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Natural History of Cow's Milk Protein Allergy in Preterm Infants: Insights from a Retrospective Cohort Study
Hanna Abu Hanna1, Avishay Lahad2, Muhammad Said2
1Faculty of Medicine, Technion, Haifa, Israel, hanna.97@gmail.com.
Insights
Cow's milk protein allergy (CMPA) in preterm infants often resolves by age one. Early diagnosis and reintroduction of cow milk protein may improve outcomes for these children.
Area of Science:
- Neonatal Medicine
- Allergy and Immunology
- Pediatric Gastroenterology
Background:
- Cow's milk protein allergy (CMPA) affects 2-3% of healthy children.
- The natural history of CMPA in preterm infants is not well-documented.
- Preterm infants represent a unique population for studying CMPA.
Purpose of the Study:
- To investigate the disease characteristics of CMPA in preterm infants.
- To determine the long-term natural history of CMPA in this cohort.
- To identify factors influencing CMPA resolution and atopic development.
Main Methods:
- Retrospective cohort study of 141 preterm infants.
- Utilized medical records from Clalit Health Services (CHS).
- Reviewed clinical manifestations and laboratory variables at onset and during follow-up.
Main Results:
- CMPA persistence was 16% at 1 year, decreasing to 1.5% by 6 years.
- 39% of infants developed atopic conditions, with asthma being most common (31%).
- Cesarean delivery was linked to a higher risk of subsequent atopic disease (HR 1.22, p=0.009).
Conclusions:
- CMPA in preterm infants typically resolves within the first year.
- Accurate diagnosis and timely reintroduction of cow milk protein are crucial.
- Optimizing management may reduce unnecessary interventions and improve long-term health outcomes.
Introduction:
Cow's milk protein allergy (CMPA) affects approximately 2-3% of healthy children. The natural history of CMPA is poorly described in preterm infants. The aim of the study was to determine disease characteristics and long-term natural history of CMPA in preterm infants.
Methods:
This was a retrospective cohort study of Clalit Health Services (CHS) members (the largest of 4 integrated health care organizations in Israel). The medical records of children, who developed, as preterm infants, symptoms suggestive for CMPA during their hospitalization at the neonatal intensive care unit between June 2009 and June 2020 and subsequently were attending primary care clinics of the CHS in Northeastern Israel, were retrospectively reviewed for clinical manifestation and laboratory variables at disease onset and during follow-up.
Results:
Among 141 preterm infants (mean gestational age 31 weeks, median follow-up 3.4 years), CMPA persistence was 16% at 1 year, 1.8% at 3 years, and 1.5% at 6 years. Atopic conditions developed at 39%, with asthma being most frequent (31%). Cesarean delivery was associated with higher risk of subsequent atopic disease (HR 1.22, p = 0.009).
Conclusions:
CMPA in preterm infants is often resolved by 1 year. Accurate diagnosis and earlier reintroduction of cow milk protein may improve outcomes and reduce unnecessary interventions.
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