Clinical Studies of Intractable Diarrhea During Infancy

ABSTRACT

PURPOSE: Intractable diarrhea during infancy is one of the major causes of infant mortality. But, its etiology, clinical courses, or methods of treatment are not well known. Therefore, we conducted a clinical approach to intractable diarrhea during infancy. METHODS: We have retrospectively evaluated clinical characteristics, laboratory findings, methods of treatment, days required for recovery, in 23 infants who were admitted with intractable diarrhea, from January 1993 to December 1996. RESULTS: The onset age was 18.4 +/- 17.8 days and the duration of diarrhea was 28.8 +/- 16.5 days. All patients were fed artificial milk before the onset of diarrhea. The possible causes of diarrhea were infection (60.8%), change of milk, milk concentration (17.4%), or an unknown origin (21.8%). Laboratory findings on admission showed hemoglobin 9.5 +/- 2.2g/dL, serum albumin 2.9 +/- 0.7g/dL. E. coli was cultured in urine in 1 case. Stool rotavirus antibody was positive in 1 case. Nineteen patients (82.6%) required total parenteral nutrition for 18.3 +/- 13.6 days and antibiotics were administered to 20 patients (86.9%). Twenty-two patients (95.7%) were fed special element formula milk. All but one who died of necrotizing enterocolitis, recovered. Special element fomula milk was used for 92.6 +/- 20.5 days after discharge, and there were no cases of recurrence. CONCLUSION: We considered appropriate oral element fomulas, total parenteral nutrition and the proper treatment of infection as important factors in future outcome of intractable diarrhea during infancy. We thought the short-term administration of special formula milk can be substituted for normal milk or a weaning diet. However, encouraging breast feeding may perhaps be a more effective way of preventing this problem.