新生儿食物蛋白诱导性小肠结肠炎综合征2例并文献复习

Two Cases of Neonatal Food Protein-Induced Enterocolitis Syndrome and Literature Review

目的:探讨新生儿食物蛋白诱导性小肠结肠炎(NFPIES)的临床特点及治疗。方法:回顾性分析2021年8月与2021年12月于青岛大学附属医院诊断的2例NFPIES患儿的临床资料,以“新生儿”“食物蛋白诱导小肠结肠炎”和“neonate”“food protein induced enterocolitis syndrome”为关键词分别在中国期刊全文数据库(CNKI)、万方数据知识服务平台、PubMed进行检索(建库至2022年12月),总结NFPIES患儿的临床特点。结果:例1,患儿女,7天,因“便血1天半”入院。患儿系G5P2,胎龄39周 1天,出生体重3600 g。患儿父亲有湿疹、鼻炎病史,患儿哥哥有鼻炎病史。入院时体重下降11.3%,小便量少,皮肤颜色苍白,皮肤弹性差。例2,患儿男,6天,因“便血3天”入院。患儿系G2P2,胎龄38周,出生体重3450 g。患儿父亲有鼻炎病史。入院时体重下降6%。查体:血压71/43 mmHg,反应欠佳,面色欠红润,皮肤弹性差。2例患儿生后均有配方奶喂养史,均有低白蛋白、脱水临床表现,更换为氨基酸奶粉喂养后,便血等临床症状得到缓解,诊断为慢性重度FPIES。文献复习结果:根据本研究设定的文献检索策略,共计检索到6篇关于NFPIES的文献,共14例患儿。临床表现主要为呕吐、腹胀、便血、发热等,其中7例嗜酸性粒细胞升高。结论:NFPIES没有特异性的临床表现及实验室检查,要求医师详细询问疾病发作时临床表现及父母过敏史等信息,需注意与新生儿坏死性小肠结肠炎(NEC)、感染性胃肠炎及炎症性肠病等疾病鉴别,避免过度检查及治疗。

Objective: To explore the clinical characteristics and treatment of neonatal food protein-induced enterocolitis (NFPIES). Methods: The clinical data of 2 children with NFPIES diagnosed in the Affiliated Hospital of Qingdao University from August 2021 to December 2021 were analyzed retrospectively. With “newborn”, “neonate” and “food protein induced enterocolitis syndrome” as the key words, they were searched in China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform and PubMed respectively (until December 2022), and the clinical characteristics of children with NFPIES were summarized. Results: Case 1, a 7-day-old girl, was admitted to the hospital because of “bloody stool for one and a half days”. The baby is G5P2, with a gestational age of 39 weeks 1 day and a birth weight of 3600 g. The father of the child has a history of eczema and rhinitis, and the brother of the child has a history of rhinitis. At the time of admission, she lost 11.3% weight, had less urine, pale skin color and poor skin elasticity. Case 2, a 6-day-old boy was admitted to the hospital because of “bloody stool for 3 days”. The baby is G2P2, with a gestational age of 38 weeks and a birth weight of 3450 g. The father had a history of rhinitis. Weight loss at admission was 6%. Physical examination: blood pressure 71/43 mmHg, poor response, ruddy complexion and poor skin elasticity. Both children had a history of formula milk feeding after birth, and both had clinical manifestations of low albumin and dehydration. After changing to amino acid milk powder feeding, the clinical symptoms such as hematochezia were relieved, and they were diagnosed as chronic severe FPIES. Literature review results: According to the literature retrieval strategy set in this study, a total of 6 literatures about NFPIES were retrieved, involving 14 children. The main clinical manifestations were vomiting, abdominal distension, bloody stool, fever, etc. Among them, 7 cases had elevated eosinophils. Conclusion: NFPIES has no specific clinical manifestations and laboratory tests. Doctors are required to inquire about the clinical manifestations and parents’ allergic history at the onset of the disease in detail, and pay attention to the differentiation from neonatal necrotizing enterocolitis (NEC), infectious gastroenteritis and inflammatory bowel disease to avoid excessive examination and treatment.