Feeding intervention study on allergic proctocolitis in children induced by cow milk protein

Abstract

Objective To assess nutritional risks in children with allergic proctocolitis induced by cow milk protein, and to observe the effects of the feeding strategies for them with different interventions in feeding, and then to identify the best time and the best way to modify feeding strategies according to different individual. Methods The effectiveness of different feeding interventions was retrospectively analyzed after 2 weeks in 171 cases with allergic proctocolitis induced by cow milk protein in Hunan Children's Hospital during the period of Jan.2012 to Jul.2013.Thirty-two cases received breast feeding (18.7%) and 139 cases received non-breast feeding (81.3%). Intervention methods: 32 cases with breast feeding received the same feeding method; among 139 babies with non-breast feeding group, 36 were plus free amino acid (AAF) (21.1%), and 103 were plus the extensively hydrolyzed formula (eHF). The intervention formula changes were observed in 8, 12 and 24 weeks, respectively, and nutritional risks in 0, 3, 6 months were assessed, respectively. Results There were 171 patients totally, male to female ratio was 1.5 to 1.0, and the average age was (4.1±1.3) months.After 2 weeks, 147 cases were notably effective, accounting for 86%, and in the breast feeding group 79.2% of the patients were notably effective, and there was no significance compared with the AAF group and eHF group (P>0.05). The intervention formulation changes during the following 6 months were as follows: in 8 weeks, 30 cases in the breast feeding group breastfeeding continued, 2 cases turned to eHF feeding for the lack of breast milk, 21 cases were fed with AAF (12.3%), 85 cases with eHF (49.7%), and 35 cases with moderately hydrolyzed formula (20.5%); in 12 weeks: 23 cases had breast feeding (13.5%), 16 cases were fed with free amino acid formula powder (9.4%), 56 cases with extensively hydrolyzed formula (32.7%), and 76 cases with moderately hydrolyzed formula (44.4%); in 24 weeks: 21 cases (12.3%) had breast feeding, 7 cases were fed with AAF(4.1%), 13 cases with moderately hydrolyzed formula(7.6%), and 130 cases with normal formula(76.0%). The mean levels of the nutritional risks were assessed according to STAMP in 0, 3, 6 months respectively: breast feeding group[(1.69±0.78) scores, (1.50±0.88) scores, (1.53±0.67) scores, P>0.05]; AAF group[(1.72±0.78) scores, (1.53±0.88) scores, (1.53±0.65) scores, P>0.05]; eHF group[(1.80±0.69) scores, (1.68±0.68) scores, (1.66±0.65) scores, P>0.05]. Conclusions The nutrition risk levels in children with milk protein allergic proctocolitis are low, and different feeding interventions according to tolerance had no impact on the nutritional status; Breast feeding could effectively avoid cow milk allergy, and symptoms of the children with allergic proctocolitis would be relieved after 2-week intervention, and more than half of children could gain part of immune tolerance after intervention for 3 months or more, so for the children with allergic proctocolitis induced by cow milk protein, routine formula feeding should be stopped after 3 months, and individualized feeding intervention can be carried out according to immune tolerance to relieve the financial burden. Key words: Proctocolitis, cow milk protein allergy; Feeding intervention; Child