本法简易、快速、安全、无创伤。经纸层析法及临床疗效均证实有一定的灵敏度及特异性,可作为国内诊断小儿乳糖吸收不良及不耐受的初筛方法以及监护乳糖不耐受治疗期间去乳糖疗法的剂量与疗程。     

小儿腹泻时粪还原糖改变及其临床意义

腹泻为小儿最常见疾病之一,尤其在秋冬季节多发,它可以引起乳糖吸收不良(LM)和乳糖不耐受症(LI)。为了解其发生情况,我们对2001年7月至2001年12月收住我院的98例腹泻患儿进行粪还原糖的测定,现报道如下。     

汉族儿童乳糖吸收不良和不耐症

探讨儿童乳糖吸收不良（ＬＭ）和不耐症（ＬＩ）发生率与年龄的关系。方法随机选择重庆地区汉族健康儿童１３８名，男７２名，女６６名，年龄为４个月～１２岁。用乙醇乳精耐量试验（ＬＴＴＥ）尿半乳糖（Ｕ－ｇａｌ）测定与症状反应评分（ＳＲＳ）进行评判。结果１３８名汉族儿童中ＬＭ和ＬＩ发生率：＜４岁、４～５岁、６～７岁、８～９岁、１０～１２岁分别为１０％、５０％、６９．６％、８７％和９１．７％。＜４岁组ＬＭ和ＬＩ发生率明显低于其他各组（Ｐ＜０．０１）。无症状反应者５７名（４１．３％），有症状反应者８１名（５８．７％），其中ＳＲＳ为１～５者７４名（９１．４％）。腹痛、腹泻、腹胀或排气增加的发生率分别为３８．４％、３２．６％、２２．５％，且均随ＳＲＳ的增加而增加。结论儿童ＬＭ和ＬＩ发生率随年龄增加而增加，ＬＭ和ＬＩ常见的症状反应为腹痛、腹泻和腹胀（或排气增加），其发生率随ＳＲＳ增加而增加。     

乳糖吸收不良和不耐症

乳糖吸收不良(LM)和乳糖不耐症(LI)是由乳糖酶缺乏(LD)所引起的。获得性 LD 与遗传有关;继发性 LD 与小肠粘膜损伤有关。虽然诊断 LD 最准确的方法是直接空肠粘膜活检法,然而乙醇乳糖耐量试验(LTTE)和乳糖呼气氢试验(LBHT)法也为较可靠的间接诊断法。对 LD 的治疗以减少和禁止含乳糖食品或使用乳糖替代品等为主要手段。     

新生儿乳糖不耐受

新生儿乳糖不耐受症是由于乳糖酶缺乏,不能完全消化分解母乳或牛乳中的乳糖所引起的一系列消化系统症状。乳糖是主要存在于哺乳动物乳汁中的一种双糖,母乳中乳糖含量为7.2 g/100 ml,牛乳中乳糖含量为4.7 g/100 ml。乳制品是新生儿主要的能量来源,乳糖为新生儿提供约20%的能量。在生长发育过程中,乳糖不仅在能量供给方面起重要作用,亦参与大脑的发育进程。     

小儿乳糖不耐受临床探讨

为探讨乳糖不耐受（ＬＩ）在兰州地区的发病情况,我们自１９９１．３１￣１９９３．８采用徐州医学院推荐的醋酸铅氢氧化学法,观察腹泻患和２９５８便,不伴有腹泻闰 状的肠道外感染患儿２０３例,并以４０例健康婴儿粪便对照。发现３岁以下腹泻患儿中乳不耐受的发生率占４６．９％,且年龄越小发生率越高,各年龄组之间有显著差异;３岁以上患儿无１例１１这与不再以乳食为主有关;轮状病毒性肠炎的ＬＩ发生率显著高于细菌性肠炎     

Lactose malabsorption and recurrent abdominal pain in Italian children

The role of lactose malabsorption (LM) was investigated in 32 children (mean age 8.13 +/- 2.46 years) with recurrent abdominal pain (RAP). LM was detected in 75% of them by a lactose breath hydrogen test (LBHT) after a 2-g/kg (max 50-g) load. Of the 18 malabsorbers who participated in a 3-month lactose-free diet (LFD), 14 were judged "improved" and reported lower pain frequency (p less than 0.001). The malabsorbers who improved versus the not improved had comparable past lactose ingestion but were distinguishable on the basis of their lactose absorption capacity (0.36 vs. 0.81 g/kg; p less than 0.01), as subsequently determined by multiple LBHTs with 25-, 12.5-, and 6-g loads. The ratio between past lactose ingestion and lactose absorption was 1.89 in the improved and 0.55 in the not improved groups (p less than 0.01), retrospectively indicating lactose as a possible cause of the symptoms in the improved group. The reintroduction of lactose in amounts not exceeding the absorption capacity into the diet of each malabsorber who had improved with LFD caused relapse in none of the 14 subjects monitored for 2-6 months. In conclusion, LM seems an important cause of symptoms in Italian children with RAP. Assessment of the lactose absorption threshold of each subject of LBHTs provides a basis for reintroduction of "calibrated" amounts of lactose-containing foods (e.g., milk) into the diet.     

Cow's milk protein intolerance in infants under 1 year of age: A prospective epidemiological study

Incidence and clinical manifestation of cow's milk protein intolerance (CMPI) were studied in 1158 unselected newborn infants followed prospectively from birth to 1 year of age. No food changes were required in 914 infants who were used as healthy controls. When CMPI was suspected (211 infants), diagnostic dietary interventions according to a standard protocol were performed. After exclusion of lactose intolerance, two positive cow's milk elimination/challenge tests were considered diagnostic of CMPI. Two hundred and eleven symptomatic infants were examined for possible CMPI. A large group of 80 infants improved on a lactose reduced formula. In 87/211 infants CMPI was excluded (sick controls). Finally CMPI was proven in 26 infants. The calculated incidence rate for CMPI was 2.8%. The principal symptoms in infants with CMPI were gastrointestinal, dermatological and respiratory in 50%, 31% and 19% respectively. A positive family history for atopy (first or second degree relatives) was more frequent in either CMPI infants (65%), or sick controls (63%) when compared to either healthy controls (35%) or infants improving on a low lactose formula (51%). Differences between patients with CMPI and sick controls were only found for the presence of atopy in at least 2 first degree relatives [(5/26 in CMPI infants and 4/87 in sick controls (P<0.05)] and for multiorgan involvement [10/26 infants with CMPI as opposed to 12/87 in the sick control group (P<0.02)]. These statistical differences are too weak to be of clinical value.     

Clinico-etiological and EEG profile of neonatal seizures

Objective To evaluate clinical, etiological and EEG profile of neonatal seizures. Methods In all the neonates enrolled in the study baseline information recorded was sex, gestational age, weight, ponderal index etc. Clinical profile of seizure episode included age at onset of seizure, type and duration of seizure, associated autonomic changes, medication given, response time to medication and possible cause. Relevant maternal history including antenatal and peripartum history was recorded. Relevant history and examination of newborn were noted. Essential investigations done in all subjects included blood glucose, serum calcium, serum sodium and arterial pH. USG cranium and EEG were done at earliest in all the subjects wherever feasible. Additional investigations were done as guided by history, physical examination and essential investigations. Results Ninety babies with clinical seizures were enrolled into the study over one year period with an overall incidence of 1.17% (0.69% in term babies and 6.14% in preterm babies). Abnormal EEG’s were found in one third cases out of 60 EEG’s done in 90 babies. 26.7% of babies with perinatal asphyxia had abnormal EEG’s (8/30). While 60% of babies with HIE II had abnormal discharges, background activity was suppressed in 66.66% EEG’s in babies with HIE III. Conclusions Overall incidence of neonatal seizures was 11.7/1000 live births, majority being preterm very low birth weight babies before 5 days of life. Perinatal asphyxia was responsible in 44.44% babies followed by metabolic abnormalities (23.33%). EEG abnormalities were present in 33.34% babies.     

窒息新生儿肾损害及一氧化氮保护作用

为了解机械通气治疗的窒息新生儿肾损害的发生情况，比较不同窒息程度与肾损害的关系。并探讨一氧化氮（NO）吸入治疗对肾脏的影响。对机械通气治疗的41例窒息新生儿（轻度窒息19例，重度窒息22例），进行回顾性分析，其中13例同时予以NO吸入治疗。结果显示：41中17例（占41．5％），有不同程度的肾损害，重度窒息患儿肾损害发生率明显高于轻度窒息患儿（P＝0．014）。予以NO吸入治疗的窒息患儿肾损害的改善较未予以NO吸入治疗者明显，9例未用NO吸入治疗的肾损害患儿在机械通气治疗后2例肾损害好转，5例无好转，另2例未随访，8例用NO吸入治疗的肾损害患儿在NO吸入治疗后肾损害好转6例，另2例未随访，提示窒息新生儿肾损害的发生率相当高，而NO吸入治疗能较明显的改善窒息后的肾损害。     

聚合酶链反应检测新生儿沙眼衣原体肺炎初探

应用聚合酶链反应（PCR）检测沙眼衣原体（CT）DNA，84例新生儿肺炎咽拭子中检出21例，阳性率25％。其中剖宫产儿阳性率16．6％（2／21）；经产遗产儿阳性率26．4％（19／72）；早产低体重儿阳性率50％（5／10）。提示新生儿为CT感染的高危群体；其感染CT以通过孕妇产道获得为主，偶有宫内感染；早产低体重儿易被CT感染且症状较重。PCR检测CT感染具有快速、敏感特异的优点，有助于新生儿CT肺炎的诊断。     

Protein hydrolysates: hypoallergenic milks and extensively hydrolyzed formulas. Immuno-allergic basis for their use in prevention and treatment of milk allergy]

Allergy to milk has an estimated incidence of 2.5%. Hypoallergenic milks are partial hydrolysates of proteins with lactose. Extensive hydrolysates of casein are mainly small peptides and do not include lactose in their formula. A primary allergenicity as well as a cross-sensitivity are shown for all partial hydrolysates. Even extensive hydrolysates have a weak potential of cross-allergy. The prevention of cow's milk allergy in infants at peculiar risk, born from atopic parents, is based on breast-feeding and/or partial or extensive hydrolysates. There is no conclusive evidence for the usefulness of eviction of dairy products during pregnancy or during the period of breast-feeding. The treatment needs exclusively extensive casein hydrolysates ensuring a 90% protection with 95% confidence intervals. Predictive prick tests in certain cases may help the choice of another hydrolysate. Severe cases with failure to thrive or multiple food intolerance require an amino-acid based formula (Neocate). A rational diversification of the diet is advised in order to prevent the onset of a multiple food intolerance syndrome which could avert from the recovery of cow milk allergy.     

TEMPORARY INTESTINAL LACTASE DEFICIENCY IN LIGHT-TREATED JAUNDICED INFANTS

Abstract The intestinal lactase activity in six newborn jaundiced light-treated infants with diarrhea and in eight normal controls were compared by lactose tolerance test (LTT). The ability to hydrolyze lactose was minimal in the jaundiced infants during light-treatment compared to the controls which could absorb lactose very well. Peroral intestinal biopsies were taken from the newborn jaundiced infants during light-treatment. By histochemical technique no intestinal lactase activity was found in these intestines. When the jaundiced infants with diarrhea were given lactose-free diet, the stools normalized. The effect was reversed when breast milk was given while the baby was still jaundiced and light-treated. These findings indicate that the increased amounts of unconjugated bilirubin in the intestine of jaundiced infants during light-treatment inhibit the intestinal brush-border lactase. When the icterus fades the lactase is again active. The practical consequence is to give light-treated infants lactose-free diet if they get diarrhea, and to reintroduce breast milk or other lactose containing diet when the baby is no longer icteric.     

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目的探讨新生儿颅脑损伤与新生儿窒息的相互关系。方法2004-12—2005-05江西省妇幼保健院对196例新生儿进行颅脑B超探查,并结合临床资料对其结果进行对比分析。结果196例新生儿中共有脑损伤73例,其中早产儿为54例,占早产儿的60%(54/90),足月儿脑损伤为19例,占足月儿的17·92%(19/106),低体重儿脑损伤47例,占低体重儿的56%(47/84),正常体重儿脑损伤为26例,占正常体重儿的23·2%(26/112)。早产儿、低体重儿颅脑损伤发生率分别较足月儿、正常体重儿明显升高,且有显著差异(P<0·01,P<0·05)。早产儿、低体重儿颅脑损伤在对照组与窒息组间无统计学意义(P>0·05),而足月儿、正常体重儿、剖宫产儿颅脑损伤在对照组、窒息组间存在显著差别(P<0·05)。结论新生儿窒息是引起足月儿、正常体重儿、剖宫产儿颅脑损伤的主要因素之一;早产儿、低体重儿脑损伤发生率明显高于足月儿、正常体重儿;减少早产儿、低体重儿的出生,可有效降低新生儿颅脑损伤的发生率;颅脑B超可作为新生儿早期颅脑损伤的诊断、筛查、跟踪随访的重要检查手段之一。