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Journal of the Korean Pediatric Society 1995;38(7):936-945.
Published online July 15, 1995.
Intractable Diarrhea in Early Infancy : Clinical Features on Admission and A Nutritional Management
Jong Won Shin, Kyung Won Hwang, Young Ho Ahn, Jin Bok Hwang, Chang Ho Han, Hai Lee Chung, Young Dae Kwon
Department of Pediatrics, Taegu Catholic University School of Medicine, Taegu, Korea
생후 3개월내에 발생한 영아기 난치성 설사 환아의 임상소견 및 치료방침에 관한 임상적 고찰
신종원, 황경원, 안영호, 황진복, 한창호, 정혜리, 권영대
대구가톨릭대학교 의과대학 소아과학교실
Abstract
Purpose
: We studied to assess the value of clinical findings on admission in screening of intractable diarrhea in early infancy(IDI) and the efficiency of early trial of semi-elemental form-ula (protein hydrolysate) as a nutritional management in IDI.
Methods
: We carried out a retrospective review of medical records of twenty-eight early infants with diarrhea and malnutrition who were diagnosed as IDI at Department of Pediatrics, Taegu Catholic University Hospital between January 1990 and May 1993.
Results
: 1) The mean age of the patients was 28.914.5(10 - 86)days. The duration of diarrhea on admission was 66.1(1 - 30)days. Twenty-four cases(85%) were below 3 percentile in body weight on admission and no patients was fed breast milk over 7 days after birth. 2) Laboratory data on admission showed serum protein level 4.80.5(3.7 - 6.1) g/dl, serum albumin level 2.20.3(1.8 - 3.3)g/dl, serum bicarbonate level 11.35.7(2.7 - 22.3) mEq/L and band form of leukocytes on the peripheral blood smear was 23.715.6(4 - 64) %. 3) Necrotizing enterocolitis was developed in 5(18%) cases and the incidence was much more common in patients with 'Not-Tried' or 'Not-Early Tried' of semi-elemental formula as a nutritional management(p<0.05). 4) 'Early Tried' patients with semi-elementa formula showed rapid improvement in body weight and thriving, early remission, lower incidence of necrotizing enterocolitis and motality than other groups(p<0.05).
Conclusion
: IDI must be considered and early trial of semi-elemental formula can be recommended if a young infant suffered from diarrhea and malnutrition shows features of ① body weight<3 percentile ②serum albumin<3.0g/dl ③ band neutrophil>5% on peripheral blood smear on admission.
Key Words: Early infancy, Intractable, Diarrhea, Protein hydrolysate


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