Diarrhoea of newborn - Causes, Symptoms and Treatment .MF .
Diarrhea (diarrhea) - a pathological condition in which there is increased frequency of bowel movements, and changes in the qualitative composition of the chair.Before we talk about diarrhea in children, need to know the standard indicators of childhood.
first stool of the newborn - meconium, it is viscous and dark as pitch.So meconium within the first day and gradually replaced by a normal newborn stool.Meconium is formed even in utero, shortly before the birth, when there is a spontaneous ingestion of amniotic fluid.This is the norm.
normal stools in infants
|Children breastfed||Children on mixed and artificial feeding|
|Number||From 15 grams during the first term from the moment of birth and reaches 50g a year||also|
|consistency||unformed, mushy, medium-viscous||thick, zamazkoobraznoy consistency|
|frequency of bowel movements||3-4 times a day to 6 months, after 6 months - 1-2 times a day||also, but can be a tendency to constipation|
|Color|| Bright yellow with greenish otenkom ||Darker than when breastfeeding and the color spectrum can be shifted to a brown hue|
|Smell||Sour||Astringent,sometimes marked unpleasant odor resembling putrid|
These rules are explained by the following facts:
1. The acid and pepsinoobrazovanie is low in the stomach of newborns that causes a neutral environment, in which only a fraction of 2 pepsin can function: hemozin andgastriksin suitable for splitting only breast milk, and adapted formulas.
2. Features of the pancreas are under development, in particular lipolytic and amylolytic activity, so the process of splitting of dairy fat plays an important role gastric lipase and human milk.
3. Slow excretion of bile acids.
As a result, due to functional immaturity of the enzyme system of the stomach and pancreas, most of the load takes the intestines, so the slightest shifts in power (incl and mother, if the child is breast-fed) may lead to a syndrome of dyspepsia,bloating, colic, diarrhea.
event of a fault can be suspected pathology.The most common cause is considered to be infectious and parasitic defeat that in the newborn, probably erroneously, if the hygiene regulations, which contain child saved.In the formation of diarrheal syndrome in newborn development mechanism involving 4: intestinal hypersecretion, increased osmotic pressure in the cavity of the intestine, violation of transit of intestinal contents and intestinal gipereksudatsiya.Below is a list of diseases to be focused precisely on infancy, because the causes of diarrhea in infants much more than in adulthood, and they are more insidious in nature.Only after the elimination of the most likely causes of the child's well-being and stability, the problem can be considered solved.
Possible causes of diarrhea in infants
classification of the causes shown by the level of destruction, ranging from sub-cellular structures and to the tissue level, with prevalence of diarrhea among the symptoms.The prevalence of these diseases equi, and treatment are different.
1. Infectious and parasitic enteritis.
2. Infectious and inflammatory diseases with congenital immunodeficiencies (Bruton's disease, deficiency of IgA, combined immunodeficiency, neutropenia, allergic enteropathy), lipodystrophy, autoimmune enteropathy.
3. Alimentrnye (a disease of infants, arising due to mismatch of volume or composition of the physiological features of the child food).
4. Endocrine pathology: lack of exocrine pancreatic function.
5. Enzimopaicheskaya (enzyme) in the pathology of intestinal enzymes levels: violation of cavity, the wall or membrane digestion as a result of changes in the intestinal enzyme structure.
6. Damage to carrier proteins in the assimilation of fat-soluble substances, vitamins and micronutrients.
7. Congenital disorders of structure of enterocytes (intestinal structural unit): atrophy, epitelialnayadisplaziya etc, lymphatic and vascular tissue.
8. Reduced absorption surface: short bowel syndrome, cecum syndrome.
9. endocrinopathies, including hormone-producing tumors: VIPOM, gastrinoma, somatostatinoma, carcinoid.
10. Trudnoklassifitsiruemye disease (pathogenesis is not fully understood, but not bad amenable to correctional treatment): Crohn's disease, celiac disease.
predisposing factors for diarrhea in infants:
- Reduced slime bowel function, which is a non-specific protective barrier.
- High pH (acid-base balance) of gastric juice.Ie, hydrochloric acid is not produced sufficiently to "protect" the gastrointestinal tract (GI tract) and to participate in the activation of enzymes of digestion.
- Reduction of the content of secretory IgA (immunoglobulin This is the first line of defense gastrointestinal mucosa).
- Reduced immunity in the absence of breastfeeding (because it is the mother of memory immune cells entering the body of the child through the milk, forming a passive immunity to the disease, which had been ill mother herself).
- Low supply transport systems regulating the reabsorption (suction) Na / Cl / Mg, and other elements that the diarrhea causes a rapid loss of their formation and imbalance.
Let us every reason in more detail.
infectious and parasitic enteritis.
• Intestinal infections directly cause diarrheal syndrome: shigellosis, salmonellosis, ehsherihioza, intestinal form yersiniosis, pseudotuberculosis, cholera, rotavirus, typhoid, botulism.
• Intestinal infections caused by conditionally pathogenic microflora: proteose, klebsiellёznaya infection, Pseudomonas infection, klostridiozy, campylobacteriosis.
• Parasitic infections: diarrhea syndrome often cause certain classes - trematodes (opistorhoz), cestodes, nematodes (pinworms, Ascaris).
Either way, the presence of a foreign agent determines the development of infectious and toxic symptoms and changes in the laboratory data.
Infectious and inflammatory diseases with congenital immunodeficiencies.
• Allergic enteropathy. Symptoms appear with the introduction of complementary foods or supplementary feeding, marked steatorrhea intestinal type (fatty acids and fatty acid soaps) + unstable stool (constipation alternating with indulgence) + exudative enteropathy (loss of plasma protein through the intestinal wall, which eventually leads to edema,cardiovascular nedosatochnosti etc).
• IgA deficiency (the common variable unclassifiable immunodeficiency syndrome): isolated IgA deficiency, so in addition to diarrhea is always a dysbiosis.Symptoms observed in the first days of life as a result of the inadequate response to the opportunistic and pathogenic colonies of intestinal flora.
• disease Bruton (violation of maturation of B-lymphocytes) - genetically caused disease, suffering maturation of B cells, which means that the symptoms are much more diverse, although starting from the gastrointestinal tract, but as they grow older there is the accession of secondary infection is not only due tointestinal microflora, but also in general from any infection of the goal - the mucous membranes, respiratory tract, urinary system, central nervous system, etc.
• Lipodystrophy (Whipple's disease) - the disease occurs more frequently in adults, but there are options described in children.This disease is considered to be a system with diarrhea arthralgia + + + different polymorphic fever clinic (heart failure, lung, central nervous system).
• autoimmune enteropathy - in this case, the activation of T-lymphocytes directed against autoimmune own enterocytes.Symptoms with a predominance of diarrhea syndrome, manifested in the first 2 months and is characterized by progressive chronic course.
If you suspect that the immune abnormalities, in addition to standard clinical and laboratory investigations, it is necessary to take into account the immunological markers (in particular carried out search of autoantibodies to structural elements of the digestive tract, etc.), the study of the morphology of the small intestine, as well as the genetic method.Consultation immunologist.
endocrine disorders (lack of exocrine pancreatic function).
malformations of the pancreas: ectopia, anulyarnaya and forked iron hypoplasia.When this pathology is a violation of "ejection" of pancreatic enzymes into the duodenum, with normal structure and secretion of the enzymes themselves, the exception is hypoplasia.At last pathology suffer qualitative and quantitative characteristics of pancreatic enzyme system.Hypoplasia may be total, partial and congenital - depending on this determined by the variability of clinical symptoms.
But anyway, at the forefront steatorrhea varying degrees, up to a constant leakage of oil from the anus.
malfunction of the pancreas are seen as the main cause of species vnuripolosnogo malobsorbtsii.
In order to confirm or refute the diagnosis in cases of suspected violation of the exocrine function of the pancreas, it is necessary to go from simple to complex: coprogram, pancreatic elastase - where appropriate, biochemical blood tests, antibodies to certain parasitic infections in order to avoid obstruction ductless, antielato the structural elements of the pancreas.Also do not forget about ultrasound techniques.When making decisions about the incarnation of diagnostic procedures, you should consult with a specialist in order to avoid unnecessary expenditure.
Enzimopaticheskaya pathology (at the level of the intestine).
is another indicator malobsorbtsii syndrome.This type may include the following types of failure: disaccharidase (lactase, sucrase-izomaltaznaya, trehalase) enterokinaznaya, duodenaznaya.
disaccharidase If you suspect disease, should take into account a number of features:
- Children of all ages high maltose activity of the mucous membrane of the small intestine, while the activity of sucrose it is much lower.Lactose Activity mucosa, marked the first year of life, with age gradually falls, being kept at a minimum level in the adult.
- Enzyme activity, in some cases, a hormone-process - as activators and lactose glyukokorikoidy is thyroxine.
All this is important to know the purpose of tracing the causes, in order to avoid errors in the event diagnosicheskih diarrheal syndrome (eg, introduction of inappropriate complementary foods for qualitative composition / supplementary feeding, the presence of endocrinopathy).
• lactose deficiency. If during this pathological process in the foreground of the following symptoms:
- Intestinal colic: there is an incomplete splitting of disaccharides in the distal intestine, there is a ferment with the release of H +, this leads to gas and as a consequence - increase in pressure in the intestines thatcausing pain and discomfort.
- Vomiting and regurgitation due to the increased pressure in the abdomen due to gas formation and the weakness of the cardiac sphincter of the stomach.
- Diarrhoea: because of the arisen fermentation, there is a shift of acid-base balance in the acidic side at the expense of fatty acids (lactic, propionic, butyric, acetic) - these organic acids are osmoaktivnymi, so there is osmotic diarrhea, passing, after the cancellation of the corresponding saccharide.
1) Coprogram: reduced fecal pH & lt; 5,5;fatty acids, iodophilic flora.
2) Load tests: the use of sugar curve when giving lactose 1.5 g / kg (50 g) determine the concentration of glucose on an empty stomach and after 15/30/60 minutes, so when lakoznoy insufficient glycemic curve has a flat appearance.
Treatment: Keeping a food diary.Low-mixture (APL-100, Low-Nutrilon, Omneo, etc.), while more severe cases - lactose-free mixture based on soy protein.Against the background of these compounds, it is necessary to make up the content of Ca2 +.
• sucrose-izomaltoznaya failure: genetically associated disease with characteristic clinical signs - resistant watery diarrhea, intestinal colic, flatulence, non-sweet food.The diagnosis is based on the extracellular starch in the stool, the acidic pH, sucrose and plane-load curve.
Treatment is the exclusion of sucrose and starch, and while maintaining the symptoms on the background diet - add Sucraid drug.
Enterotsellyulyarnaya insufficiency with malabsorption (damage at the level of the carrier proteins in the intestine)
• Malobsorbtsiya glucose-galactose - a genetic mutation that leads to disruption of the structure transfer protein membrane structures.Clinically, this genetic defect is manifested in the form of watery stools with a sour smell, from 10 to 20 times a day, reminiscent of urine, containing in its composition a large amount of glucose and galactose, marked polyuria due melliturii.
Treatment in this case, translation is reduced to a mixture of fructose or a mixture based on protein hydrolysates, hereinafter - milk-replacement diet and sugar - fructose.
• fructose malabsorption. It is based on a violation of the structure of the protein transporter of fructose, there is a violation of one of the transport of glucose in the intestines (glucose synthesis from fructose in the intestinal wall, followed by suction).diarrhea syndrome occurs after consumption of juices and fruits, because neutilizarovannaya osmoaktivnaya fructose causes osmotic diarrhea.The only exception among the products is a banana, because the content of glucose and fructose in it equally.
as diagnostics to the fore keeping a food diary and glycemic load curve.In this case, it will be a straight line.In this case, you need to make a differential diagnosis of fruktozemii in which will mark the enlargement of the liver, fructose in the urine, reducing the activity of the liver enzyme fructose-1-fosfoldolazy.
Treatment: exception of fructose - oranges, apples, pears, peaches, cherries.
• Primary malobsorbtsiya salts of bile acids. In this case, the basis of the disease is also a genetic mutation that leads to disruption of the protein structure of the carrier in the ileum.In this case, the broken part and the enterohepatic circulation of bile acids is not sucked back into the liver.The acquired form of this disease may be at a resection of the small intestine after Crohn's disease.
Symptoms: nevsosavsheysya bile acids stimulate the secretion and motility of the intestine, as a result, there is a secretory diarrhea type, untreatable, aggravated by the transfer to artificial feeding.Due to malabsorption of fat-soluble vitamin absorption and impaired vitamin K appear hemorrhagic rash and swelling (up to anosarki).
Diagnosis: steatorrhea due to fatty acids, gipoholisterinemiya, hypoproteinemia, reduced complement.
Treatment: diet therapy - the replacement of long-TAG, medium-to (Portage, Prigichstimil, Alfaro, Izokal, Nutrizon).
• enteropathic acrodermatitis. When this pathology is violated zinc absorption.Symptoms emerge and develop in the translation of the child on artificial feeding, because human milk contains Zn binding ligand (protein), which provides a mastering.At the forefront loose stools, steatorrhea, erythroderma with deskvomatsiey epithelium (eritromatozny / vezikullobullёzny / pustular dermatitis) in the perioral area, perineum, limbs, hair loss is marked with the formation of alopecia, paronychia.If untreated, formed secondary immunodeficiency.
Diagnosis is to identify and compared the level of [Zn] in the blood and urine.
therapists Shabanova IE