水解蛋白配方与婴幼儿牛奶过敏的预防和治疗

食物过敏是婴幼儿最早出现的过敏问题,牛奶是婴幼儿最常见的过敏食物。牛奶过敏的临床表现多种多样,可涉及皮肤、呼吸道、消化道等多器官多系统。母乳喂养是过敏高风险婴儿的首选喂养方式,但对不能进行母乳喂养的婴儿应选择适当的低敏配方奶,水解蛋白是获得低敏配方的最好方法。根据水解的程度,水解蛋白配方分为适度水解蛋白配方和完全水解蛋白配方。完全水解配方被推荐用于牛乳蛋白过敏婴儿的治疗,适度水解配方通常推荐用于特应质高风险婴儿的初级干预。     

早产儿母乳喂养的益处和挑战(摘译)

尽管母乳喂养的益处众所周知,但早产儿的母乳喂养率和持续时间一直低于足月儿。本文汇总了目前关于早产儿母乳喂养方面的研究,并对相关文献进行了综述。一、早产儿母乳喂养的益处 1．营养方面的益处母乳中的一些物质是配方奶所不能提供的。蛋白质组成成分独特,乳清蛋白比配方奶中的含量更多,且母乳中的乳清蛋白更利于早产儿消化和加速胃排空。母乳中的低聚糖可以阻止细菌粘附于宿主的消化道黏膜,可减少低出生体重儿的坏死性小肠结肠炎(NEC)的发生。母乳     

牛奶蛋白过敏患儿的营养干预

目的 分析牛奶蛋白过敏(CMPA)儿童基本情况,探讨个体化应用氨基酸配方粉、深度水解乳清蛋白婴儿配方粉治疗后的干预效果及转归.方法 收集2009年2 -12月在中国医科大学附属盛京医院儿科就诊,符合CMPA诊断的180例患儿为干预对象.在营养门诊对其喂养史、一般情况进行回顾性分析,给予牛奶回避及治疗类配方粉营养干预7d后回访疗效,指导辅食的选择和添加,并随访3个月、6个月后配方粉喂养婴儿的变化及疗效.结果 180例患儿牛奶过敏高发年龄段为＞2 ～4月龄组(64例,占35.5％);母乳喂养者21例(11.7％),非纯母乳喂养者159例(88.3％);有家族史者32例(17.8％);男女比为1.65:1.干预7d后显效比例最高的临床症状为腹泻(61例,占83.6％).3个月后纯氨基酸配方粉喂养76例(占46.0％),深度水解配方喂养54例(占32.7％),适度水解配方奶粉喂养为25例(占15.3％).6个月后喂养主要是纯氨基酸配方(39例,占24.9％),其次为牛奶配方粉(36例,占22.9％).结论 母乳喂养有利于避免婴儿牛奶过敏,营养干预3个月内不宜喂养含牛奶蛋白配方奶粉,营养干预6个月后部分患儿可获牛奶耐受.牛奶过敏患儿喂养配方粉的转归各不相同,应结合患儿家庭经济能力、病情变化等个体化营养干预.     

过敏高风险婴儿的早期营养干预

近十几年,过敏性疾病的初级预防一直受到关注.营养干预是重要的初级预防措施.早期营养干预的措施不再强调妊娠期和哺乳期母亲饮食限制,仍然强调母乳喂养,当母乳不足或者不能进行母乳喂养时,可选择部分水解配方和深度水解配方,深度水解配方的预防效果好于部分水解配方.益生元和益生菌、ω3不饱和脂肪酸对过敏有一定的预防作用,但还需要作进一步研究.     

乳蛋白部分水解婴儿配方粉细分年龄段的益处

<正>生命早期1 000天是个体生长发育的"机遇窗口期"。这一时期的营养状况与一生的健康状况息息相关,早期营养差异会对婴儿期的生长发育及健康乃至远期的健康产生极大的影响。我国每年新出生婴儿由于各种疾病等的影响,不能用母乳或普通婴儿配方食品喂养,如早产/低出生体质量儿、牛奶蛋白过敏婴儿、胃肠疾病婴儿等。特殊     

早产儿强化母乳喂养后的血浆氨基酸检测

早产儿理想的生长速度应为同股龄胎儿的生长速度，即16g／kg／d。但母乳喂养的早产儿蛋白摄入量相对不足，生长速度较缓慢。为保证母乳喂养早产儿的正常生长发育，母乳强化物（HumanMilkFortifiorHMF）已开始使用，以人乳蛋白为原料的HMF（简称HMP）被视为更为理想的强化剂。本实验通过对早产儿添加HMP后血浆氨基酸的检测，初步评价HMP对早产儿代谢和生长的意义。资料与方法19例早产儿来自北京妇产医院和首都儿科研究所。随机分为人乳强化组（实验组），人乳组（对照组），配方乳强化组（实验组）及配方乳组（对照组）。病情稳定后…     

高乳清蛋白婴儿配方奶对新生儿生长发育及氨基酸代谢的影响

目的探讨高乳清蛋白婴儿配方奶对新生儿生长发育及氨基酸代谢的影响。方法采用双盲随机对照前瞻性研究选取60例健康足月新生儿,随机分为配方Ⅰ组、配方Ⅱ组(每组各30例),同期母乳喂养新生儿30例为母乳组。配方Ⅰ组出生后予高乳清蛋白婴儿配方奶(蛋白质14 g·L-1、蛋白质/能量比2.0 g/418 kJ、乳清蛋白/酪蛋白=90/10)喂养,配方Ⅱ组为普通婴儿配方奶(蛋白质18 g·L-1、蛋白质/能量比2.6 g/418 kJ、乳清蛋白/酪蛋白=60/40)喂养;母乳组出生后完全母乳喂养。于出生28 d采取各组静脉血测定血清氨基酸、清蛋白、前清蛋白水平,同时测定身高、体质量及头围生长发育指标。结果 1.配方Ⅰ组出生28 d体格发育指标及血清清蛋白、前清蛋白水平与母乳组比较差异均无统计学意义(Pa>0.05);配方Ⅱ组出生28 d体质量及血清前清蛋白水平均明显低于母乳组,差异均有统计学意义(P<0.05,0.01)。2.配方Ⅰ组除血清天冬氨酸、蛋氨酸、色氨酸、苯丙氨酸明显低于母乳组(P<0.05,0.01),苏氨酸明显高于母乳组(P<0.01)外,其余18种氨基酸水平与母乳组比较差异均无统计学意义(Pa>0.05)。配方Ⅱ组血清天冬氨酸、瓜氨酸、色氨酸、苯丙氨酸均明显低于母乳组(P<0.05,0.01),天冬酰胺、甘氨酸、酪氨酸、苏氨酸均明显高于母乳组(Pa<0.01),其余15种氨基酸水平与母乳组比较差异均无统计学意义(Pa>0.05)。配方Ⅰ组血清丝氨酸、甘氨酸、酪氨酸、脯氨酸及苯丙氨酸水平均显著低于配方Ⅱ组,瓜氨酸高于配方Ⅱ组(P<0.01,0.05)。结论 1.高乳清蛋白婴儿配方奶喂养新生儿体格发育指标可达到母乳喂养儿水平,与普通婴儿配方奶喂养儿比较,新生儿期体质量增长及血清前清蛋白水平更接近母乳喂养儿。2.高乳清蛋白婴儿配方奶喂养与普通婴儿配方奶喂养新生儿比较血清氨基酸水平更接近母乳,但不能完全替代母乳喂养。     

母乳强化剂在母乳喂养早产儿中的应用

目的 通过前瞻性对照试验评价强化母乳对住院早产儿短期生长、营养状况的影响.方法 出生胎龄≤34周、出生体重≤1 800 g的24例早产儿分为强化母乳组(试验组,11例)和早产配方奶组(对照组,13例).试验组早产儿的母乳喂养量均超过总奶量的50%,当喂养量达到100 ml/(kg·d)时开始添加FM85母乳强化剂,不够的奶量用早产配方奶补足;对照组全部用早产配方奶喂养.对两组的生长速度、血生化指标、肠内外营养情况、合并症进行比较.结果 试验组出生胎龄(30.6±2.9)周,平均出生体重(1 80±286)g;对照组出生胎龄(31.6±1.9)周,平均出生体重(1 436±201)g.试验组在住院期间,平均母乳量占总喂养量81.6%,母乳强化剂在平均胎龄34.1周、生后24.6 d时开始添加.试验组与对照组的体重[18.9 vs 7.1 g/(kg·d),P=0.364]、身长(1.16 vs .00 cm/周,P=0.308)、头围(0.79 vs .61 cm/周,P=0.057)的增长速度近似,差异无统计学意义.出院时两组血尿素氮水平相似,试验组血清白蛋白、前白蛋白、血磷水平较对照组低,血清碱性磷酸酶和血钙值较对照组高,喂养不耐受、坏死性小肠结肠炎、院内感染的发生率无统计学意义.结论 强化母乳喂养与早产配方奶喂养的早产儿在住院期间的生长速度相似.     

院内不同喂养方式对早产/低出生体质量儿体格生长影响的比较

目的通过前瞻性随机对照研究评价比较不同喂养方式下,早产/低出生体质量儿住院期间的体格生长、血液生化和喂养安全性。方法按照不同喂养方式将出生胎龄<37周、出生体质量≤2500 g的158例早产儿分为早产/低出生体质量婴儿液态配方奶组(早产奶组,58例)、纯母乳喂养组(母乳组,47例)、液态配方奶及纯母乳混合喂养组(混合组,53例),比较各组的体格生长、血液生化指标,喂养不耐受、感染事件发生率,静脉营养使用时间,住院时间及宫外发育迟缓(EUGR)发生率等项目。结果早产奶组、母乳组、混合组婴儿的体质量增长速率分别为(16.46±5.14)g/(kg.d)、(11.56±4.11)g/(kg.d)、(15.19±4.53)g/(kg.d),三组间差异有统计学意义(P<0.01);头围增长速率分别为(0.72±0.34)cm/周、(0.49±0.34)cm/周、(0.71±0.29)cm/周,三组间差异有统计学意义(P<0.01);身长增长速率分别为(0.89±0.41)cm/周、(0.69±0.38)cm/周、(0.89±0.39)cm/周,三组间差异有统计学意义(P<0.05)。早产奶组的出生体质量恢复时间、静脉营养使用时间也短于其余两组,住院时间各组差异无统计学意义;出生3d和2周后各组早产儿组间比较表明血尿素氮、白蛋白水平相似,但组内比较显示入院2周后各组均有尿素氮下降和白蛋白上升;喂养不耐受、感染事件发生率的差异无统计学意义。出院时早产奶组婴儿头围、EUGR发生率低于母乳组(P<0.05)。结论早产儿院内喂养采用早产奶安全,并且在促进早产儿体格生长方面优于单纯母乳喂养。     

牛奶蛋白过敏婴儿的配方奶使用指南:澳大利亚专家组共识

概要 3种婴儿配方奶(豆基配方、深度水解配方和氨基酸配方)可用于治疗牛奶蛋白过敏症. 应根据过敏综合征选择配方奶. 深度水解配方奶首选用于治疗6个月以下婴儿的速发性牛奶蛋白过敏(非全身过敏反应)、食物蛋白诱发的小肠结肠炎综合征、特应性湿疹、胃肠道综合征和食物蛋白诱发的直肠结肠炎.豆基配方奶首选用于治疗6个月以上婴儿的速发性食物反应、胃肠道综合征或不伴生长发育障碍的特异性皮炎.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.