儿童精准用药视角下维生素AD滴剂致新生儿血便不良反应的病例分析及临床启示

Case Analysis and Clinical Implications of Neonatal Hematochezia Adverse Reaction Induced by Vitamin AD Drops from the Perspective of Pediatric Precision Medicine

关键词:  维生素AD滴剂  不良反应  血便  新生儿  过敏反应  精准用药

Key words:  vitamin AD drops  adverse reaction  hematochezia  neonate  allergic reaction  precision medicine

摘要:

目的? 探讨维生素AD滴剂导致新生儿血便的不良反应及其机制,为临床提供参考。方法? 报道2024年9月绍兴市妇幼保健院收治的24日龄女性患儿案例。患儿因黄疸住院,服用维生素AD滴剂后出现血便,停药及换用深度水解蛋白奶粉后好转。出院后更换维生素AD滴剂品牌后血便复发。通过停药观察、粪便检测及随访进行诊断评估。结果? 患儿两次服用不同品牌维生素AD滴剂后均出现黏液血便,粪便隐血试验阳性。停药后血便逐渐缓解消失,粪便隐血转阴。排除其他因素后,判定血便与维生素AD滴剂高度相关。结论 维生素AD滴剂中的植物油/动物油脂类辅料可能引发新生儿过敏反应,导致血便。临床遇新生儿不明原因血便时,应询问补充剂用药史,及时诊断性停药,对高敏体质患儿建议选用低致敏性补充剂。

Abstract:

Objective? To explore the adverse reaction of neonatal hematochezia caused by Vitamin AD Drops and its mechanism, so as to provide reference for clinical practice. Methods A case of a 24-day-old female infant admitted to Shaoxing Maternal and Child Health Hospital in September 2024 was reported. The infant was hospitalized due to jaundice and developed hematochezia after taking Vitamin AD Drops; the symptom improved after drug withdrawal and switching to extensively hydrolyzed protein milk powder. Hematochezia recurred after changing the brand of Vitamin AD Drops following discharge. Diagnostic evaluation was conducted through drug withdrawal observation, stool tests, and follow-up. Results The infant developed mucous hematochezia with positive fecal occult blood test after taking two different brands of Vitamin AD Drops. Hematochezia gradually relieved and disappeared after drug withdrawal, and fecal occult blood turned negative. After excluding other factors, it was determined that hematochezia was highly correlated with Vitamin AD Drops. Conclusion? Vegetable oil/animal oil-based excipients in Vitamin AD Drops may trigger allergic reactions in neonates, leading to hematochezia. In clinical practice, when neonatal hematochezia occurs, the medication history of supplements should be inquired, diagnostic drug withdrawal should be conducted in a timely manner, and hypoallergenic supplements are recommended for infants with hypersensitive diathesis.