Different clinical manifestation of cow’s milk allergy in two preterm twins newborns

Abstract

Adverse reactions to cow's milk in the first year of life occur in 2-7%. There is an increase in the incidence of cow's milk protein allergy (CMA) in newborn population including premature infants. We report two cases of CMA in preterm twins. The first one developed recurrent episodes of proctocolitis and the second one two necrotizing enterocolitis (NEC) -like episodes. Our cases demonstrate different clinical presentations of the same disease and add to literature the peculiarity of the early onset, the recurrence of episodes of enterocolitis associated with increasing systemic eosinophilia and episodes clinically and radiologically mimicking NEC.

Different presentations of cow`s milk protein allergy during neonatal period

“…However NEC is the most important differential diagnosis to exclude in preterm neonates with rectal bleeding especially if accompanied with signs of systemic instability. As seen in the literature review 3 preterm cases and 1 term newborn had presented with signs of NEC and initially treated as such who later were diagnosed to have allergic proctocolitis 1,3,7 . Two of them even received NEC treatment twice 1,3 .…”

“…As seen in the literature review 3 preterm cases and 1 term newborn had presented with signs of NEC and initially treated as such who later were diagnosed to have allergic proctocolitis 1,3,7 . Two of them even received NEC treatment twice 1,3 . NEC was suspected in three of our preterm cases because of abdominal distension, CRP positivity and dilated intestinal loops on plain radiography which necessitated broad spectrum antibiotics and cessation of enteral feeding at least for a short period of time.…”

“…CMPA is considered to develop due to exposure to cow's milk proteins transferred via breast milk and/or formula 1 . Approximately half of the cases occur during exclusive breastfeeding supporting the possibility of transfer of cow's milk protein via breast milk 2 .…”

“…Cow's milk protein allergy (CMPA) is the most common cause of allergy in infants 1 . The incidence of CMPA in the first year of life is 2-7% and is reported as 0.34-2 % in preterms 2 , although there seems to be an increase in recent years in preterm population.…”

“…The incidence of CMPA in the first year of life is 2-7% and is reported as 0.34-2 % in preterms 2 , although there seems to be an increase in recent years in preterm population. Since 1990, 20 cases who were diagnosed to have CMPA during neonatal period have been reported in English literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . The most common clinical sign of CMPA is bloody stool in a well-appearing infant.…”