Milk curd obstruction in premature infants receiving fortified expressed breast milk

Milk curd obstruction is one of the less common causes of neonatal bowel obstruction. It has been described in premature infants who received high caloric formula feeds. We report presentation, management and outcome of premature neonates who developed milk curd obstruction while being fed fortified expressed breast milk.

A retrospective case note review of babies who were treated for milk curd obstruction in Royal Children's Hospital and Mater Children's Hospital in Brisbane between 2001 and 2007 was performed.

Nine preterm neonates developed milk curd obstruction (mean gestational age 27 weeks). All babies received fortified expressed breast milk. Symptoms presented were those of bowel obstruction in the majority of cases. Laparotomy was required in eight babies, one had a pre-existing ileostomy that was washed out. Two babies died shortly after surgery, while two followed several months later.

The diagnosis of milk curd obstruction should be considered in all premature babies with signs of bowel obstruction who are fed expressed breast milk with caloric fortification.