Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2004 Feb;80(940):80–83. doi: 10.1136/pmj.2003.007930

Neonatal congenital microvillus atrophy

N Pecache 1, S Patole 1, R Hagan 1, D Hill 1, A Charles 1, J Papadimitriou 1
PMCID: PMC1742937  PMID: 14970294

Abstract

Congenital microvillous atrophy (CMVA) is the leading cause of neonatal secretory diarrhoea with onset either in the first 72 hours of life (early onset) or at 6–8 weeks after birth (late onset). To date over 30 cases have been reported worldwide. The prognosis for this life threatening condition continues to be poor. Therapeutic agents like somatostatin and epidermal growth factor are either ineffective or of marginal benefit. Overall five year survival after small bowel transplantation is currently ∼50%. The following brief review is aimed towards helping neonatologists/perinatologists in the early diagnosis, and management of CMVA and in counselling the parents appropriately.

Full Text

The Full Text of this article is available as a PDF (223.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aichbichler B. W., Zerr C. H., Santa Ana C. A., Porter J. L., Fordtran J. S. Proton-pump inhibition of gastric chloride secretion in congenital chloridorrhea. N Engl J Med. 1997 Jan 9;336(2):106–109. doi: 10.1056/NEJM199701093360205. [DOI] [PubMed] [Google Scholar]
  2. Assmann B., Hoffmann G. F., Wagner L., Bräutigam C., Seyberth H. W., Duran M., Van Kuilenburg A. B., Wevers R., Van Gennip A. H. Dihydropyrimidinase deficiency and congenital microvillous atrophy: coincidence or genetic relation? J Inherit Metab Dis. 1997 Sep;20(5):681–688. doi: 10.1023/a:1005374426168. [DOI] [PubMed] [Google Scholar]
  3. Belmont John W., Reid Barbara, Taylor William, Baker Susan S., Moore Warren H., Morriss Michael C., Podrebarac Susan M., Glass Nancy, Schwartz I. David. Congenital sucrase-isomaltase deficiency presenting with failure to thrive, hypercalcemia, and nephrocalcinosis. BMC Pediatr. 2002 Apr 25;2:4–4. doi: 10.1186/1471-2431-2-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Birenbaum E., Shahar E., Aladjem M., Brish M. Neonatal hypernatremic dehydration due to excessively concentrated prepared milk formula. Clin Pediatr (Phila) 1981 Oct;20(10):627–629. doi: 10.1177/000992288102001003. [DOI] [PubMed] [Google Scholar]
  5. Bunn S. K., Beath S. V., McKeirnan P. J., Kelly D. A., Buckles J. A., Mirza D., Mayer A. D., de Goyet J. D. Treatment of microvillus inclusion disease by intestinal transplantation. J Pediatr Gastroenterol Nutr. 2000 Aug;31(2):176–180. doi: 10.1097/00005176-200008000-00016. [DOI] [PubMed] [Google Scholar]
  6. Candy D. C., Larcher V. F., Cameron D. J., Norman A. P., Tripp J. H., Milla P. J., Pincott J. R., Harries J. T. Lethal familial protracted diarrhoea. Arch Dis Child. 1981 Jan;56(1):15–23. doi: 10.1136/adc.56.1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chiaratti de Oliveira A., dos Santos A. M., Martins A. M., D'Almeida V. Screening for inborn errors of metabolism among newborns with metabolic disturbance and/or neurological manifestations without determined cause. Sao Paulo Med J. 2001 Sep 6;119(5):160–164. doi: 10.1590/S1516-31802001000500002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Costalos C. Lactose malabsorption is not a cause of diarrhea during phototherapy. J Pediatr Gastroenterol Nutr. 1986 Mar-Apr;5(2):334–334. [PubMed] [Google Scholar]
  9. Couper R. T., Berzen A., Berall G., Sherman P. M. Clinical response to the long acting somatostatin analogue SMS 201-995 in a child with congenital microvillus atrophy. Gut. 1989 Jul;30(7):1020–1024. doi: 10.1136/gut.30.7.1020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Cutz E., Rhoads J. M., Drumm B., Sherman P. M., Durie P. R., Forstner G. G. Microvillus inclusion disease: an inherited defect of brush-border assembly and differentiation. N Engl J Med. 1989 Mar 9;320(10):646–651. doi: 10.1056/NEJM198903093201006. [DOI] [PubMed] [Google Scholar]
  11. Cutz E., Sherman P. M., Davidson G. P. Enteropathies associated with protracted diarrhea of infancy: clinicopathological features, cellular and molecular mechanisms. Pediatr Pathol Lab Med. 1997 May-Jun;17(3):335–368. [PubMed] [Google Scholar]
  12. Davidson G. P., Cutz E., Hamilton J. R., Gall D. G. Familial enteropathy: a syndrome of protracted diarrhea from birth, failure to thrive, and hypoplastic villus atrophy. Gastroenterology. 1978 Nov;75(5):783–790. [PubMed] [Google Scholar]
  13. De Curtis M., Guandalini S., Fasano A., Saitta F., Ciccimarra F. Diarrhoea in jaundiced neonates treated with phototherapy: role of intestinal secretion. Arch Dis Child. 1989 Aug;64(8):1161–1164. doi: 10.1136/adc.64.8.1161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Di Rocco M., Marta R. X linked immune dysregulation, neonatal insulin dependent diabetes, and intractable diarrhoea. Arch Dis Child Fetal Neonatal Ed. 1996 Sep;75(2):F144–F144. doi: 10.1136/fn.75.2.f144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Evans L., Grasset E., Heyman M., Dumontier A. M., Beau J. P., Desjeux J. F. Congenital selective malabsorption of glucose and galactose. J Pediatr Gastroenterol Nutr. 1985 Dec;4(6):878–886. doi: 10.1097/00005176-198512000-00006. [DOI] [PubMed] [Google Scholar]
  16. Farthing M. J. The role of somatostatin analogues in the treatment of refractory diarrhoea. Digestion. 1996;57 (Suppl 1):107–113. doi: 10.1159/000201412. [DOI] [PubMed] [Google Scholar]
  17. Fonseca E., Contreras F., García-Frías E., Carrascosa M. C. Neonatal lupus erythematosus with multisystem organ involvement preceding cutaneous lesions. Lupus. 1991 Nov;1(1):49–50. doi: 10.1177/096120339100100109. [DOI] [PubMed] [Google Scholar]
  18. Friedman Deborah M., Rupel Ann, Glickstein Julie, Buyon Jill P. Congenital heart block in neonatal lupus: the pediatric cardiologist's perspective. Indian J Pediatr. 2002 Jun;69(6):517–522. doi: 10.1007/BF02722656. [DOI] [PubMed] [Google Scholar]
  19. Gambarara M., Ferretti F., Papadatou B., Diamanti A., Lucidi V., Bella S., Rosati P., Castro M. Complications during home parenteral nutrition in children affected by congenital microvillous atrophy. Transplant Proc. 1997 May;29(3):1870–1871. doi: 10.1016/s0041-1345(97)00104-8. [DOI] [PubMed] [Google Scholar]
  20. Herzog D., Atkison P., Grant D., Paradis K., Williams S., Seidman E. Combined bowel-liver transplantation in an infant with microvillous inclusion disease. J Pediatr Gastroenterol Nutr. 1996 May;22(4):405–408. doi: 10.1097/00005176-199605000-00013. [DOI] [PubMed] [Google Scholar]
  21. Hicks J., Barrish J., Zhu S. H. Neonatal syncytial giant cell hepatitis with paramyxoviral-like inclusions. Ultrastruct Pathol. 2001 Jan-Feb;25(1):65–71. doi: 10.1080/019131201300004708. [DOI] [PubMed] [Google Scholar]
  22. Hill D. J., Heine R. G., Cameron D. J., Francis D. E., Bines J. E. The natural history of intolerance to soy and extensively hydrolyzed formula in infants with multiple food protein intolerance. J Pediatr. 1999 Jul;135(1):118–121. doi: 10.1016/s0022-3476(99)70341-0. [DOI] [PubMed] [Google Scholar]
  23. Hwang Sandy T., Shulman Robert J. Update on management and treatment of short gut. Clin Perinatol. 2002 Mar;29(1):181-94, vii. doi: 10.1016/s0095-5108(03)00070-8. [DOI] [PubMed] [Google Scholar]
  24. Kagitani K., Yamamoto T., Miki K., Matsumoto S., Shima M., Tajiri H., Harada T., Okada S. Hypophosphatemic rickets accompanying congenital microvillous atrophy. J Bone Miner Res. 1998 Dec;13(12):1946–1952. doi: 10.1359/jbmr.1998.13.12.1946. [DOI] [PubMed] [Google Scholar]
  25. Kanof M. E., Rance N. E., Hamilton S. R., Luk G. D., Lake A. M. Congenital diarrhea with intestinal inflammation and epithelial immaturity. J Pediatr Gastroenterol Nutr. 1987 Jan-Feb;6(1):141–146. doi: 10.1097/00005176-198701000-00024. [DOI] [PubMed] [Google Scholar]
  26. Lake B. D. Microvillus inclusion disease: specific diagnostic features shown by alkaline phosphatase histochemistry. J Clin Pathol. 1988 Aug;41(8):880–882. doi: 10.1136/jcp.41.8.880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lundkvist K., Ewald U., Lindgren P. G. Congenital chloride diarrhoea: a prenatal differential diagnosis of small bowel atresia. Acta Paediatr. 1996 Mar;85(3):295–298. doi: 10.1111/j.1651-2227.1996.tb14019.x. [DOI] [PubMed] [Google Scholar]
  28. Martínez Miguel A., Egea Anastasio Serrano, López Javier Manzanares, Benítez Enrique Medina. Intestinal microvillous atrophy in a patient with Down syndrome and aganglionic megacolon. Ultrastruct Pathol. 2002 Jan-Feb;26(1):41–45. doi: 10.1080/01913120252934323. [DOI] [PubMed] [Google Scholar]
  29. Mention K., Michaud L., Dobbelaere D., Guimber D., Gottrand F., Turck D. Neonatal severe intractable diarrhoea as the presenting manifestation of an unclassified congenital disorder of glycosylation (CDG-x). Arch Dis Child Fetal Neonatal Ed. 2001 Nov;85(3):F217–F219. doi: 10.1136/fn.85.3.F217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Michail S., Collins J. F., Xu H., Kaufman S., Vanderhoof J., Ghishan F. K. Abnormal expression of brush-border membrane transporters in the duodenal mucosa of two patients with microvillus inclusion disease. J Pediatr Gastroenterol Nutr. 1998 Nov;27(5):536–542. doi: 10.1097/00005176-199811000-00008. [DOI] [PubMed] [Google Scholar]
  31. Mierau G. W., Wills E. J., Wyatt-Ashmead J., Hoffenberg E. J., Cutz E. Microvillous inclusion disease: report of a case with atypical features. Ultrastruct Pathol. 2001 Nov-Dec;25(6):517–521. doi: 10.1080/019131201753343548. [DOI] [PubMed] [Google Scholar]
  32. Okuma T., Nakamura M., Totake H., Fukunaga Y. Microbial contamination of enteral feeding formulas and diarrhea. Nutrition. 2000 Sep;16(9):719–722. doi: 10.1016/s0899-9007(99)00229-4. [DOI] [PubMed] [Google Scholar]
  33. Oliva M. M., Perman J. A., Saavedra J. M., Young-Ramsaran J., Schwarz K. B. Successful intestinal transplantation for microvillus inclusion disease. Gastroenterology. 1994 Mar;106(3):771–774. doi: 10.1016/0016-5085(94)90714-5. [DOI] [PubMed] [Google Scholar]
  34. Phillips A. D., Jenkins P., Raafat F., Walker-Smith J. A. Congenital microvillous atrophy: specific diagnostic features. Arch Dis Child. 1985 Feb;60(2):135–140. doi: 10.1136/adc.60.2.135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Phillips A. D., Jenkins P., Raafat F., Walker-Smith J. A. Congenital microvillous atrophy: specific diagnostic features. Arch Dis Child. 1985 Feb;60(2):135–140. doi: 10.1136/adc.60.2.135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Phillips A. D., Schmitz J. Familial microvillous atrophy: a clinicopathological survey of 23 cases. J Pediatr Gastroenterol Nutr. 1992 May;14(4):380–396. [PubMed] [Google Scholar]
  37. Phillips A. D., Szafranski M., Man L. Y., Wall W. J. Periodic acid-Schiff staining abnormality in microvillous atrophy: photometric and ultrastructural studies. J Pediatr Gastroenterol Nutr. 2000 Jan;30(1):34–42. doi: 10.1097/00005176-200001000-00015. [DOI] [PubMed] [Google Scholar]
  38. Powell G. K. Enterocolitis in low-birth-weight infants associated with milk and soy protein intolerance. J Pediatr. 1976 May;88(5):840–844. doi: 10.1016/s0022-3476(76)81128-6. [DOI] [PubMed] [Google Scholar]
  39. Raafat F., Green N. J., Nathavitharana K. A., Booth I. W. Intestinal microvillous dystrophy: a variant of microvillous inclusion disease or a new entity? Hum Pathol. 1994 Nov;25(11):1243–1248. doi: 10.1016/0046-8177(94)90043-4. [DOI] [PubMed] [Google Scholar]
  40. Randak C., Langnas A. N., Kaufman S. S., Phillips A. D., Wisecarver J. L., Hadorn H. B., Vanderhoof J. A. Pretransplant management and small bowel-liver transplantation in an infant with microvillus inclusion disease. J Pediatr Gastroenterol Nutr. 1998 Sep;27(3):333–337. doi: 10.1097/00005176-199809000-00012. [DOI] [PubMed] [Google Scholar]
  41. Robe L. B., Gromisch D. S., Iosub S. Symptoms of neonatal ethanol withdrawal. Curr Alcohol. 1981;8:485–493. [PubMed] [Google Scholar]
  42. Roberts J., Searle J. Neonatal diabetes mellitus associated with severe diarrhea, hyperimmunoglobulin E syndrome, and absence of islets of Langerhans. Pediatr Pathol Lab Med. 1995 May-Jun;15(3):477–483. doi: 10.3109/15513819509026984. [DOI] [PubMed] [Google Scholar]
  43. Rose N. C., Kaplan P., Scott S., Kousoulis A., Librizzi R. Prenatal presentation of congenital chloride diarrhea: clinical report and review of the literature. Am J Perinatol. 1992 Sep-Nov;9(5-6):398–400. doi: 10.1055/s-2007-999274. [DOI] [PubMed] [Google Scholar]
  44. Ruemmele F. M., Bindl L., Woelfle J., Buderus S., Phillips A. D., Lentze M. J. Recurrent episodes of necrotizing enterocolitis complicating congenital microvillous atrophy. Dig Dis Sci. 2001 Jun;46(6):1264–1269. doi: 10.1023/a:1010667413709. [DOI] [PubMed] [Google Scholar]
  45. Saudubray J. M., Nassogne M. C., de Lonlay P., Touati G. Clinical approach to inherited metabolic disorders in neonates: an overview. Semin Neonatol. 2002 Feb;7(1):3–15. doi: 10.1053/siny.2001.0083. [DOI] [PubMed] [Google Scholar]
  46. Simmons B. P., Gelfand M. S., Haas M., Metts L., Ferguson J. Enterobacter sakazakii infections in neonates associated with intrinsic contamination of a powdered infant formula. Infect Control Hosp Epidemiol. 1989 Sep;10(9):398–401. doi: 10.1086/646060. [DOI] [PubMed] [Google Scholar]
  47. Soliman A. T., elZalabany M. M., Bappal B., alSalmi I., de Silva V., Asfour M. Permanent neonatal diabetes mellitus: epidemiology, mode of presentation, pathogenesis and growth. Indian J Pediatr. 1999 May-Jun;66(3):363–373. doi: 10.1007/BF02845526. [DOI] [PubMed] [Google Scholar]
  48. Strauss A. A., Modaniou H. D., Bosu S. K. Neonatal manifestations of maternal phencyclidine (PCP) abuse. Pediatrics. 1981 Oct;68(4):550–552. [PubMed] [Google Scholar]
  49. Tyson H. K. Neonatal withdrawal symptoms associated with maternal use of propoxyphene hydrochloride (Darvon). J Pediatr. 1974 Nov;85(5):684–685. doi: 10.1016/s0022-3476(74)80519-6. [DOI] [PubMed] [Google Scholar]
  50. Vanderhoof J. A., Murray N. D., Kaufman S. S., Mack D. R., Antonson D. L., Corkins M. R., Perry D., Kruger R. Intolerance to protein hydrolysate infant formulas: an underrecognized cause of gastrointestinal symptoms in infants. J Pediatr. 1997 Nov;131(5):741–744. doi: 10.1016/s0022-3476(97)70103-3. [DOI] [PubMed] [Google Scholar]
  51. Verloes A., Lombet J., Lambert Y., Hubert A. F., Deprez M., Fridman V., Gosseye S., Rigo J., Sokal E. Tricho-hepato-enteric syndrome: further delineation of a distinct syndrome with neonatal hemochromatosis phenotype, intractable diarrhea, and hair anomalies. Am J Med Genet. 1997 Feb 11;68(4):391–395. doi: 10.1002/(sici)1096-8628(19970211)68:4<391::aid-ajmg3>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  52. Walker-Smith J. A., Phillips A. D., Walford N., Gregory H., Fitzgerald J. D., MacCullagh K., Wright N. A. Intravenous epidermal growth factor/urogastrone increases small-intestinal cell proliferation in congenital microvillous atrophy. Lancet. 1985 Nov 30;2(8466):1239–1240. doi: 10.1016/s0140-6736(85)90762-7. [DOI] [PubMed] [Google Scholar]
  53. Ward E., Picton S. Intolerance to an extensively hydrolysed formula mistaken for postoperative diarrhoea in a child with neuroblastoma. J Hum Nutr Diet. 2001 Apr;14(2):149–152. doi: 10.1046/j.1365-277x.2001.00279.x. [DOI] [PubMed] [Google Scholar]
  54. Zimmerman D. Fetal and neonatal hyperthyroidism. Thyroid. 1999 Jul;9(7):727–733. doi: 10.1089/thy.1999.9.727. [DOI] [PubMed] [Google Scholar]
  55. de Lonlay P., Seta N., Barrot S., Chabrol B., Drouin V., Gabriel B. M., Journel H., Kretz M., Laurent J., Le Merrer M. A broad spectrum of clinical presentations in congenital disorders of glycosylation I: a series of 26 cases. J Med Genet. 2001 Jan;38(1):14–19. doi: 10.1136/jmg.38.1.14. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES