Hill I D, Bowie M D, Mann M D, Viljoen D
Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Ann Trop Paediatr. 1991;11(3):283-7. doi: 10.1080/02724936.1991.11747515.
Dietary manipulation is often the first step in the treatment of infants with persistent acute dehydrating diarrhoea. This usually entails elimination of lactose, but other disaccharides or whole protein may be causing the disease. Serial elimination of these takes time and it may be preferable to use a whole protein and disaccharide-free formula as the first feed change. This study assessed the effect on stool weight of a change from cow's milk formula feeds to one of four different formulae in infants with severe diarrhoea persisting after 3 days in hospital. Two feeds were lactose-free soy formulae containing sucrose, one was disaccharide-free soy formula and one a disaccharide-free protein hydrolysate. Regardless of which feed the infants received, diarrhoea resolved in approximately 50% following the change in diet. Comparing those who got better with those who did not, the former were generally better nourished and had an initial lower stool output, but it was impossible to predict on clinical grounds which individual would respond to the removal of cow's milk. The results suggest that elimination of lactose in infants with persistent severe diarrhoea will benefit a significant number in the early stage of the disease. As there is no additional benefit from eliminating sucrose or whole protein at this stage, the cheapest available lactose-free formula should be used initially.
饮食调整通常是持续性急性脱水腹泻婴儿治疗的第一步。这通常需要去除乳糖，但其他双糖或完整蛋白质可能是病因。逐一去除这些物质需要时间，或许一开始改用不含完整蛋白质和双糖的配方奶更为可取。本研究评估了住院3天后仍患有严重腹泻的婴儿从牛奶配方奶改用四种不同配方奶之一对粪便重量的影响。两种是含蔗糖的无乳糖大豆配方奶，一种是无双糖大豆配方奶，另一种是无双糖蛋白质水解物配方奶。无论婴儿接受哪种配方奶，饮食改变后约50%的婴儿腹泻得到缓解。将病情好转的婴儿与未好转的婴儿进行比较，前者通常营养状况更好，且最初的粪便排出量较低，但无法根据临床情况预测哪个个体对去除牛奶会有反应。结果表明，在持续性严重腹泻婴儿疾病早期去除乳糖会使相当一部分婴儿受益。由于在此阶段去除蔗糖或完整蛋白质并无额外益处，最初应使用最便宜的无乳糖配方奶。
