Case Report Of Exclusively Breast-fed Neonate With Cow Milk Protein Allergy (CMPA) | 86794
Neonatal and Pediatric Medicine
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The occurrence of Cow Milk Protein Allergy (CMPA) has been recognized in India. Overall the incidence of CMPA in the infants fed with formula milk is 5-7% and in breastfed infants it is 0.5-1%. Though the incidence is less in breastfed infants and early presentation is rare here in this case report we present a case of CMPA associated with exclusive breastfeeding. A three months old female baby presented with complaints of streaks of blood in stool. The infant had one episode of blood streak in stool at two months of age. At three months of age baby was brought for neonatal consultation when episode of blood streak in stool increased to 4 times in a week. The baby was otherwise well. Stool examination revealed reddish yellow ill formed alkaline reaction with traces of mucus and blood, pus cells 12-15, RBC 10-12/HPF, no cyst/ova and eosinophil count was 3 cells/cmm and occult blood positive. Colonoscopy revealed loss of vascular pattern and nodularity + throughout. Biopsy finding revealed intact colonic lining epithelium. Lamina propria shows focal congestion, moderate lymphoplasmacytic cells infiltrate with occasional eosinophils, bits of colonic mucosa with surface inflammatory cell exudate. No significant increase in eosinophils was noted. The mother reported an increased intake of milk and almonds in the days prior to the episode. As the episodes of blood streaks in stool increased, she was initially advised to stop almonds and eggs. But the symptoms did not subside and she was then advised total exclusion of CMP in her diet. The symptoms however, still persisted. Dietary evaluation revealed intake of CMP from sources having hidden content of milk e.g. bread. Mother was again counseled for CMP free diet and breast feed was continued. The episodes of blood streaks in baby’s stools settled. Gradually complementary feed was started at five months of age with semolina (suji) halva and mashed banana. In conclusion, we share our experience of managing a case of allergic proctocolitis due to CMPA in an exclusively breast fed neonate. It is important to remember hidden sources of CMP intake while modifying maternal diet.
Sandhya Ghai is working as a Principal at National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India. She has received Doctorate degree from Panjab University, Chandigarh. She published more than 100 papers in national and international journals. She was awarded with Best Educationist Award and is life member of many organizations.
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