English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Tools annual

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Presents the access of premium content as premium feature

Premium Content

Global: Zendy Plus annual

Global: Zendy Free Plan

Food protein-induced enterocolitis syndrome (FPIES) is an IgE-independent allergic disease that manifests with gastrointestinal symptoms such as vomiting and diarrhea [1]. We report 2 neonatal cases of FPIES presenting with transient biliary dilatation and pale stool. Patient 1 was a girl with a gestational age of 34 weeks and birth weight of 2206 g. Owing to the preterm birth, she was admitted to the neonatal intensive care unit. Enteral feeding with cow’s milk was initiated on the day of birth, and the amount given was gradually increased. Pale stool (Supplementary Figure S1) was observed after 7 days; the patient had repeated vomiting episodes after taking cow’s milk and exhibited general malaise, bloody stools, and diarrhea after 8 days (Supplementary Figure S2). Abdominal ultrasound revealed dilatation of the biliary tract (Supplementary Figure S3). A blood test revealed total bilirubin (T-Bil) of 14.10 mg/dL and direct bilirubin (D-Bil) of 1.51 mg/dL. The patient was suspected of having FPIES caused by cow’s milk proteins. Consequently, she could no longer receive milk, and fluid supplementation and central venous nutritional therapy were initiated. Once vomiting and bloody stools had resolved with no recurrence after discontinuation of milk feeding, enteral feeding comprising breast milk or extensively hydrolyzed casein formula (New MA-1) was initiated from day 10, and no recurrence of symptoms was observed. A fecal test on day 8 revealed eosinophil accumulation; the blood test revealed cow’s milk–specific IgE antibody titers of less than 0.10 UA/mL. In addition, an allergen lymphocyte stimulation test (ALST) with lactoferrin was positive, with a stimulation index (SI) of 4.06. Although transient elevation of D-Bil was also observed, D-Bil levels gradually normalized after peaking at 2.09 mg/dL on day 13. Ultrasound on day 9 revealed improvement in biliary dilatation. The patient continued to receive breast milk or extensively hydrolyzed casein formula and was discharged on day 22. She continued to receive either breast milk or extensively hydrolyzed casein formula orally after discharge, and no gastrointestinal symptoms were reported. An oral food challenge with cow's milk was performed at 5 months of age, after obtaining informed written consent from the patient’s guardian. As a result, approximately 30 minutes after receiving 20 mL of milk, the patient developed swelling and redness on her face. After 1 month, cow’s milk–specific IgE titers were 3.16 UA/mL. Patient 2 was a girl with a gestational age of 39 weeks and birth weight of 3328 g. Oral feeding with cow’s milk was introduced on the day of birth. The patient had repeated vomiting episodes after taking cow’s milk from day 4. In addition, she experienced bloody stools, diarrhea (Supplementary Figure S4), and general malaise from day 7. She was subsequently referred to our hospital. FPIES caused by cow’s milk proteins was suspected. In response, the patient no longer received milk, and fluid supplementation and central venous nutritional therapy were initiated. No vomiting was observed, and the patient’s bloody stools improved, disappearing on day 12. Abdominal ultrasound on day 15 revealed biliary dilatation (Figure), as well as elevated D-Bil levels (>2 mg/dL). Enteral nutrition comprising breast milk or extensively hydrolyzed casein formula (New MA-1) was initiated on day 16, and no vomiting or bloody stools were observed. Although pale stools (Supplementary Figure S5) were identified on day 23, this symptom, as well as biliary dilatation, had disappeared by day 28. Cow’s milk–specific IgE antibody titers were <0.10 UA/mL, and ALSTs with lactoferrin and κ-casein resulted in an SI of 10.75 and 31.97, respectively. Biliary dilatation and pale stools improved over time, and there were no organic disorders of the biliary tract. The patient continued to receive breast milk or extensively hydrolyzed casein formula and was released on day 37, with no recurrence of symptoms. However, 1 hour after accidental ingestion of processed products containing milk at age 1.3 years, she exhibited repeated vomiting and asthenia and was taken immediately to hospital, where she received intravenous corticosteroids. To our knowledge, this is the first report of transient biliary dilatation and pale stool caused by FPIES. FPIES is diagnosed based on a single major criterion and 3 or more other minor criteria [2-5]. FPIES is difficult to

Two Neonatal Cases of Food Protein-Induced Enterocolitis Syndrome With Pale Stool and Transient Biliary Dilatation