嬰兒腸絞痛治療之現況更新

An Jupdate of current available therapies for infantile colic

嬰兒腸絞痛是兒科門診中父母最常見的主訴之一。其特色是突發性、高頻率，且無法安撫的哭鬧，持續數小時以上，好發於傍晚時段，常見於三個月以內的新生兒。此情形不僅造成小孩的疼痛不適，更容易引發其他家庭成員的負面的情緒。有許多關於嬰兒腸絞痛病因的理論被提出，包括親子關係衝突、腸道賀爾蒙失調、腸道蠕動異常、胃食道逆流、碳水化合物消化不良、蛋白質過敏及腸道菌叢改變等。腸絞痛的治療目前並沒有定論，包括行為介入、自然療法、藥物治療以及飲食調整等。最近的研究報告顯示，水解蛋白配方及低乳糖配方皆能有效地減少新生兒哭鬧的頻率和時間。所以，新一代部分水解併低乳糖的配方，或許同以被廣泛地應用以改善嬰兒腸絞痛的問題。此外，一些證據也顯示添加益生菌可以減緩部份的腸絞痛。然而，還需要更多大規模研究來佐證以製訂相關的實證醫學建議。總而言之，腸絞痛的冶療取決於其致病原困。至今，沒有單一的方法可以徹底有效地應用於所有的新生兒身上。此外，為新生兒解決不適的問題同時，治療的安全性也是父母和醫師所關注的議題。

Infantile colic is one of the most frequent chief complain by parents in the pediatrics clinics. It was described as paroxysmal, high-pitched and inconsolable crying that lasted for hours, usually during late evening, and affecting newborn younger than 3 months of age.This circumstance not only caused pain and discomfort to the child, but also induced distress emotions to all family members. Many theories have been proposed regarding the etiologies of infantile colic. Some of the commonly discussed causative factors include maternal-child psychosocial conflict, gut hormones impairment, intestinal motility dysregulation, gastroesophageal reflux, carbohydrate malabsorption, protein allergy, and altered intestinal flora. Many suggestions have been proposed to cope with the disease but there is no consensus yet. These include behavioral interventions, naturopathic therapy, pharmacological treatment as well as dietary management. Recent studies have shown that both protein hydrolysates formula and low lactose formula can reduce the incident rate and crying time. Thus, the emergence of new combination of partial hydrolyzed proteins and low lactose formula might be a promising solution for infantile colic. On the other hand, some evidences also revealed that infant with colic might benefit from supplement of certain probiotics. However, larger studies are necessary before evidence-based recommendations can be made. In conclusions, the efficacy of therapy depends on the etiology which caused infantile colic. Until today, no single intervention has been proven to be perfectly effective in all cases. While dealing with this problem, safety issue is also one of the main concerns to both parents and physician.