挪威奥斯陆大学医院Håvard Ove Skjerven团队近日取得一项新成果。经过不懈努力，他们探讨了皮肤润肤剂和早期补充喂养来预防婴儿异位性皮炎的疗效。相关论文于2020年2月19日发表在《柳叶刀》杂志上。

婴儿早期使用皮肤润肤剂可以预防异位性皮炎，而早期补充食物可以减少高危婴儿的食物过敏。该研究旨在确定从2周龄开始使用常规皮肤润肤剂，或在12周龄至16周龄之间早期补充喂养是否可以降低婴儿12个月时异位性皮炎的发生率。

这项基于人群的随机临床试验在挪威和瑞典进行，2015年12月9日至2016年10月31日，研究组共招募了2697名孕妇，从2015年4月14日至2017年4月11日招募了2397名新生儿。婴儿随机分为4类：1）对皮肤护理没有具体建议（对照组）；2）每日使用润肤剂（皮肤干预组）；3）及早补充花生、牛奶、小麦和鸡蛋（食物干预组）；4）皮肤和食物联合干预（联合干预组）。

12个月时，对照组中有8%的婴儿发生异位性皮炎，皮肤干预组有11%，食物干预组有9%，联合干预组有5%。皮肤润肤剂和早期补充喂养均未减少异位性皮炎的发生率，皮肤干预的风险差异为3.1％，食品干预的风??险差异为1.0％，均可控。没有发现干预措施的安全隐患。与对照组相比，皮肤干预、食物干预和联合干预组中皮肤症状和体征的发生率显著降低。

总之，早期使用皮肤润肤剂和早期补充喂养都不能降低婴儿12个月时异位性皮炎的发生率。研究结果不支持采用这些干预措施来预防婴儿1岁时的异位性皮炎。

附：英文原文

Title: Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial

Author: Håvard Ove Skjerven, Eva Maria Rehbinder, Riyas Vettukattil, Marissa LeBlanc, Berit Granum, Guttorm Haugen, Gunilla Hedlin, Linn Landr, Benjamin J Marsland, Knut Rudi, Kathrine Dnvold Sjborg, Cilla Sderhll, Anne Cathrine Staff, Kai-Hkon Carlsen, Anna Asarnoj, Karen Eline Stensby Bains, Oda C Ldrup Carlsen, Kim M Advocaat Endre, Peder Annus Granlund, Johanne Uthus Hermansen, Hrefna Katrín Gudmundsdóttir, Katarina Hilde, Geir Hland, Ina Kreyberg, Inge Christoffer Olsen, Caroline-Aleksi Olsson Mgi, Live Solveig Nordhagen, Carina Madelen Saunders, Ingebjrg Skrindo, Sandra G Tedner, Magdalena R Vrnesbranden, Johanna Wiik, Christine Monceyron Jonassen, Bjrn Nordlund, Karin C Ldrup Carlsen

Issue&Volume: 2020-02-19

Abstract: BackgroundSkin emollients applied during early infancy could prevent atopic dermatitis, and early complementary food introduction might reduce food allergy in high-risk infants. The study aimed to determine if either regular skin emollients applied from 2 weeks of age, or early complementary feeding introduced between 12 and 16 weeks of age, reduced development of atopic dermatitis by age 12 months in the general infant population.MethodsThis population-based 2×2 factorial, randomised clinical trial was done at Oslo University Hospital and stfold Hospital Trust, Oslo, Norway; and Karolinska University Hospital, Stockholm, Sweden. Infants of women recruited antenatally at the routine ultrasound pregnancy screening at 18 weeks were cluster-randomised at birth from 2015 to 2017 to the following groups: (1) controls with no specific advice on skin care while advised to follow national guidelines on infant nutrition (no intervention group); (2) skin emollients (bath additives and facial cream; skin intervention group); (3) early complementary feeding of peanut, cow's milk, wheat, and egg (food intervention group); or (4) combined skin and food interventions (combined intervention group). Participants were randomly assigned (1:1:1:1) using computer- generated cluster randomisation based on 92 geographical living area blocks as well as eight 3-month time blocks. Carers were instructed to apply the interventions on at least 4 days per week. Atopic dermatitis by age 12 months was the primary outcome, based on clinical investigations at 3, 6 and 12 months by investigators masked to group allocation. Atopic dermatitis was assessed after completing the 12-month investigations and diagnosed if either of the UK Working Party and Hanifin and Rajka (12 months only) diagnostic criteria were fulfilled. The primary efficacy analyses was done by intention-to-treat analysis on all randomly assigned participants. Food allergy results will be reported once all investigations at age 3 years are completed in 2020. This was a study performed within ORAACLE (the Oslo Research Group of Asthma and Allergy in Childhood; the Lung and Environment). The study is registered at clinicaltrials.gov, NCT02449850.Findings2697 women were recruited between Dec 9, 2014, and Oct 31, 2016, from whom 2397 newborn infants were enrolled from April 14, 2015, to April 11, 2017. Atopic dermatitis was observed in 478 (8%) of 596 infants in the no intervention group, 64 (11%) of 575 in the skin intervention group, 58 (9%) of 642 in the food intervention group, and 31 (5%) of 583 in the combined intervention group. Neither skin emollients nor early complementary feeding reduced development of atopic dermatitis, with a risk difference of 3·1% (95% CI –0·3 to 6·5) for skin intervention and 1·0% (–2·1 to 4·1) for food intervention, in favour of control. No safety concerns with the interventions were identified. Reported skin symptoms and signs (including itching, oedema, exanthema, dry skin, and urticaria) were no more frequent in the skin, food, and combined intervention groups than in the no intervention group.InterpretationNeither early skin emollients nor early complementary feeding reduced development of atopic dermatitis by age 12 months. Our study does not support the use of these interventions to prevent atopic dermatitis by 12 months of age in infants.

DOI: 10.1016/S0140-6736(19)32983-6

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32983-6/fulltext