Awareness or neglecting the diagnosis of cow milk protein allergy in the neonatal period.

IF 1.3 4区 医学 Q4 NUTRITION & DIETETICS
Gonca Vardar, Mine Ozdil, Sinan Tufekci
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引用次数: 0

Abstract

Background and objectives: Cow milk protein allergy (CMPA) can mimic surgical disease, gastroenteritis, sepsis, and necrotizing enterocolitis in the neonatal period. For this reason, we aimed to evaluate the clinical features, differential diagnosis, and treatment methods of neonates with CMPA.

Methods and study design: The charts of twenty-six breastfed full-term and preterm newborns presenting with CMPA between October 2018 and February 2021 were retrospectively reviewed. The clinical symptoms, laboratory findings, and methods used in diagnosis and treatment were analyzed.

Results: CMPA was diagnosed in preterm infants 50% (n=13) at the same rate as in full-term infants 50% (n=13) between 32 to 38 weeks corrected age (median 36 weeks). Among patients with CMPA, 69.2% (n=18) had blood in the stool at the onset. Cow's Milk-related Symptom Score score was found to be significantly higher prior to diagnosis vs. after treatment with the cow milk protein-free mom's milk diet [12(11-13) vs. 4(3-5), p<0.001]. Seventy-two hours after the commencement of the mothers' elimination diet, macroscopic blood in stool disappeared in all patients except one patient. Oral food challenge (OFC) for the diagnosis of CMPA was carried out on all (n=26) neonates. Eosinophilia was seen in 46.2% of patients (n=12). The methemoglobin concentration was 1.1 to 1.5% (median 1.3%).

Conclusions: CMPA should be kept in mind for well-appearing preterm and full-term infants suspected of necrotizing enterocolitis and gastroenteritis, respectively, presenting with bloody stool and eosinophilia. The use of OFC can be implemented since neonates were very well monitored in the neonatal intensive care unit. Treatment is possible by continuing breastfeeding.

新生儿期对牛奶蛋白过敏诊断的认识或忽视。
背景和目的:牛奶蛋白过敏(CMPA)可在新生儿期引起外科疾病、肠胃炎、败血症和坏死性小肠结肠炎。因此,我们旨在评估新生儿CMPA的临床特征、鉴别诊断和治疗方法。方法和研究设计:回顾性分析2018年10月至2021年2月26例出现CMPA的母乳喂养足月和早产儿的图表。分析临床症状、实验室检查结果及诊断和治疗方法。结果:在32 - 38周龄(中位36周)之间,早产儿CMPA的诊断率为50% (n=13),足月婴儿的诊断率为50% (n=13)。在CMPA患者中,69.2% (n=18)的患者在发病时便带血。牛奶相关症状评分在诊断前明显高于无牛奶蛋白母乳饮食治疗后的评分[12(11-13)vs. 4(3-5)]。结论:对于疑似坏死性小肠结肠炎和肠胃炎的早产儿和足月婴儿,应牢记CMPA,分别表现为便血和嗜酸性粒细胞增多。OFC的使用是可以实施的,因为新生儿在新生儿重症监护病房得到了很好的监测。可以通过继续母乳喂养来治疗。
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来源期刊
CiteScore
2.50
自引率
7.70%
发文量
58
审稿时长
6-12 weeks
期刊介绍: The aims of the Asia Pacific Journal of Clinical Nutrition (APJCN) are to publish high quality clinical nutrition relevant research findings which can build the capacity of clinical nutritionists in the region and enhance the practice of human nutrition and related disciplines for health promotion and disease prevention. APJCN will publish original research reports, reviews, short communications and case reports. News, book reviews and other items will also be included. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer-reviewed by at least two anonymous reviewers and the Editor. The Editorial Board reserves the right to refuse any material for publication and advises that authors should retain copies of submitted manuscripts and correspondence as material cannot be returned. Final acceptance or rejection rests with the Editorial Board
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