日本未熟児新生児学会雑誌　第26巻第2号　90～93頁（2014年）

日本未熟児新生児学会雑誌　26(2)：320-323；2014　

受付日：平成25．09．24

受理日：平成26．03．05

母乳強化剤投与を契機に新生児消化管アレルギーと診断した極低出生体重児の1例

A Case of Very Low Birth Weight Infant was Diagnosed as Gastrointestinal Food Allergies in Neonates That was Triggered by Human Milk Fortifier

公立昭和病院　小児科

Department of Pediatrics, Showa General Hospital

大場邦弘・小花奈都子・林　健太・石川涼子・野田絵理・小鍛治雅之

Kunihiro OBA，Natsuko OBANA，Kenta HAYASHI，Ryoko ISHIKAWA，Eri NODA，Masayuki KOKAJI

Key Words：human milk fortifier，preterm infants，very low birth weight infant，eosinophilia，gastrointestinal food allergies in neonates

　在胎30 週6 日に緊急帝王切開で体重1,106gで出生した女児。日齢1 から牛由来ミルクで栄養を開始した。日齢3・4に血便が1回ずつ出現し，経腸栄養を中止した。日齢6から母乳栄養を再開し，日齢17から母乳強化剤の投与を開始した。日齢25に無呼吸発作と徐脈の回数が増え，血液検査で著明な好酸球増多を認めた。消化管アレルギーを疑い母乳強化剤の投与を中止し，翌日に症状は改善した。そして，牛乳特異的IgEは陽性であった。その後の栄養は乳製品除去母乳とアミノ酸乳で，症状の再燃はなく，退院前の高度加水分解乳による負荷試験の結果が陽性であったため，牛由来ミルク蛋白およびミルクペプチドに対する新生児消化管アレルギーと診断した。離乳食開始前の生後6か月時には，一旦陰性となっていた牛乳特異的IgEが再度陽性となり，卵白特異的IgEも陽性となった。

　The case was born at 1,106 g body weight, 30 weeks and 6 days of gestation by emergency cesarean section. Infant formula was provided from 1-day-old. Bloody stools appeared once each 3- and 4-day-old. Therefore her nutrition was stopped. Her nutrition was changed to breast milk, it was again provided from 6-day-old. Human milk fortifier was provided from 17-day-old. Number of apnea and bradycardia had increased obviously at 25-day-old. From the various test results, she had a severe eosinophilia and positive milk-specific IgE. Human milk fortifier was stopped. And then, the next day, their symptoms were disappeared. After change to amino acid-based formulas and breast milk ahead of dairy products intake, there was no recurrence of symptoms. Result of food provocation test using hydrolyzed infant formulas was positive before hospital discharge. Therefore, she was diagnosed as gastrointestinal food allergies in neonates to peptide and protein of cow's milk. At 6 months of age before the start of solid food, her milk-specific IgE becomes positive again, and egg white-specific IgE was also positive.