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