I. Overview
Infantile diarrhea is a syndrome of gastrointestinal dysfunction in infancy and early childhood, mainly diarrhea and vomiting, with the highest incidence in summer and autumn. The causative factors of this disease are divided into three aspects: physical, infection and digestive disorders. The main clinical manifestations are increased stool frequency, loose stools and water-electrolyte disorders. The disease can be treated properly with good results, but if left untreated and serious water-electrolyte disorders occur, it can endanger the life of the child.
Second, the etiology
1.Physical factors
This disease mainly occurs in infants and young children, and its endogenous characteristics are as follows
(1) The gastrointestinal tract of infants is not mature enough, the activity of enzymes is low, but the nutritional needs are relatively high, and the gastrointestinal tract is heavily burdened.
(2) The development of neurological, endocrine, circulatory system, liver and kidney functions are immature during infancy, and the regulatory function is poor.
(3) The immune function of infants is also not perfect. Serum E. coli antibody titers are lowest from birth to 2 weeks of age and gradually increase later. Therefore, infants and children are susceptible to E. coli enteritis. The high E. coli antibody titers in breast milk, especially the high pathogenic E. coli secretory IgA in colostrum, make breastfed infants less likely to develop the disease and less susceptible. Similarly, small infants have low antibodies to rotavirus, and when the same collective epidemic occurs, small infants have more disease.
(4) The distribution of body fluids in infants is different from that of adults, as extracellular fluids account for a higher proportion, and water metabolism is vigorous and poorly regulated, making them more prone to fluid and electrolyte disorders. Infants are susceptible to rickets and malnutrition, which can easily lead to digestive disorders, and at this time the intestinal secretion type IgA is insufficient, and diarrhea is easily delayed.
2.Infection factors
Divided into intra- and extra-digestive tract infection, the former is the main.
(1) infection in the digestive tract pathogenic microorganisms can enter the pediatric digestive tract with contaminated food or water, so it is easy to occur in artificially fed children. Feeding utensils or food itself, such as unsterilized or inadequate disinfection, may also be infected. Viruses can also be contracted through the respiratory tract or water sources. Secondly, infection from adult carriers, who become asymptomatic intestinal carriers, can lead to pathogenic transmission.
(2) Infections outside the digestive tract Infection of organs and tissues outside the digestive tract can also cause diarrhea, which is commonly seen in otitis media, pharyngitis, pneumonia, urinary tract infections and skin infections. Diarrhea is not serious and is more common at younger ages. The cause of diarrhea is partly due to digestive disorders caused by infections outside the intestinal tract, and partly may be caused by infections with the same pathogen (mainly viruses) both inside and outside the intestinal tract.
(3) Disorders of intestinal flora caused by misuse of antibiotics Long-term application of a large number of broad-spectrum antibiotics, such as chloramphenicol, kanamycin, gentamicin, ampicillin, various cephalosporins, especially when two or more are used, in addition to direct stimulation of the intestinal tract or stimulation of the vegetative nerve caused by increased intestinal peristalsis, reduced glucose absorption, reduced activity of disaccharidase and diarrhea, more serious is to cause disorders of intestinal flora. . At this time, the normal intestinal Escherichia coli disappeared or significantly reduced, while drug-resistant Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Clostridium difficile or Candida albicans can proliferate, causing enteritis that is more difficult to control by drugs.
3, digestive disorders
(1) Dietary factors.
(2) Intolerance to carbohydrates.
(3) Food allergy.
(4) Drug effects.
(5) Other factors: such as unclean environment, too little outdoor activities, sudden changes in lifestyle, sudden changes in external climate (called “wind, cold, summer, wet diarrhea” in Chinese medicine), etc. are also likely to cause diarrhea in infants.
Third, the clinical manifestations
The main clinical manifestations are increased number of stools, loose stools and water-electrolyte disorders.
IV. Examination
Routine blood tests.
Stool microscopy: fat droplets or a small amount of mucus in dyspepsia, white blood cells and occasionally red blood cells and phagocytes in enteritis, fungal enteritis can be seen as fungal claspers and mycelium, and culture can isolate pathogenic bacteria.
V. Diagnosis
Diagnosis is made based on clinical manifestations and relevant examinations.
Sixth, complications
Diarrhea often leads to malnutrition, multivitamin deficiency, multiple infections and water-electrolyte disorders, and impaired heart, liver and kidney function.
1.Extra-digestive tract infection
Infections outside the digestive tract may be the cause of diarrhea, but they are also often caused by low systemic resistance after diarrhea. The common ones are septic skin infection, urinary tract infection, otitis media, upper respiratory tract infection, bronchitis, pneumonia, phlebitis and sepsis. Viral enteritis is occasionally complicated by myocarditis.
2. thrush
The disease is prolonged or the original malnutrition of the child easy to complicate thrush, especially after long-term use of broad-spectrum antibiotics more, if not timely discontinued, the fungus can invade the intestinal tract, and even cause systemic fungal disease.
3.Toxic hepatitis
Jaundice can occur during the course of diarrhea, mostly seen in children with pre-existing malnutrition. Possible enteritis caused by E. coli, complicated by E. coli sepsis, leading to toxic hepatitis. The disease worsens quickly after diarrhea, and death occurs soon after the appearance of jaundice. However, if detected early and timely injection of polymyxin, ampicillin or carbenicillin, most can be cured.
4, malnutrition and vitamin deficiency
Diarrhea prolonged for a long time, or repeatedly fasting, long-term calorie deficiency, easily lead to malnutrition, anemia and vitamin A deficiency. Prolonged diarrhea leads to impaired liver function, reduced absorption of vitamin K and reduced prothrombin, resulting in bleeding.
5.Other
Acute renal failure can be complicated when dehydration is heavy. In addition, there are toxic intestinal paralysis, intestinal bleeding, intestinal perforation, intestinal sleeve and gastric dilatation. It can also cause acute heart failure, hypernatremia or hyponatremia, or hyperkalemia due to improper infusion. Inadequate care of vomiting in small infants can cause asphyxia.
VII. Treatment
Principles: Prevention of dehydration, correction of dehydration, continuation of diet, reasonable use of drugs.
1.Diet therapy
Continue the original diet, which is light and easy to digest, and reduce supplementary food appropriately. If there is lactose intolerance or allergic diarrhea, change to lactose-free milk powder and deeply hydrolyzed or free amino acid milk powder feeding.
2.Liquid therapy
(1) Oral method Suitable for mild to moderate dehydration or vomiting is not heavy.
(2) Intravenous rehydration method is used for moderate and severe dehydration.
3.Control of infection
For the cause of the disease, reasonably choose antibacterial drugs.
4.Symptomatic treatment
For diarrhea, take oral montmorillonite. For digestion, take pepsin combination or multi-enzyme tablets orally. Treat symptomatically according to the condition.
VIII. Prognosis
The prognosis of infantile diarrhea is related to the physical condition of the child, the cause of the disease, the timing of treatment and the treatment method.
Prevention
Pay attention to feeding, strengthen physical fitness, pay attention to dietary hygiene, and increase supplementary food for infants in a gradual manner. Avoid contact with children suffering from diarrhea.