Food protein-induced enterocolitis syndrome versus necrotizing enterocolitis of the newborn, is there a relationship?

Main Article Content

Angela B. Hoyos

Abstract

In recent years in neonatal units, an increase number of babies have protein allergy to cow's milk called by some FPIES (Food protein-induced enterocolitis syndrome), including term and preterm infants. Proinflammatory interleukin elevation has been reported associated to this syndrome. Hospitalized babies present in good condition but with severe abdominal distension, hematochezia, vomiting and/or diarrhea. After transient interruption of oral route and later hydrolyzed milk feedings, they become asymptomatic. Probiotics therapy has been used. On the other hand, extreme premature and some term infants develop necrotizing enterocolitis (NEC) with similar but more severe symptoms, with pneumatosis and some with porta vein gas and/or pneumoperitoneum. The incidence is higher in babies fed bovine derivate milk nutrition. NEC triggers are unknown, but probiotics are preventive. In Clínica del Country´s NICU in nine years, we treated 76 FPIES and 27 NEC. The FPIES were more mature, older and 0 mortality. NEC were very immature, younger and with 63% mortality. Three clinical scenarios are presented that illustrates the similarities and differences of these two pathologies. We speculate that proinflammatory cascade is triggered by the same antigen but acting on different populations, and so, producing either FPLIES or NEC. If this is true, hydrolyzed fortifiers could be useful.


 

Keywords: necrotizing enterocolitis, neonatal, food protein-induced enterocolitis syndrome, fortifiers

Article Details

How to Cite
HOYOS, Angela B.. Food protein-induced enterocolitis syndrome versus necrotizing enterocolitis of the newborn, is there a relationship?. Medical Research Archives, [S.l.], v. 8, n. 4, apr. 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2099>. Date accessed: 06 dec. 2024. doi: https://doi.org/10.18103/mra.v8i4.2099.
Section
Research Articles

References

1 Mehr S, Frith K, Barnes EH, Campbell DE; FPIES Study Group. Food protein-induced enterocolitis syndrome in Australia: A population-based study, 2012-2014. J Allergy Clin Immunol. 2017 Nov;140(5):1323-30.
2 Kimura M, Shimomura M, Morishita H, Meguro T, Seto S. Serum C-reactive protein in food protein-induced enterocolitis syndrome versus food protein-induced proctocolitis in Japan. Pediatr Int. 2016 Sep;58(9):836-41.
3 Nowak-Wegrzyn A, Berin MC, Mehr S. Food Protein-Induced Enterocolitis Syndrome. J Allergy Clin Immunol Pract. 2020 Jan;8(1):24-35.
4 Lenfestey MW, de la Cruz D, Neu J. Food Protein-Induced Enterocolitis Instead of Necrotizing Enterocolitis? A Neonatal Intensive Care Unit Case Series. J Pediatr. 2018 Sep;200:270-3.
5 Capitan F, Robu AC, Schiopu C, et al. β-Lactoglobulin detected in human milk forms noncovalent complexes with maltooligosaccharides as revealed by chip-nanoelectrospray high-resolution tandem mass spectrometry. Amino Acids. 2015 Nov;47(11):2399-407.
6 Guadamuro L, Diaz M, Jiménez S, et al. Fecal Changes Following Introduction of Milk in Infants With Outgrowing Non-IgE Cow's Milk Protein Allergy Are Influenced by Previous Consumption of the Probiotic LGG. Front Immunol. 2019 Aug 2;10:1819
7 Qamer S, Deshmukh M, Patole S. Probiotics for cow's milk protein allergy: a systematic review of randomized controlled trials. Eur J Pediatr. 2019 Aug;178(8):1139-49.
8 Kimura M, Ito Y, Shimomura M, Morishita H, Meguro T, Adachi Y, Seto S. Cytokine profile after oral food challenge in infants with food protein-induced enterocolitis syndrome. Allergol Int. 2017 Jul;66(3):452-7.
9 D'Apolito M, Campanozzi A, Giardino I, Pettoello-Mantovani M. Levels of inflammatory cytokines from peripheral blood mononuclear cells of children with cow's milk protein allergy. Turk Pediatri Ars. 2017 Dec 1;52(4):208-12.
10 Jones IH, Hall NJ. Contemporary Outcomes for Infants with Necrotizing Enterocolitis-A Systematic Review. J Pediatr. 2020 Jan 22. pii: S0022-3476(19)31519-7
11 Overman RE Jr, Criss CN, Gadepalli SK. Necrotizing enterocolitis in term neonates: A different disease process? J Pediatr Surg. 2019 Jun;54(6):1143-6.
12 Tracy SA, Lazow SP, Castro-Aragon IM, et al. Is Abdominal Sonography a Useful Adjunct to Abdominal Radiography in Evaluating Neonates with Suspected Necrotizing Enterocolitis? J Am Coll Surg. 2020 Feb 17.
13 Ochoa TJ, Mendoza K, Carcamo C, Zegarra J, Bellomo S, Jacobs J, Cossey V. Is Mother's Own Milk Lactoferrin Intake Associated with Reduced Neonatal Sepsis, Necrotizing Enterocolitis, and Death? Neonatology. 2020 Feb 13:1-8.
14 Sandhu A, Fast S, Bonnar K, Baier RJ, Narvey M. Human-Based Human Milk Fortifier as Rescue Therapy in Very Low Birth Weight Infants Demonstrating Intolerance to Bovine-Based Human Milk Fortifier. Breastfeed Med. 2017 Nov;12(9):570-3.
15 Sánchez-Hidalgo VM, Flores-Huerta S, Matute-González G, Urquieta-Aguila B, Bernabe-García M, Cisneros-Silva IE. A fortifier comprising protein, vitamins, and calcium-glycerophosphate for preterm human milk. Arch Med Res. 2000 Nov-Dec;31(6):564-70.
16 Cruz D, Bazacliu C. Enteral feeding composition and necrotizing enterocolitis. Semin Fetal Neonatal Med. 2018 Dec;23(6):406-10
17 Pillai A, Albersheim S, Matheson J, Lalari V, Wei S, Innis SM, Elango R. Evaluation of A Concentrated Preterm Formula as a Liquid Human Milk Fortifier in Preterm Babies at Increased Risk of Feed Intolerance. Nutrients. 2018 Oct 4;10(10).
18 Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev. 2013 Oct;89 Suppl 2:S13-20.
19 Wisgrill L, Weinhandl A, Unterasinger L, et al. Interleukin-6 serum levels predict surgical intervention in infants with necrotizing enterocolitis. J Pediatr Surg. 2019 Mar;54(3):449-54.
20 Terrin G, Stronati L, Cucchiara S, De Curtis M. Serum Markers of Necrotizing Enterocolitis: A Systematic Review. J Pediatr Gastroenterol Nutr. 2017 Dec;65(6):e120-32.
21 Robertson C, Savva GM, Clapuci R, Jones J, Maimouni H, Brown E, Minocha A, Hall LJ, Clarke P. Incidence of necrotising enterocolitis before and after introducing routine prophylactic Lactobacillus and Bifidobacterium probiotics. Arch Dis Child Fetal Neonatal Ed. 2019 Oct 30
22 AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2014 Apr 10;(4):CD005496.
23 Chi C, Buys N, Li C, Sun J, Yin C. Effects of prebiotics on sepsis, necrotizing enterocolitis, mortality, feeding intolerance, time to full enteral feeding, length of hospital stay, and stool frequency in preterm infants: a meta-analysis. Eur J Clin Nutr. 2019 May;73(5):657-70.