缺鐵性貧血之腦性麻痺孩童營養照護

Nutritional Care of Iron-Deficiency Anemia in a Child With Cerebral Palsy

朱姵穎(Pei-Ying Zhu) ； 李佩霓(Pei-Ni Lee)

《臺灣膳食營養學雜誌》 12卷2期 (2020/12) Pp. 25-35

https://doi.org/10.6709/TJD.202012_12(2).0003

摘要

腦性麻痺（cerebral palsy, CP）屬於一種早期發作、非漸進性的神經性運動障礙疾病，會影響胎兒或嬰兒腦部發育。而體重不足、嚴重的運動障礙及餵食與吞嚥困難會增加CP孩童營養不良的風險，進而因缺乏維生素、礦物質而造成貧血的現象。此個案為一名10歲女性孩童，診斷罹患僵直性兩側癱型CP、缺鐵性貧血，日常生活由案母全責照護，且因長期照護的疲乏導致每日餐食內容、餐次不固定、鐵劑滴劑亦無按醫囑服用。案母因擔心個案營養狀況不佳，缺鐵性貧血狀況日漸嚴重，且不願因進食不佳改為腸道營養，於2019年2月～12月期間求助於營養諮詢門診。營養診斷：個案主要問題為熱量攝取不足及食物與營養相關知識不足（problem, P）。個案的病因（etiology, E）為案母對於長期照顧感到疲乏而造成個案在食物或營養獲取上的不足（signs/symptoms, S），及案母未曾接受過飲食相關衛教。經固定每日攝取餐次、膳食供應內容及水分攝取的調整後，個案的血清鐵（serum iron, Fe）由124 μg/dL上升至154 μg/dL，鐵蛋白（ferritin）由1.2 μg/dL上升至12.7 μg/dL及每日熱量由543.2 kcal/day上升至1069.6 kcal/day，血液生化值及每日熱量攝取均得到改善。缺鐵性貧血個案須持續追蹤進食量、生長情形、血液檢測檢測值及家屬照顧狀況等，以監測、調整確保最佳營養攝入，幫助優化患者的健康。

關鍵字

腦性麻痺 ； 缺鐵性貧血 ； 營養

並列摘要

Cerebral palsy (CP) comprises a heterogeneous group of early-onset, non-progressive, and neuro-motor disorders that affect the developing fetal or infant brain. The children with CP with the greatest risk of having significant nutritional problems are those who present with poor weight gain at a young age, who have significant motor impairments, and who have feeding and swallowing problems. Due to neurologic diseases, patients with nutritional problems frequently suffer from anemia; moreover, anemia results from vitamin and mineral deficiencies. The subject was a 10 years-old girl who had CP and iron- deficiency anemia with the daily care by her mother. The caregiver (mother) had worried about the irregular eating patterns leading to malnutrition and iron anemia, she came for dietary counseling in outpatient departments from February to December 2019. The nutritional diagnosis was inadequate energy intake and food and deficit of nutrition-related knowledge. Signs and symptoms included insufficient food or nutrition intake and never received diet-related health education. After receiving dietary counseling as well as adjusting food choices of regular meals and water intake, the daily calorie intake and biochemical lab data of the case were improved. Serum iron went up from 124 μg/dL to 154 μg/dL, ferritin from 1.2 μg/dL to 12.7 μg/dL, and daily caloric intake from 543.2 kcal/day to 1069.6 kcal/day. At present, the subject is still under the monitoring of the eating patterns as well as medication adherence in order to optimize her health.

並列關鍵字

cerebral palsy ； iron deficiency anemia ； nutrition