Hoshi Keisuke, Mukai Takeo, Kumasawa Keiichi, Takahashi Naoto
Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan.
Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo, Japan.
Front Pediatr. 2023 Jun 27;11:1213782. doi: 10.3389/fped.2023.1213782. eCollection 2023.
The patient was a female newborn. Ultrasonography performed at 35 weeks and 3 days of gestation revealed honeycomb-like dilatation and peri-intestinal strong echo patterns in the gastrointestinal tract. Nonreassuring fetal status was also diagnosed, leading to an emergency Cesarean section. The baby's birth weight was 2,127 g, whereas the Apgar 1 min and 5 min scores were 8 and 9, respectively. The amniotic fluid showed fecal and hematogenous turbidity. After delivery, there was hematogenous intragastric residue and defecation. Thereafter, the bloody intragastric residue and fecal discharge improved. Aggregations of eosinophils in the stool were observed, and gastrointestinal allergy was suspected. Enteral feeding with the hydrolyzed protein formula was initiated and symptoms did not recur. The allergen-specific lymphocyte stimulation test was positive for lactoferrin, and the patient was suspected with neonatal cow's milk allergy or neonatal transient eosinophilic colitis. After her condition stabilized, an oral challenge test was performed using breast milk without dairy products, and the test was negative. Gastrointestinal allergy is rare even , and when gastrointestinal bleeding is suspected , hemorrhagic or surgical gastrointestinal diseases should be ruled out first; however, the possibility of gastrointestinal allergy should also be kept in mind.
该患者为一名女性新生儿。妊娠35周零3天时进行的超声检查显示,胃肠道呈蜂窝状扩张,肠道周围有强回声模式。还诊断出胎儿状况不佳,遂进行急诊剖宫产。婴儿出生体重为2127克,1分钟和5分钟的阿氏评分分别为8分和9分。羊水呈粪染和血性浑浊。分娩后,胃内有血性残留物且有排便。此后,胃内血性残留物和粪便排出情况有所改善。观察到粪便中有嗜酸性粒细胞聚集,怀疑有胃肠道过敏。开始采用水解蛋白配方进行肠内喂养,症状未再复发。变应原特异性淋巴细胞刺激试验对乳铁蛋白呈阳性,该患者被怀疑患有新生儿牛奶过敏或新生儿短暂性嗜酸性粒细胞性结肠炎。病情稳定后,使用不含乳制品的母乳进行口服激发试验,结果为阴性。胃肠道过敏即便罕见,当怀疑有胃肠道出血时,首先应排除出血性或外科性胃肠道疾病;然而,也应牢记胃肠道过敏的可能性。