Table 1.
Case reports of preterm infant with a diagnosis of cow's milk allergy in the literature.
| Case | GA | BW (g) | Feeds | Day of presentation | Symptom | Abd x-ray | Laboratory | Diagnosesa | Outcome | Diet |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 (77) | 25 | 710 | HMF DOL 20 | 20 | AD | b | PE | CMA | Fortification changed to Nutramigen without modification of maternal diet. | EHF |
| 2 (78) | 26 | 965 | PTF, MOM + HMF | 17, 28, 61 | AD, E, sluggish BS, lethargic, pale, bradycardia, desaturations, H | Nonspecific diffusely dilated; PI | PE; stool Leu | NEC 2A, CMA | Three episodes of enterocolitis with PI that improved with NPO and ABX. Transitioned to AAF after the third episode. | AAF |
| 3 (79) | 27 | 1,150 | HM, CMF DOL 42 | 48 | H, mucinous stools | Non-specific changes | PE, Colonic biopsy with EI | CMPI | Improved after NPO and casein hydrolysate-based formula. | HF |
| 4 (77) | 27 | 910 | HMF DOL 32 | 41 | H | Nml | PE | NEC 1, CMA | Improved after NPO and ABX. Feeds restarted with MOM fortified with AAF without change in maternal diet | MOM, AAF |
| 5 (77) | 28 | 1,145 | HMF DOL 10 | 14, 30 | AD, H | Mild, diffuse, small bowel distension; no PI | PE | NEC 1, CMA | Improved after NPO and ABX. Restrained MOM fortified with Nutramigen without dietary restrictions. | MOM |
| 6 (80) | 28 | 1,133 | HM + Formula | 25 | H, AD | PI, dilated bowel | PE, FE, eleavted inflammatory markers, Th | NEC | Ex Lap revealed NEC, performed ileostomy | b |
| 7 (81) | 30 | 1,340 | PTF/Fortified HM | 8 | H, mucinous stool | Nml | PE, anemia, biopsy with EI, skin prick +, RAST + at 10 months | Allergic Colitis | Made NPO. Continued to have bloody stools on EHF requiring 3 blood transfusions. Improved on AAF. | AAF |
| 8 (82) | 30 | 965 | HM + HMF (DOL 8) | 10 | lethargy, E, AD, H, mucous stools | Nml | PE | Allergic Colitis | Improved with NPO, but symptoms reoccurred when restarting BM. Improved on AAF. | AAF |
| 9 (82) | 30 | 1,340 | HM + HMF (DOL 8) | 10, 27 | AD, +FOBT, tenderness | Nonspecific diffusely dilated bowel loops, PI | PE | NEC 2A | Improved with NPO then symptoms reoccurred after fortification. Treated for NEC then transitioned to AAF. | AAF |
| 10 (83) | 31 | b | CMF | 30 | E, H, AD | Nml | anemia, FE, elevated fecal calprotectin | CMA | Required a blood transfusion and improved with ABX and EHF | EHF |
| 11 (83) | 31 | b | CMF | H | Fecal eos, elevated fecal calprotectin | CMA | Improved after transitioning to EHF | EHF | ||
| 12 (84) | 31 | 1,300 | HM | 16 | AD, +FOBT | Dilated loops | PE | NEC, CMA | Improved with NPO, ABX and AAF | AAF |
| 13 (84) | 31 | 1,215 | HM + HMF | 20 | AD, +FOBT | Dilated loops | PE | NEC, CMA | Improved with NPO, ABX and AAF | AAF |
| 14 (84) | 32 | 1,950 | HM/CMF | 12 | Diaper rash, H, AD | Nml | Leu, elevated CRP | NEC, CMA | Improved once transitioned to AAF by DOL 6 | AAF |
| 15 (84) | 32 | 1,600 | CMF, SBF | 15,24 | Watery diarrhea, H, lethargy, hypothermia, AD, decreased BS | distended loops, intramural air in stomach | Leu | NEC | Improved while NPO and started SBF. CMF at 24 DOL with systemic symptoms. Improved while NPO on ABX and AAF. | EHF |
| 16 (7) | 33 | 2,570 | CMF | 1 | H, acidosis, AD | Nml | Leu, PE, anemia, EI | CMA | Improved with NPO. Bloody stool persisted with reintroduction of formula feeds. Improved after abx and AAF | AAF |
| 17 (85) | 33 | 2,350 | MOM/CMF | 2 | H | Nml | PE | CMA | Improved on AAF | AAF |
| 18 (86) | 33 | 2,090 | NPO | 1 | H | Dilated gas filled loops | PE, Acidosis, Leu | CMA | Improved with HM and casein hydrolyzed formula | HM |
| 19 (84) | 34 | 1,495 | HM + HMF | 14 | AD, +FOBT | Dilated loops | PE, elevated CRP | NEC, CMA | Improved on AAF | AAF |
| 20 (79) | 35 | 2,670 | MOM, CMF | 10 | H, mucinous stool, AD, tenderness | Abnormal gas pattern, no intramural gas | PE, rectal biopsy EI, RASTb | CMPI | Improved after NPO | HF |
| 21 (6) | 35 | 2,700 | MOM | 35 | H, sleepiness | PI | Nml | NEC | Improved after NPO and ABX | EHF |
| 22 (84) | 36 | 2,500 | MOM | 4 | H, pallor | Nml | PE, elevated CRP, anemia | NEC, CMA | Improved on AAF | AAF |
AAF, amino acid formula; ABX, antibiotics; AD, abdominal distention; BS, bowel sounds; BW, birth weight; CMA, cow's milk allergy; CMF, cow's milk formula; CMPI, cow's milk protein intolerance; CRP, C reactive protein; E, emesis; EHF, extensively hydrolyzed formula; EI, eosinophilic infiltrate; Ex Lap, exploratory laparotomy; FE, fecal eosinophilia; GA, gestational age; H, hematochezia; Leu, leukocytosis; MOM, mother's own milk; NEC, necrotizing enterocolitis; Nml, normal; NPO, Nil Per Os; PE, peripheral eosinophilia; PI, pneumatosis intestinalis; SBF, soy based formula; Th, thrombocytopenia.
a
Includes initial and final diagnosis.
b
Information unavailable.