Very early onset perinatal constipation: Can it be cow's milk protein allergy?

Area of Science:

• Pediatrics
• Allergy Immunology
• Gastroenterology

Background:

• Delayed meconium passage or constipation in newborns often prompts investigation for serious conditions like Hirschsprung's disease (HD) and meconium ileus.
• Diagnosing HD typically requires invasive procedures such as anorectal manometry or rectal suction biopsy.
• Cow's milk protein allergy (CMPA) is a common infant condition, but symptoms can manifest from birth due to in-utero allergen exposure.

Purpose of the Study:

• To explore Cow's Milk Protein Allergy (CMPA) as an atypical cause of perinatal constipation.
• To propose non-invasive diagnostic and management strategies for CMPA-induced perinatal constipation.
• To evaluate the potential for avoiding invasive testing in cases of perinatal constipation.

Main Methods:

• Literature review on CMPA presentation in neonates.
• Analysis of atypical presentations of CMPA, focusing on constipation.
• Discussion of dietary elimination as a diagnostic and therapeutic tool.

Main Results:

• CMPA can present atypically with perinatal constipation, rather than classic symptoms like diarrhea or bloody stools.
• Maternal dietary exposure to cow's milk protein may lead to in-utero sensitization and early-onset symptoms in infants.
• Dietary elimination of cow's milk protein can lead to rapid symptom improvement in affected infants.

Conclusions:

• CMPA should be considered in the differential diagnosis of perinatal constipation.
• Non-invasive dietary modification for CMPA offers a safe alternative to invasive testing for certain cases of neonatal constipation.
• Implementing a diagnostic pathway that prioritizes ruling out CMPA may prevent unnecessary invasive procedures.