Milk Curd Obstruction in Human Milk-Fed Preterm Infants

Abstract

Background: Milk curd obstruction as a cause of intestinal obstruction has been known since 1959, but has nearly disappeared. However, in recent years it has experienced a revival in small premature infants. Objective: The aim of this study was to evaluate the clinical characteristics of milk curd obstruction (lactobezoar) in preterm infants. Methods: Data of preterm infants with milk curd obstruction cared for at a large tertiary neonatal intensive care unit between 2012 and 2016 were retrieved from the electronic registry and paper records. Results: A total of 10 infants (2 girls, 8 boys) were identified: the median birth weight was 595 g (range 270–922), gestational age was 24.4 weeks (23.4–27.0), weight-for-gestational age percentile was 16 (0–62), and age at diagnosis was 28 days (16–64). Five infants (50%) were small for gestational age. All neonates had received fortified human milk (added protein 2.0 g/100 mL, range 0–2.8; added calcium 2,400 µmol/100 mL, range 0–6 844; added phosphate 2,400 µmol/100 mL, range 0–5,178). Seven neonates underwent surgery, and 2 infants died. Hyperechoic masses in extended bowel loops, visualised by abdominal ultrasound, and pale/acholic faeces were hallmarks of milk curd obstruction. Conclusions: In this study, milk curd obstruction occurred exclusively in infants with a birth weight < 1,000 g (2.2%) and < 28 weeks’ gestational age (2.4%). Male and small for gestational age infants appeared to be at increased risk. Paying attention to the colour of the faeces of infants at risk might help to diagnose milk curd obstruction at an early stage.

Whole-Exome Sequencing Identified Novel CLMP Mutations in a Family With Congenital Short Bowel Syndrome Presenting Differently in Two Probands

“…Lactobezoar is mainly composed of undigested milk and mucus protein or fatty acid calcium stone (Heinz-Erian et al, 2012;Murase et al, 2013). It occurs mainly in neonates who are either premature or small for gestational age (Longardt et al, 2019). The case numbers decreased after the 1980s, possibly due to the advancement of neonatal care and the improvement of formula manufacturing (Iwamuro et al, 2015).…”

Milk curd problems in preterm infants are not just about obstructive symptoms

“…When we compared our experiences with published case studies of ileal milk curd, 1 this led us to conclude that gastric localisation seems to have a more benign evolution, with complete resolution after conservative management and no need for surgery.…”

“…The infant was discharged at 27 days of life, when she was 37 + 2 weeks of postmenstrual age.Milk curd is an undigested milk concretion, which rarely occur in infants, but is a known cause of gastrointestinal obstruction. The main risk factors are prematurity and low birth weight 1.…”

Appropriate Phosphorus Intake by Parenteral Nutrition Prevents Metabolic Bone Disease of Prematurity in Extremely Low‐Birth‐Weight Infants

“…The current guidelines on pediatric parenteral nutrition (PN) are based on a theoretical model and lack recommendations for extremely preterm infants 5 . In enteral nutrition, achieving adequate mineral supply is also difficult because of a low gut‐absorption rate of Ca (∼50%–60%) and a risk of milk curd obstruction 6 . Additionally, gut‐absorption rates of Ca are reduced with vitamin D deficiency.…”