Abstract
Aims
Cow milk protein allergy (CMPA) is a common condition of infancy, with an incidence of between 2–5% amongst formula fed infants. Despite the regularity with which this condition is encountered, there is a paucity of data, in part due to the diverse clinical presentation and lack of definitive diagnostic tests. Current management beyond dietary exclusion of cow’s milk protein involves the use of a semi-elemental or elemental formula.
Methods
A retrospective chart review of applications made to the Home Enteral Nutrition (HEN) program for CMPA was undertaken. The HEN program is a provincial service co-ordinating the allocation of formula to children requiring specialised formula.
Results
From 2004 - 2014, 210 patients were provided semi-elemental or elemental formula on the basis of suspected CMPA. Overall, an increasing trend in referrals was seen. In 2004 only 3 patients were provided specialized specialised formula vs 41 in 2013. The median age at application was 3.5 months (IQR: 2.0; 6.3) with 51.4% being male.
Symptoms at presentation indicated that bloody diarrhoea with or without emesis was present in 53.4% of patients, with other presentations including isolated emesis in 16.2%, non-bloody diarrhoea in 13.3%, and a combination of vomiting and diarrhoea in 8.6%. Miscellaneous symptoms including failure to thrive, irritability, and others make up the remaining 8.6%.
The median weight-age Z score at baseline was -0.81 (IQR: -1.85; 0.02), indicative of an underweight for age population. The referral pathway most commonly utilised included pediatric gastroenterologist in 49.6% and paediatricians in 45.2% of referrals. Family doctor referrals accounted for only 5.2% of the cases.
Elemental formula was used in 66.7% of cases. Feed administration was achieved orally in 96% of patients, with only 4% of children requiring ng tube feeds.
The median duration for utilisation of specialised formula was 10.5 months (IQR: 6; 12), with a median age at termination of HEN support at 13 months (IQR: 12; 18), indicative of successful transition to milk protein containing diet at one year of age in the majority of patients. The duration of formula use did not differ depending on the formula type or presentation (bloody diarrhea or not) (p=0.577). 100% of patients had discontinued the use of the specialized formula by three years of age.
Conclusions
An increased trend was seen for the number of children utilizing specialized formula for CMPA, however the duration of formula supplementation is in keeping with other international centres. Our group did have a higher use of elemental formula (vs. semi-elemental) however this may be on account of the incremental cost of elemental formula. Presenting symptoms did not highlight a differential duration of formula use and all patients improved with time.
Funding Agencies
None