Jamie Alexander Grech, Pace K, Mizzi C and Shoukry M
Mater Dei Hospital, Malta
Posters & Accepted Abstracts: J Neonatal Biol
Cow’s Milk Protein Allergy (CMPA) represents the majority of food allergies in children, especially in early childhood, with an incidence of up to 3% in the first year of life. Indeed, 90% of patients develop CMPA before they reach 3 months of age and often within a week of introducing cow’s milk protein into their diet. Classical presentation may involve variable gastrointestinal symptomatology, inclusively regurgitation, vomiting, diarrhoea or constipation, among other non-gastrointestinal signs and symptoms. We report an unusual presentation of CMPA in a previously healthy eight day old formula fed baby girl, who was admitted due to multiple episodes of vomiting followed by a single instance of bile-stained vomiting associated with marooncoloured blood stained stools on the first day of admission. Physical examination was non-remarkable. Initial diagnostic investigation included a water-contrast upper gastrointestinal tract study with follow-through and delayed films, to exclude mid-gut malrotation as sinister surgical pathology. Elimination of ominous pathologies from the differential diagnosis and cessation of symptoms with interruption of formula feeds led to a working diagnosis of CMPA. Reintroduction of hypo-allergic formula feeds elicited no relapse of symptoms, and the patient improved dramatically, further supporting this diagnosis. High index of suspicion is mandatory in management of such challenging cases.
Jamie Grech completed undergraduate medical education at the University of Malta in 2016, before completing a Postgraduate Certificate in Child Welfare and Wellbeing from Oxford Brookes University. He is currently reading for a Master of Science degree in Neonatal Medicine at Cardiff University while undergoing Foundation Programme training at Mater Dei Hospital, Malta.