Pneumatosis intestinalis: Does it always indicate necrotizing enterocolitis?

Area of Science:

• Neonatal medicine
• Pediatric gastroenterology
• Radiology

Background:

• Pneumatosis intestinalis (PI) is a rare radiological finding, often linked to necrotizing enterocolitis (NEC) in neonates.
• Cow's milk protein allergy (CMA) is a common allergy in infants, typically presenting after consuming milk-based formulas or through breastfeeding.

Observation:

• Three neonates with PI were evaluated; two had diagnosed CMA and/or NEC, and one had acute gastroenteritis.
• Two neonates presented with PI and NEC-like appearance (NEC-LA), with one experiencing multiple episodes.
• All neonates showed rapid clinical improvement and disease remission after transitioning to an amino acid-based formula.

Findings:

• Cow's milk protein allergy (CMA) should be considered as a potential cause of PI in neonates, alongside NEC.
• Case 2 experienced recurrent NEC-LA episodes, suggesting a strong link to CMA.
• The study proposes that CMA management protocols should guide feeding strategies for recurrent NEC.

Implications:

• This study suggests reconsidering the diagnostic approach to neonatal PI, incorporating CMA as a differential diagnosis.
• Early identification and management of CMA may prevent severe gastrointestinal complications in neonates.
• Implementing CMA management protocols can improve outcomes for neonates with PI and suspected allergies.