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Manifestations of Cow's-Milk Protein Intolerance in Preterm Infants

Jonathan Cordova1, Sudhir Sriram, Tiffany Patton

  • 1*Section of Gastroenterology, Hepatology and Nutrition †Section of Pediatric Neonatology, University of Chicago, Chicago, IL.

Journal of Pediatric Gastroenterology and Nutrition
|August 8, 2015
PubMed

Insights

Cow

Area of Science:

  • Neonatal Medicine
  • Pediatric Gastroenterology
  • Clinical Nutrition

Background:

  • Cow's-milk protein intolerance (CMPI) is often underdiagnosed in preterm infants.
  • Early recognition of CMPI is crucial for appropriate nutritional management and improved outcomes in vulnerable neonates.
  • Preterm infants present unique challenges in diagnosing feeding intolerances due to complex medical conditions.

Purpose of the Study:

  • To investigate the clinical indicators and preceding events associated with the diagnosis of cow's-milk protein intolerance (CMPI) in preterm infants.
  • To identify patterns in clinical care, such as parenteral nutrition (PN) support, that may correlate with CMPI diagnosis.
  • To enhance the understanding of CMPI presentation in a neonatal intensive care unit (NICU) setting.

Main Methods:

  • Retrospective analysis of preterm infants receiving parenteral nutrition (PN) in a level-III NICU over a 12-month period.
  • Assessment of clinical parameters including birth weight, diagnoses, PN duration/frequency, initial enteral feeds, and enteral autonomy.
  • CMPI diagnosis was confirmed by resolution of feeding intolerance upon switching from intact protein to hydrolysate or amino acid-based formulas.

Main Results:

  • Of 348 infants receiving PN, 19 (5%) were diagnosed with CMPI.
  • Requirement for multiple PN courses was significantly associated with a higher likelihood of CMPI (14/51 vs. 5/297, P < 0.001).
  • Nine infants diagnosed with CMPI initially presented with necrotizing enterocolitis (NEC), followed by persistent feeding intolerance and NEC-like recurrences.

Conclusions:

  • Recurrent feeding intolerance and "NEC-like illness" after recovery from NEC, particularly when requiring multiple PN courses, may indicate CMPI in preterm infants.
  • These clinical events suggest that CMPI should be considered in the differential diagnosis of persistent feeding issues in preterm infants, especially those with a history of NEC.
  • This study highlights the importance of considering CMPI in preterm infants with complex feeding intolerance and a history of NEC.
Abstract

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