top of page

Cow’s milk protein allergy in preemie

Writer's picture: CPBFCPBF

By Dr. Namrata Todurkar




Starting feeds and maintaining optimal growth is one of the most important aspects of NICU care. The smaller the baby, the greater the risk of feeding intolerance. Mother’s milk is the best form of nutrition for preterm babies, but due to a variety of reasons, formula feeds are also used. Most of the commercially available preterm formulas are made up of cow’s milk derived proteins. Cow’s milk proteins are comprised of two major protein fractions: casein (76% to 86%), and whey (14% to 24%), both of which are responsible for sensitizing babies prone to allergy when cow’s milk is introduced through formula or when a breastfeeding mother consumes dairy products. Cow's milk protein allergy (CMPA) is one of the most common food allergies affecting neonates, with significant implications for their health, growth, and overall well-being. This immune-mediated response to the proteins found in cow's milk can present in a variety of ways, often mimicking other conditions, which can complicate diagnosis and management. This blog will discuss CMPA in preterm neonates.


What is CMPA?


CMPA is an adverse reaction triggered by the immune system in response to cow's milk proteins, such as casein and whey. Unlike lactose intolerance, which is related to the digestive system's inability to process lactose (a sugar in milk), CMPA involves an immune reaction that can affect multiple systems in the body.


What are the Symptoms of CMPA?


Symptoms of CMPA usually appear within a week of exposure to cow’s milk in the baby’s diet. The age of diagnosis is inversely correlated with postnatal age in preterm infants. This may be because it takes many weeks for their immune systems to mature enough to produce an adverse immune response. Preterm infants may be more at risk for CMPA because they have more intestinal permeability, which can allow antigens to be absorbed. CMPA can be difficult to differentiate from necrotizing enterocolitis (NEC) or sepsis because the clinical presentation can be quite similar such as:


· Blood/mucus in stools

· Vomiting

· Abdominal distention

· Diarrhea

· Eczema-like rash

· Poor growth

· Poor feeding

· Irritability

· Gastro-esophageal reflux symptoms


However, babies with CMPA are generally stable with normal vital signs and have normal laboratory parameters when investigated for sepsis. They may however have overlapping abdominal X-ray findings and therefore it is very important to not miss NEC when a baby presents with blood/mucus in stools.


How is CMPA managed?


The cornerstone of CMPA management is the elimination of cow's milk proteins from the neonate’s diet:


1. For breastfed infants: Mothers need to remove all dairy from their diets, as these proteins can pass into breast milk. Support from a dietitian is essential to ensure maternal nutrition.


2. For formula-fed infants: Switching to a hypoallergenic formula is recommended. Options include:

◦ Extensively hydrolyzed formulas: Where proteins are broken down into smaller fragments, making them less likely to trigger an allergic response.

◦ Amino acid-based formulas: Used in severe cases or when symptoms persist despite using extensively hydrolyzed formulas.


What are the outcomes with a CMPA diagnosis?


The prognosis for CMPA in neonates is generally excellent. Most children outgrow the allergy by the age of 1 to 3 years. Periodic assessments by healthcare providers can help determine when it is safe to reintroduce cow's milk. This process should be done cautiously, often starting with small amounts in a controlled setting.


Summary:


Cow’s milk protein allergy in neonates is a complex but manageable condition. Necrotizing enterocolitis and sepsis must be ruled out with certainty before coming to a diagnosis of CMPA. Early recognition and proper management are key to alleviating symptoms, promoting growth, and ensuring the well-being of affected infants. CMPA can place a significant emotional and financial burden on families, especially if the allergy is severe or poorly understood. Education and support are critical in helping families navigate dietary changes and avoid accidental exposure. Collaboration with dieticians, allergists, and pediatricians ensures comprehensive care





Dr. Namrata Todurkar, MBBS, MD (Pediatrics), DNB (Pediatrics). Fellowship in Neonatology from National Neonatology Forum India. Fellow in Neonatal-Perinatal Medicine at the University of British Columbia. Areas of interest: Neonatal nutrition, Fluid and Electrolyte Management, Inborn Errors, Neurodevelopmental follow-up of preterm infants. Dr. Todurkar is a volunteer blogger at CPBF.




109 views0 comments

Recent Posts

See All

Comments


  • Facebook
  • Youtube
  • Instagram
  • X
  • LinkedIn

Thanks to our sponsor AstraZeneca for supporting the redesign of this website.

CBPF-logo-oct2021-horizontal-purple.png

4225B Dundas St W,  
Etobicoke, ON. M8X1Y3
Charitable registration number 801837287RR0001

EFCNI_Award_2020_CPBF_FBPC.png

Contact us

Success! Message received.

CPBF strives to be sensitive and responsive and welcoming to everybody. If there is a misuse of language or terminology, please let us know in a professional and constructive manner.

bottom of page