All issues > Volume 48(9); 2005

Original Article

Korean J Pediatr. 2005;48(9):991-997. Published online September 15, 2005.

Risk Factors for the Early Recognition of Cow's Milk Protein-induced Enterocolitis

Sung Hyuk SH Lee¹, Seon Yun SY Choi¹, Byung Cheol BC Lee¹, Won Joung WJ Choi¹, Byung Kyu BK Choe¹, Yeo Hyang YH Kim¹, Una UN Kang², Sin S Kam³, Jin-Bok JB Hwang¹

¹Departments of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
²Departments of Pathology, Keimyung University School of Medicine, Daegu, Korea
³Department of Preventive Medicine , Kyungpook National University School of Medicine, Daegu, Korea

Correspondence Jin-Bok JB Hwang ,Email: pedgi@korea.com

Abstract

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.

Keywords :Cow's milk protein-induced enterocolitis , Risk factor