Case-control study of milk curd obstruction in newborn infants in a tertiary surgical neonatal intensive care unit.

IF 3.9 2区医学 Q1 PEDIATRICS

Archives of Disease in Childhood - Fetal and Neonatal Edition Pub Date : 2024-10-15 DOI:10.1136/archdischild-2024-327565

Orla Walsh, Ross Anthony, Zeke Wang, Barbara Elizabeth Cormack, Frank Harry Bloomfield

{"title":"Case-control study of milk curd obstruction in newborn infants in a tertiary surgical neonatal intensive care unit.","authors":"Orla Walsh, Ross Anthony, Zeke Wang, Barbara Elizabeth Cormack, Frank Harry Bloomfield","doi":"10.1136/archdischild-2024-327565","DOIUrl":null,"url":null,"abstract":"Background: Milk curd obstruction (MCO), in which milk becomes inspissated, is a rare, serious, complication of preterm birth. Case reports implicate male sex and bovine-derived human milk fortifier (HMF) use as predisposing factors. We investigated this through a case-control study.Methods: MCO cases in the Starship Child Health neonatal database between 2008 and 2020 were matched with controls in a 1:2 ratio based on gestational age (±1 week), birth weight (±200 g) and date of birth (±1 month). Data were analysed using the Student's t-test, Mann-Whitney U-test or χ² test as appropriate. Data are median (IQR) or n (%).Results: Of 20 MCO cases, gestation was 26.1 (24.5-28.1) weeks, birth weight was 822 (713-961) g, 15 (75%) were male. 40 controls were well-matched for gestation (26.1 (24.8-27.9) weeks) and birth weight (849 (690-1066) g) but only 18 (45%) were male (p=0.05). MCO occurred at 21 (15-33) days; 6 (30%) cases died compared with 3 (7.5%) controls (p=0.06). HMF was commenced at 243 (150-309) hours in cases and 224 (172-321) hours in controls (p=0.95); full-fortification (manufacturer's recommended dose) was achieved in 8 (40%) cases and 27 (68%) controls (p=0.08). In cases, MCO occurred 10 (7-17) days after commencing HMF. Medically/surgically-managed gut pathology occurred in 7 (35%) cases prior to MCO but in no controls (p<0.001).Conclusions: Our data support male sex but not HMF use as a predisposition to MCO. Evidence of prior medical/surgical gut pathology may be a premonition for MCO; however, further research is required to confirm this.","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Disease in Childhood - Fetal and Neonatal Edition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/archdischild-2024-327565","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Milk curd obstruction (MCO), in which milk becomes inspissated, is a rare, serious, complication of preterm birth. Case reports implicate male sex and bovine-derived human milk fortifier (HMF) use as predisposing factors. We investigated this through a case-control study.

Methods: MCO cases in the Starship Child Health neonatal database between 2008 and 2020 were matched with controls in a 1:2 ratio based on gestational age (±1 week), birth weight (±200 g) and date of birth (±1 month). Data were analysed using the Student's t-test, Mann-Whitney U-test or χ² test as appropriate. Data are median (IQR) or n (%).

Results: Of 20 MCO cases, gestation was 26.1 (24.5-28.1) weeks, birth weight was 822 (713-961) g, 15 (75%) were male. 40 controls were well-matched for gestation (26.1 (24.8-27.9) weeks) and birth weight (849 (690-1066) g) but only 18 (45%) were male (p=0.05). MCO occurred at 21 (15-33) days; 6 (30%) cases died compared with 3 (7.5%) controls (p=0.06). HMF was commenced at 243 (150-309) hours in cases and 224 (172-321) hours in controls (p=0.95); full-fortification (manufacturer's recommended dose) was achieved in 8 (40%) cases and 27 (68%) controls (p=0.08). In cases, MCO occurred 10 (7-17) days after commencing HMF. Medically/surgically-managed gut pathology occurred in 7 (35%) cases prior to MCO but in no controls (p<0.001).

Conclusions: Our data support male sex but not HMF use as a predisposition to MCO. Evidence of prior medical/surgical gut pathology may be a premonition for MCO; however, further research is required to confirm this.

查看原文本刊更多论文

新生儿外科三级重症监护室新生儿凝乳阻塞的病例对照研究。

背景：乳汁凝结阻塞（MCO）是早产的一种罕见、严重的并发症。病例报告显示，男性性别和使用牛源性母乳强化剂（HMF）是易患因素。我们通过病例对照研究对此进行了调查：方法：根据胎龄（±1 周）、出生体重（±200 克）和出生日期（±1 个月），以 1:2 的比例将 2008 年至 2020 年间星舰儿童健康新生儿数据库中的 MCO 病例与对照组进行配对。数据分析采用学生 t 检验、曼-惠特尼 U 检验或 χ² 检验（视情况而定）。数据为中位数（IQR）或n（%）：在 20 例 MCO 患者中，妊娠期为 26.1（24.5-28.1）周，出生体重为 822（713-961）克，15 例（75%）为男性。40 例对照组的孕期（26.1（24.8-27.9）周）和出生体重（849（690-1066）克）完全匹配，但只有 18 例（45%）为男性（P=0.05）。MCO发生在21（15-33）天；6例（30%）病例死亡，对照组为3例（7.5%）（P=0.06）。病例在 243（150-309）小时开始服用 HMF，对照组在 224（172-321）小时开始服用 HMF（p=0.95）；8 例（40%）病例和 27 例（68%）对照组达到了完全强化（制造商推荐剂量）（p=0.08）。在病例中，MCO 发生在开始服用 HMF 后 10 (7-17) 天。在 MCO 之前，7 例（35%）病例出现了药物/手术治疗的肠道病变，但对照组中没有病例（P=0.08）：我们的数据支持男性性别而非使用 HMF 易导致 MCO。先前内科/外科肠道病变的证据可能是 MCO 的前兆；但是，还需要进一步的研究来证实这一点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Archives of Disease in Childhood - Fetal and Neonatal Edition 医学-小儿科

CiteScore

9.00

自引率

4.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.