Milk curd problems in preterm infants are not just about obstructive symptoms

Curds in the way: A milk curd obstruction review and normal sonographic bowel appearances using a novel scoring system in neonates on fortified breast milk feeds

“…[1][2][3][4][5][6] It is an obstruction of the gastrointestinal tract with a gritty substance formed by calcium and fatty acids due to an imbalance between the delivered nutrients in milk feeds and the absorptive capacity of the neonatal gut. [6][7][8][9] A rare but recognised pathology in neonates, it is most common in the ileum but can occur elsewhere in the small bowel or colon. 1 The condition has an interesting history, paralleling changes in infant feeding practices.…”

“…Necrotising enterocolitis (NEC) has been reported in association with MCO as well, with and without coexisting surgery. 6,7,14 Dehydration may be a self-perpetuating risk factor, with MCO causing vomiting and reduced feeds. 1,5 Males are overrepresented in most case series, but no potential basis for this association has been proposed.…”

“…1,5 Males are overrepresented in most case series, but no potential basis for this association has been proposed. [1][2][3][4][5][6][7][8][9]14,16,[18][19][20][21] Early symptoms of MCO may mimic NEC with feed intolerance, bilious vomiting, decreased stooling, bloody stool, abdominal distension, perforation and/or physiological instability. 1,7,14,15,18 Pale acholic stooling or a palpable mass in the right lower quadrant may be more MCO specific.…”

“…[1][2][3][4][5][6][7][8][9]14,16,[18][19][20][21] Early symptoms of MCO may mimic NEC with feed intolerance, bilious vomiting, decreased stooling, bloody stool, abdominal distension, perforation and/or physiological instability. 1,7,14,15,18 Pale acholic stooling or a palpable mass in the right lower quadrant may be more MCO specific. 9,20 Abdominal radiography may show dilated loops of the small bowel with air-fluid levels and distal bowel gas paucity.…”

“…Milk curd obstruction (MCO) has historically been referred to as intestinal lactobezoar, milk inspissation syndrome, milk bolus obstruction, fecalith and fatty acid calcium stones 1–6 . It is an obstruction of the gastrointestinal tract with a gritty substance formed by calcium and fatty acids due to an imbalance between the delivered nutrients in milk feeds and the absorptive capacity of the neonatal gut 6–9 . A rare but recognised pathology in neonates, it is most common in the ileum but can occur elsewhere in the small bowel or colon 1 …”