שאלה מס׳ 26

שאלה 

מה מהבאים מהווה אינדיקציה למתן תחליף מזון לתינוקות (תמ"ל) מבוסס סויה?  

תשובות 

• A. בן 6 חודשים הסובל מחסר באנזים לקטאז משנית לשלשולים (התשובה הנכונה בבחינה)

• B. בן שבוע הניזון מתמ"ל חלבי עם יציאות דמיות, אפטיה וחמצת מטבולית  (התשובה שנענתה בבחינה) 

• C. תינוק אחרי ניתוח לב עם עדות לכילוטורקס מימין

• D. סיפור משפחתי מוכח על אלרגיה משמעותית לחלב

מקורות

עמ' 325 מהדורה 21 של הטקסטבוק נלסון (הגדול)

נסח הערעור

רגישות לחלבון חלב פרה יכול להתייצג עם יציאה דמית בגיל חודשיים ומהווה אינדיקציה להפסקת מתן פורמולה חלבית.

SOY FORMULAS עמוד 325

Soy protein–based formulas on the market are all free of cow’s milk–based protein and lactose. Carbohydrates are provided by sucrose, corn syrup solids, and maltodextrins to provide 67 kcal/dL. They meet the vitamin, mineral, and electrolyte guidelines from the AAP and the FDA for feeding term infants. The protein is a soy isolate supplemented with L-methionine, L-carnitine, and taurine to provide a protein content of 2.45-2.8 g/100 kcal, or 1.7-1.9 g/dL.
The quantity of specific fats varies by manufacturer and is usually similar to the manufacturer’s corresponding cow’s milk–based formula. The fat content is 5.0-5.5 g/100 kcal, or 3.4-3.6 g/dL. The oils used in both cow’s milk and soy formula include soy, palm, sunflower, olein, safflower, and coconut. DHA and ARA are also added.
In term infants, although soy protein–based formulas have been used to provide nutrition resulting in normal growth patterns, there are few indications for use in place of cow’s milk–based formula. Indications for soy formula include galactosemia, preference for a vegetarian diet, and hereditary lactase deficiency, because soy-based formulas are lactose free. Most healthy infants with acute gastroenteritis can be managed after rehydration with continued use of breast milk or cow’s milk–based formulas and do not require a lactose-free formula, such as soy-based formula. However, soy protein–based formulas may be indicated when documented secondary lactose intolerance occurs. Soy protein–based formulas have no advantage over cow’s milk protein–based formulas as a supplement for the breastfed infant, unless the infant has one of the indications noted previously, and are not recommended for preterm infants. The routine use of soy protein–based formula has no proven value in the prevention or management of infantile colic, fussiness, or atopic disease. Infants with documented cow’s milk protein–induced enteropathy or enterocolitis often are also sensitive to soy protein. They should be provided formula derived from extensively hydrolyzed protein or synthetic amino acids. Soy formulas contain phytoestrogens, which have been shown to have physiologic activity in rodent models, but there is no conclusive evidence of adverse developmental effects in infants fed soy formula.