[Cow's milk protein allergy after neonatal intestinal surgery].
Cases of cow's milk protein allergy have been occasionally reported after neonatal intestinal surgery.


OBJECTIVE
To measure the prevalence of cow's milk protein allergy (CMPA) following neonatal intestinal surgery.


METHODS
The files of all children who underwent intestinal surgery in the neonatal period over a four-year-period were reviewed. The diagnosis of CMPA was made on the association of one or several symptoms suggesting food allergy after the introduction of cow's milk protein in the diet, the disappearance of the symptoms after exclusion of cow's milk protein from the diet and their reappearance after reintroduction of cow's milk protein.


RESULTS
During the study period, 251 neonates underwent an intestinal surgery. Among them, 11 babies (4.3%) developed CMPA. None of them had a medical history of family atopy. Moreover, while 5 children were fed with a diet containing cow's milk protein before surgery: none of them presented initially with symptoms suggesting CMPA before intestinal surgery. Small intestine suffering was observed during operation in seven of 11 patients. No specific neonatal digestive disease or malformation was associated with CMPA. The signs revealing CMPA were primarily digestive : diarrhoea (N =3), vomiting (N =4), abdominal distension (N =2), colic or anorexia (N =2). Casein specific immunoglobulin E were present in nine of ten cases, alpha lactalbumin and/or beta lactoglobulin specific immunoglobulin E were present in six of ten cases. Prick test were performed in three children and were positive.


CONCLUSIONS
The high prevalence of CMPA among these patients with no risk factors of allergy raises the question of the role of neonatal intestinal surgery in developing food allergy. These data should be confirmed by prospective case-control studies. They underline the interest to evoke the diagnosis of CMPA when digestive symptoms occur after milk protein introduction in children undergoing neonatal intestinal surgery. Breast feeding or milk protein hydrolysate formula should be used for refeeding these patients.
El Hassani
A
A
Unité de gastroentérologie, hépatologie et nutrition, clinique de pédiatrie, clinique de chirurgie infantile, hôpital Jeanne-de-Flandre, et faculté de médecine, 59037 Lille cedex, France.
Michaud
L
L
Chartier
A
A
Penel-Capelle
D
D
Sfeir
R
R
Besson
R
R
Turck
D
D
Gottrand
F
F
D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D008297:Male; D016269:Milk Hypersensitivity / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors