Return of the milk curd syndrome

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Gastroenterology

Background:

• Milk curd syndrome, characterized by milk bolus intestinal obstruction, presents a challenge in extremely low birth weight (ELBW) infants.
• This condition, previously thought to be rare, appears to be re-emerging in clinical practice.
• Potential contributing factors include increased calcium and fat intake in ELBW infant formulas.

Purpose of the Study:

• To review the clinical presentation, diagnosis, and management of milk curd syndrome in ELBW infants.
• To highlight the diagnostic challenges, particularly differentiating from necrotizing enterocolitis (NEC).
• To discuss the effectiveness of surgical intervention for this condition.

Main Methods:

• Retrospective review of medical records for five ELBW infants diagnosed with milk curd syndrome.
• Analysis of clinical history, examination findings, diagnostic imaging, and surgical outcomes.
• Evaluation of treatment strategies, including conservative measures and surgical interventions.

Main Results:

• Diagnosis was primarily based on clinical history and examination in most cases.
• Abdominal X-rays were sometimes inconclusive and could be mistaken for localized necrotizing enterocolitis (NEC).
• Surgical enterotomy and bolus removal were effective for early diagnoses; resection was necessary in advanced cases.

Conclusions:

• Milk curd syndrome is a significant cause of intestinal obstruction in ELBW infants and requires prompt recognition.
• High calcium and fat content in feeding formulas may be contributing to the recurrence of this syndrome.
• Early surgical intervention, such as enterotomy and bolus removal, offers a safe and effective treatment, while delayed diagnosis may necessitate more extensive surgery.