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KMID : 0367420050480090991
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Journal of Korean Pediatric Society
2005 Volume.48 No. 9 p.991 ~ p.997
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Risk Factors for the Early Recognition of Cow’s Milk Protein-induced Enterocolitis
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Lee Sung-Hyuk
Choi Seon-Yun
Lee Byung-Cheol
Choi Won-Joung
Choi Byung-Kyu
Kim Yeo-Hyang
Kang Yu-Na
Kam Sin
Hwang Jin-Bok
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Abstract
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Purpose: Cow’s milk protein-induced enterocolitis(CMPIE) is a symptom complex of vomiting and/ or diarrhea caused by delayed hypersensitivity and may result in serious complications. This study was undertaken to identify high risk factors to facilitate the early recognition of CMPIE.
Methods: We reviewed the data of 101 patients, aged 15 to 45 days, admitted due to vomiting and/ or diarrhea between 2003 and 2004. After excluding 13 patients absolutely breast-fed and 2 patients transferred from other hospitals with the impression of CMPIE, the 86 study subjects were divided into three groups based on the underlying etiologies; CMPIE, infectious and non-infectious group.
Results: CMPIE was diagnosed in 11 patients(12.8%). On admission, failure to gain weight(P= 0.003), hypoalbuminemia(P=0.003), peripheral leukocytosis(P=0.015), and metabolic acidosis(P=0.014) were more significant in the CMPIE group than in the others. Multiple logistic regression analysis showed that the independent predictors of high risks for CMPIE were failure to gain weight <10 g/day(OR, 10.25[95% CI, 1.62-65.06]) and serum hypoalbuminemia <3.5 g/dL(OR, 9.18[95% CI, 1.69- 49.74]). Cow’s milk challenges were performed in the 11 CMPIE patients; vomiting(81.8%), abnormal stool test(80.0%), peripheral leukocyte count and absolute neutrophil count(ANC) increase(100.0%) (P<0.05), and enteropathy(100.0%).
Conclusion: CMPIE is not a rare clinical disease in early infancy. The high risk factors of CMPIE were identified as follow:failure to gain weight below 10 g/day, hypoalbuminemia on admission and a rapid decrease during admission. Cow’s milk challenge test with endoscopic duodenal biopsy was helpful to confirm CMPIE.
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KEYWORD
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Cow’s milk protein-induced enterocolitis, Risk factor
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