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Dr. Sandhya Ghai

Dr. Sandhya Ghai

National Institute of Nursing Education, Post-graduate Institute of Medical Education & Research, India

Title: Case Report of Exclusive breastfed Neonate with cow milk protein allergy (CMPA)

Biography

Biography: Dr. Sandhya Ghai

Abstract

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 3 months old female baby presented with complaints of streaks of blood in stool. The infant had one episode of blood streak in stool at 2 months of age. At 3 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- +ve. 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 didn’t subside and she was then advised total exclusion of CMP in her diet.  The symptoms however, still persisted. Dietaryre-evaluation revealed intake of CMP from sources having hidden content of milk e.g. bread. Mother was again counselled 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 5 months of age with Semolina (suji) halva and mashed banana. In conclusion, we share our experience of managing a case of allergic procto-colitis due to CMPA in an exclusively breast fed neonate. It is important to remember hidden sources of CMP intake while modifying maternal diet.