Different Digestive Tract Complications of Neonatal-Onset Infants with Severe Cow Milk Protein Allergy

Abstract

The objective of this study was to summarize different digestive tract complications of five neonatal-onset infants with severe cow milk protein allergy (CMPA) to improve early diagnosis, treatment, and prognosis of CMPA. We retrospectively analyzed various digestive tract complications of the five infants who were hospitalized at Guangzhou Women and Children’s Medical Center from July 2016 to June 2020. All five cases were full-term infants, with age at onset ranging from three to 28 days. Three neonates were formula-fed, and two were mixed-fed. The principal clinical manifestations included fever, diarrhea, vomiting, hematochezia, weight loss, edema, and skin ulcers. One infant was diagnosed with necrotizing enterocolitis (NEC) and underwent surgery. Milk-specific IgE was elevated in three cases, and other food-specific IgE antibodies were elevated in two cases. Case 1 revealed severe erosive esophagitis and pyloric stenosis upon gastroscopy; case 2 revealed intestinal lymphatic dilation upon gastroscopy; case 3 showed scattered crater-like ulcers of varying sizes under colonoscopy, with some of the ulcerated tissues around the ulcers showing polypoid changes; case 4 showed ascites of approximately 16 mm in depth upon abdominal ultrasonographic scan; and case 5 depicted colonic stenosis and erosive colitis upon colonoscopy. All five children were cured after receiving either amino acid formula milk (AAF) or extensively hydrolyzed formula (eHF) for enteral nutrition feeding and supportive treatment. Severe CMPA in neonates presented with atypical clinical manifestations, and a variety of complications in various parts of the digestive tract occurred—including inflammation and stenosis—which were easily misdiagnosed as NEC or very-early-onset inflammatory bowel disease (IBD). We posit that early diagnosis will reduce unnecessary operations and shorten treatment time.