牛奶蛋白过敏（CMPA）是最常见的新生儿食物过敏性疾病，是机体对牛奶中部分蛋白质分子发生的免疫反应，可由IgE介导、非IgE介导或两者混合介导。《新生儿牛奶蛋白过敏诊断与管理专家共识（2023）》对新生儿CMPA的临床特点、诊断与鉴别诊断、治疗与预防给予相应的推荐意见。

新生儿CMPA症状识别

推荐意见1：新生儿CMPA 主要为非IgE 介导类型，其临床表现多样且无特异性，多以血便起病，也有呕吐、腹胀、腹泻等症状，应及时识别并判断病情轻重，以便进一步管理和治疗。

推荐意见2：鉴于早产儿消化系统和免疫系统尚未发育完善，与足月儿相比，多数情况下早产儿发生CMPA时间更晚，症状更复杂，病情更严重，更易发生食物蛋白诱导性小肠结肠炎综合征，应重视与新生儿坏死性小肠结肠炎（NEC）等疾病鉴别。

新生儿CMPA诊断与鉴别

推荐意见3：多种婴幼儿CMPA的筛查和诊断方法如外周血嗜酸性粒细胞、过敏原皮肤点刺试验、血清IgE检测等，由于局限性不能广泛应用于新生儿。新生儿期CMPA主要依靠过敏高危因素、临床症状与摄食关系、诊断性回避试验效果以及排除其他相关疾病进行综合分析诊断，应根据临床严重程度采取有区别的诊断流程（图1）。

注：CMPA为牛奶蛋白过敏；NEC为新生儿坏死性小肠结肠炎；eHF为深度水解配方；AAF为氨基酸配方；OFC为口服食物激发

图1 新生儿CMPA诊断与管理流程图

推荐意见4：新生儿CMPA以消化系统症状为主要临床表现，通常表现为血便、腹胀、呕吐等，需与NEC、感染性肠炎、胃肠道畸形、乳糖不耐受、胃食管反流病、其他直肠及肛门出血性疾病相鉴别。

新生儿CMPA饮食管理

推荐意见5：母乳喂养新生儿发生牛奶蛋白过敏时建议继续母乳喂养，母亲严格回避含牛奶食品，并补充钙及维生素D制剂，如果出现严重过敏症状，选择氨基酸配方（AAF）深度水

解配方（eHF）养。

推荐意见6：配方喂养新生儿发生牛奶蛋白过敏时推荐采用eHF或AAF喂养。

新生儿CMPA营养管理

推荐意见7：对于牛奶蛋白过敏新生儿，尤其是早产儿、低出生体重儿及小于胎龄儿，应定期进行生长和营养评估，个性化补充相应营养素。

新生儿CMPA预防措施

推荐意见8：鉴于母乳喂养对母子双方的健康效应，避免生后早期引入含牛奶配方，可降低牛奶蛋白过敏风险。

推荐意见9：不推荐限制母亲妊娠期、哺乳期牛奶及其制品饮食以预防CMPA。

推荐意见10：不推荐母乳喂养新生儿使用pHF预防CMPA，当不能母乳喂养或母乳不足时，过敏高风险的新生儿不推荐使用pHF 或eHF 降低CMPA风险。

推荐意见11：没有足够的证据显示补充益生菌、益生元或合生元、长链多不饱和脂肪酸 、维生素 D能预防CMPA。

以上来源：中华医学会儿科学分会新生儿学组, 中华儿科杂志委员会. 新生儿牛奶蛋白过敏诊断与管理专家共识（2023） [J]. 中华儿科杂志, 2024, 62(1): 12-21.

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rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root,body:not(.pages_skin_pc) body{--appmsgExtra-BG: #F7F7F7}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root[data-weui-theme=dark],body:not(.pages_skin_pc) body[data-weui-theme=dark]{--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: 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.6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root:not([data-weui-theme=light]),body:not(.pages_skin_pc) body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: 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