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

Abstract

Milk bolus obstruction of the neonatal bowel apparently related to the use of artificial powder milk, particularly full cream cows milk, was first recognised in the late 1960s. The syndrome almost disappeared with the use of highly modified cows milk formulae but has now re-emerged in the low birth weight population with the early use of high calorific feeds specifically designed for these infants. We describe four cases of obstruction and perforation of the bowel seen on our neonatal intensive care unit in 1 calendar year and discuss the possible aetiology of this condition.

Olive oil enema in a pre‐term infant with milk curd syndrome

“…Especially in premature infants, intestinal immaturity and a trend of earlier and more rapid advancement of feeding with high caloric density formulas seem to be the most important causative factors. Furthermore, several additional factors may contribute to the cause of the syndrome such as continuous‐drip feeding techniques; nasojejunal tube feeding; bile congestion, which may cause much unabsorbed free fatty acids in the intestinal lumen; use of nutritional additives such as calcium, medium‐chain triglycerides, carbohydrates and vitamins; and dehydration; some of which were present in the current patient. These complicating factors combine to form milk curd syndrome in pre‐term infants.…”

“…Milk curd obstruction was first reported in eight infants by Cook and Rickham in 1969 as intestinal obstruction caused by impaction by hard stools . The nomenclature to describe the condition has varied and has included milk bolus obstruction, milk curd syndrome, milk inspissation, and inspissated milk syndrome . Milk curd syndrome was described in term babies in the earliest reports, but recently has been reported in premature infants with an incidence of 6% in extremely low‐birthweight infants, and has again attracted the attention of neonatologists.…”

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

“…Our fourth hypothesis was that fatty acid soap formation would bind calcium in the gut5 7 9 11 and therefore reduce calcium absorption. Using a dual calcium isotope method,18 we found evidence to support this view, and our findings are consistent with those of others using short term balances 26.…”

Milk curd obstruction in premature infants receiving fortified expressed breast milk

“…In recent years, milk curd obstruction has been described in premature low birth‐weight infants 2–5 . To date, only one infant has been described who developed milk curd obstruction after feeds with fortified breast milk 5 – all other babies received preterm formula feeds.…”

“…After the composition of formula feeds was changed to a lower fat content, milk curd obstruction became rare. Since 1980, several cases in premature low birth‐weight infants receiving high caloric density feeds were described 2–4 We report a series of premature neonates who were fed with fortified expressed breast milk (EBM) and presented with milk curd obstruction.…”