RESUMO
BACKGROUND: Distressed behavior is common in infants and is often attributed to gastroesophageal reflux (GER) or food protein intolerance. OBJECTIVE: To examine the effect of a hypoallergenic amino acid-based infant formula (AAF) on distressed behavior and GER symptoms in infants who failed to respond to extensively hydrolyzed formula and antireflux medications. STUDY DESIGN: Nineteen distressed infants (9 boys and 10 girls; median age, 5.0 months) with presumed GER underwent gastroscopy (n = 17) and esophageal 24-hour pH monitoring (n = 14). Double-blind placebo-controlled (DBPC) formula challenges of AAF versus previously besttolerated formula were conducted. RESULTS: Nine infants had histologic evidence of esophagitis, and 9 had inflammatory changes in the stomach and/or duodenum. Symptoms remitted in all infants within 2 weeks of the start of feeding with AAF. On DBPC challenge after a median period of 3 months of receiving AAF, 12 infants were intolerant to active formula (distress score, 287 vs 580 min/wk,P =. 01; symptom score, 23.1 vs 36.1, P =.03). Seven infants did not relapse and were considered tolerant (distress score, 470 vs 581, P =.77; symptom score, 29.5 vs 20.2; P =.89). CONCLUSION: Treatment with AAF may reduce distressed behavior and symptoms of GER in infants with food protein intolerance.
Assuntos
Proteínas Alimentares/efeitos adversos , Esofagite Péptica/complicações , Hipersensibilidade Alimentar/complicações , Comportamento do Lactente , Aminoácidos/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Lactente , Alimentos Infantis , Masculino , Hipersensibilidade a Leite/complicações , Vômito/etiologiaRESUMO
Infants (n = 18) with intolerance to extensively hydrolyzed formulas and soy who responded to an L-amino acid-based elemental formula (AAF) were studied until 3 years of age. By 2 years of age most tolerated non-formula foods, and by 3 years only 3 required AAF. Growth normalized during AAF feeding in 4 infants with failure to thrive.
Assuntos
Aminoácidos/uso terapêutico , Hipersensibilidade Alimentar/dietoterapia , Alimentos Formulados , Alimentos Infantis , Proteínas de Soja/imunologia , Fatores Etários , Reações Antígeno-Anticorpo , Método Duplo-Cego , Insuficiência de Crescimento/dietoterapia , Feminino , Humanos , Hidrólise , Lactente , Masculino , Proteínas do Leite/imunologiaRESUMO
Acute metabolic decompensation in maple syrup urine disease (MSUD) during otherwise minor illnesses has generally been presumed to result from massive release of leucine from protein catabolism. A stable isotope method based on the continuous infusion of (2H5)phenylalanine was used to measure protein metabolism in vivo in two children with MSUD during acute illness and when well. Net protein catabolism was greater in the unwell state (0.51 and 0.40 gm/kg per 24 hours in each child, respectively) than in the basal state (0.34 and 0.32). This rate of release of leucine from protein is compatible only with a slow (several days) rather than a dramatic rise in plasma leucine levels during acute illness in MSUD. Poor oral intake leading to a relative increase in time spent in the fasting state appears to be a more important determinant of increasing leucine levels than the catabolic effect of infection in itself. These factors suggested that branched-chain amino acid restriction should be commenced at the start of minor illness in children with MSUD, and that intake of other nutrients should be maintained or increased throughout the illness. A regimen based on these concepts was used during nine episodes of minor illness in two children with MSUD. Plasma branched-chain amino acid levels remained acceptable (less than 700 mumol/L) throughout each of these episodes. Dietary supplementation of this type may reduce the risk of metabolic decompensation during acute illnesses in children with MSUD.