Intolerance to an extensively hydrolysed formula mistaken for postoperative diarrhoea in a child with neuroblastoma

Area of Science:

• Pediatric Oncology
• Gastroenterology
• Clinical Nutrition

Background:

• Persistent diarrhea is a recognized complication after surgical resection for advanced abdominal neuroblastoma.
• Pediatric patients with neuroblastoma often require nutritional support during treatment.

Observation:

• A 10-month-old infant with stage IV neuroblastoma developed severe diarrhea post-surgery, initially attributed to the operation.
• The infant was placed on continuous nasogastric feeding with an extensively hydrolyzed, non-milk protein formula.
• Persistent diarrhea and subsequent rectal prolapse led to a diagnosis of allergic proctocolitis via colonoscopy and biopsy.

Findings:

• The infant's severe diarrhea resolved rapidly upon discontinuation of the hydrolyzed protein formula.
• This suggests a rare intolerance to the specific extensively hydrolyzed protein formula used for nutritional support.

Implications:

• Clinicians should consider rare food intolerances, particularly to specialized formulas, when managing persistent diarrhea in post-surgical neuroblastoma patients.
• Differentiating between surgical complications and iatrogenic conditions like allergic proctocolitis is crucial for appropriate patient management and nutritional support.
• Further investigation into the specific triggers of allergic proctocolitis in infants receiving specialized nutrition is warranted.