Human milk fortifier: an occult cause of bowel obstruction in extremely premature neonates.
BACKGROUND
Human milk fortifier (HMF) is used in neonatal units throughout North America to facilitate growth of preterm infants. Little data is available on the gastrointestinal side effects and potential adverse events. The purpose of this paper was to present a series of infants presenting with bowel obstruction associated with HMF.


METHODS
Cases of HMF obstruction were collected between January 2010 and December 2012. Charts were reviewed and relevant data was collected.


RESULTS
During the study period, 7 premature infants presented with bowel obstruction secondary to intestinal concretions of HMF. All babies were premature with gestational ages from 25 to 27 weeks. Birth weight was less than 1000 grams in all patients. Patients presented with feeding intolerance, bilious aspirates, abdominal distension, and obstipation. Four of the patients presented with acute deterioration and required urgent surgical intervention.


CONCLUSIONS
HMF is an important source of nutritional support in infants, which is felt to be safe. We present a series of infants where its use has resulted in significant complications. HMF should be used with caution in infants, especially those with a history of necrotizing enterocolitis. Further research should examine the calcium, protein, and fatty acid concentration tolerable in the gastrointestinal tract of infants.
Department of Surgery, Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Jennifer
J
Stanger
Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Kelley
K
Zwicker
Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Susan
S
Albersheim
Department of Surgery, Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada. Electronic address: jmurphy@cw.bc.ca.
James J
JJ
Murphy
D020345:Enterocolitis, Necrotizing / Q000150:complications; D005260:Female; D005527:Food, Fortified / Q000009:adverse effects*; D006801:Humans; D041943:Infant Formula; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D008297:Male; D008895:Milk, Human; D012189:Retrospective Studies
Human milk fortifier; Lactobezoar; Neonatal bowel obstruction; Premature infants