PE-30: The Prevalence of Cow’s Milk Protein Allergy in Infants with Gastroschisis and Intestinal Failure type 2 and 3

Abstract

Introduction: The prevalence of cow’s milk protein allergy (CMPA) in infants with gastroschisis has been reported as high as 45% [1], which is significantly higher than in the general infant population (0.5-1% of breast fed babies and 5-7% in formula-fed babies)[2]. We aimed to define the prevalence of CMPA in infants with gastroschisis and type 2 or 3 intestinal failure (IF) and compare this to other groups of infants with type 2 or 3 IF. Methods: We obtained parenteral nutrition (PN) prescriptions for infants born between July 2015 and June 2020 who had been on PN for more than 28 days (with type 2 or 3 IF) in our tertiary intestinal rehabilitation centre. We only included infants presenting in the first year of life with type 2 or 3 IF related to a gastrointestinal disorder, other than enteropathies. We recorded the underlying cause of IF and the number of patients clinically diagnosed with CMPA. The diagnosis of CMPA was made by the clinical team on the basis of gastrointestinal symptoms, presence of macroscopic blood in the stools and lack of any other alternative diagnosis with symptom resolution after initiation of a hydrolysed or amino acid based formula. We then obtained the feeding records of the patients and noted the number of infants on a hydrolysed and amino acid based formula during their hospitalisation and at the latest dietetic follow up. Results: Of 112 infants assessed, 23 (21%) were diagnosed with gastroschisis and 29 (26%) with necrotising enterocolitis (NEC); 25/29 (86%) of these were surgically managed. CMPA was diagnosed in 3/23 (13%) infants with gastroschisis, 5/25 (20%) of infants with surgically managed NEC and 5/64 (8%) of infants with other causes of type 2 and 3 IF. Out of 23 patients with gastroschisis, only one was discharged on home PN with no concerns of CMPA. Of the total 112 infants, 98 (88%) presented with type 2 IF and only 7 (7%) were also diagnosed with CMPA, while 14 (14%) infants were discharged on home PN and 6 (43%) were also diagnosed with CMPA. An amino acid based formula was trialled in 30/112 (27%) infants at some point during their hospitalisation. A hydrolysed formula was used in 54/112 (48%) infants with type 2 or 3 IF, in order to treat fat and sugar malabsorption, with 57% of children continuing to take a hydrolysed formula at the last recorded dietetic follow up. Three out of the 13 infants with CMPA (two with gastroschisis) have tolerated a dairy containing diet later on. Conclusions: The prevalence of CMPA in infants with gastroschisis and type 2 or 3 IF is much lower than previously reported. CMPA is most prevalent in infants with surgically managed NEC and type 2 or 3 IF, whilst the prevalence of CMPA in type 3 IF in general is significantly higher. The use of hydrolysed formula for the management of malabsorption may be masking the diagnosis of CMPA in children with type 2 IF.