Milk bolus obstruction in the neonate.

Randomised controlled trial of a synthetic triglyceride milk formula for preterm infants

“…Calcium soap excretion, as a proportion of fatty acids ingested, was around half the value with the Betapol diet than with diets A or B. We and others have already observed several small preterm infants who developed intestinal obstruction8 10-12 using preterm formulas with palmitate contents similar to breast milk, yet mainly in the Sn-1 or -3 positions. We have suggested that the obstruction was due to inspissated fatty acid soaps, and recently we reported a case12 where this was confirmed by analysis of inspissated material at laparotomy undertaken for disempaction of the bowel.…”

Milk bolus obstruction secondary to the early introduction of premature baby milk formula: an old syndrome re-emerging in a new population

“…Milk curd or bolus obstruction of the bowel is a well recognized clinical syndrome [2,4,7,9,10] that has until recently been only rarely recognised in the low birth weight infant. The condition had become much less common with the withdrawal of full and half cream dried cows milk preparations and condensed milks for use as infant formulae.…”

“…The cause of the obstruction was the impaction of a milk derived bolus in the lower ileum and was only seen in babies fed on reconstituted powder cows milk formulae -most frequently full cream, then in widespread use. The syndrome has been further described [2,9] and the plugs have been analysed [7] and found to be consistent with calcium soap formation. Little was added to the initial description until publcations in the American literature [5,6,8] and a single case report from the United Kingdom [3] described the development of milk bolus obstruction in low birth weight infants.…”

Milk Curd Syndrome in a Neonate Fed with Goat’s Milk

“…Baby is under follow-up. The milk curd syndrome was first described by Cook et al in 1969 [2]. It has been described in neonates who are fed with high caloric fortified expressed breast milk, [1] concentrated formula feeding, [3,4] and fortified cow's milk with high fat content The factors implicated are prematurity, low birth weight, early use of concentrated formula feeds, use of additives like calcium, medium-chain triglycerides, premature gastrointestinal physiology, cow's milk…”

“…The differential diagnoses are meconium ileus and total colonic aganglionosis. Radiological findings on abdominal X-ray, in addition to multiple dilated bowel loops and air-fluid levels are multiple intraluminal opalescent masses surrounded by a halo of air or containing bubbles of gas with ground glass appearance in the right ileac fossa [2]. Hyperechoic masses may be seen on ultrasound.…”