Objective: A randomized, double-blind controlled study compared breastfeeding, partially-and extensively-hydrolyzed protein formulas (pHF and eHF) in their effect on cow' milk allergy (CMA) and atopic symptoms in infants at risk of allergy.Methods: Healthy, full-term infants were randomized to receive a whey pHF or a whey eHF, either exclusively from birth to 4 months of age or at weaning when mothers were willing to breastfeed child. The population consisted of 141 (ITT) and 104 (PP) children in the pHF group and 138 (ITT) and 90 (PP) in the eHF group, of whom respectively 40 (ITT) and 32 (PP) and 38 (ITT) and 31 (PP) were partially breastfed. At 4 months, a milk oral food challenge was performed and at 4 and 12 months, skin prick tests with various food antigens and plasma immunoglobulin concentrations were measured. Standard growth parameters were followed. Results:The incidences of CMA and of reactions to other food antigens were similarly low in all groups. Total IgE plasma concentrations increased between 4 and 12 months in all groups but increased significantly (p=0.048) less with pHF (16.92±47.11 kU/L) than with eHF (23.68±41.29 kU/L). There was an unexpectedly higher hemoglobin level in infants fed a pHF or an eHF compared to breastfeeding. Infants in all groups grew normally according to WHO standards. Conclusion:The whey pHF and the eHF reduced the risk of CMA and of atopic symptoms similarly. The pHF was superior in reducing IgE levels during the first year of life.

micrognathia, broad occiput, low set ears, single palmar crease, and large cleft palate. Subsequent genetic tests confirmed unbalanced translocation of chromosome 3 and 7. She was gradually weaned off ventilator support at 2 weeks and was discharged from NICU. A week following discharge she presented with bronchiolitis and has continued need for High flow (Vapotherm) support. She feeds on high energy formula via a nasogastric tube due to poor weight gain and remains on treatment for moderate to severe reflux. She islikely to need gastrostomy and cleft surgery. Conclusion Dysmorphic features as reported in this case report should raise suspicion of a chromosomal defect, which needs early genetic referral and microarray. Balanced translocations are common and usually do not have specific clinical features. However unbalanced translocations are uncommon but they may have significant clinical expressions.