Lactobezoars in the neonate

Abstract

Lactobezoars (LB) were commonly reported in preterm (PT) infants prior to the introduction of whey predominant formulas. The earlier reports of LB in term infants were related to improper formula mixing and/or dehydration. LB were of concern because they resulted in obstruction and prevented the advancement of enteral feedings and optimal nutrition. Recently 2 term and 2 PT infants in the nursery developed LB during a 3 month period. Gestational age (GA) and birth weight (BW) for the PT infants were 32 weeks (wk), 1790 grams (g) and 29 wk, 1199 g. Both infants had patent ductus arteriosus and respiratory distress. Both were treated with theophylline. One had hyperbilirubinemia and the other had periventricular encephalomalacia and atrial septal defect. GA and BW of the term infants were 41 wk, 3401 g and 38 wk, 4000 g. One infant had hyperbilirubinemia and seizure-like activity. She received phenobarbital and morphine sulfate. The other infant had meconium aspiration, sepsis, and persistent fetal circulation and was treated with extracorporeal membrane oxygenation, pavulon, and morphine sulfate. Apgar scores at 5 minutes were ≥ 6 in all 4 infants. The term infants and 1 PT infant were initially fed a casein predominant 20 kcal/oz formula. One PT infant was fed a 24 kcal/oz whey predominant formula. Three were fed by bolus orogastric, and the 38 wk infant was bottle fed. Improper formula mixing was avoided by using ready-to-feed formulas. LB occurred between 9 and 32 days, and were diagnosed by barium studies. All infants were made NPO and 3 received saline gastric lavage and transpyloric feedings past the LB. All infants required parenteral nutrition (PN). In conclusion, LB are still occurring in infants and are not limited to PT infants. Medical complications and casein predominant formulas may lead to LB formation. Persistent signs of feeding intolerance suggests the presence of LB. Early evaluation and treatment may prevent prolonged PN.