Department of Pediatrics, University of Florida Shands Children's Hospital, Gainesville, FL 32608, United States.
Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Florida Shands Children's Hospital, Gainesville, FL 32608, United States.
World J Gastroenterol. 2023 Sep 7;29(33):4920-4926. doi: 10.3748/wjg.v29.i33.4920.
Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung's disease (HD), meconium ileus due to Cystic Fibrosis, The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis, such as anorectal manometry or rectal suction biopsy. What if there was another etiology of perinatal constipation, that is far lesser known? Cow's milk protein allergy (CMPA) is often diagnosed in infants within the first few weeks of life, however, there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero, therefore allowing symptoms to show as early as day one of life. The presentation is more atypical, with perinatal constipation rather than with bloody stools, diarrhea, and vomiting. The diagnosis and management would be avoidance of cow's milk protein within the diet, with results and symptom improvement in patients immediately. Therefore, we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients. This entails first ruling out CMPA with safe, noninvasive techniques with diet modification, and if unsuccessful, then moving forward with further diagnostic modalities.
围产期胎粪排出延迟或便秘传统上被认为是进一步评估严重疾病的信号，如先天性巨结肠（HD）、囊性纤维化导致的粪石性肠梗阻。HD 的诊断特别需要进行有创性检查以确认诊断，例如直肠测压或直肠抽吸活检。如果有一种病因导致围产期便秘，而且这种病因鲜为人知，又该如何呢？牛乳蛋白过敏（CMPA）通常在婴儿出生后的头几周内被诊断出来，但有研究表明，CMPA 过敏原可以在子宫内从母亲传递给婴儿，因此症状最早可在出生后的第一天出现。其表现更为不典型，表现为围产期便秘而非血性粪便、腹泻和呕吐。诊断和治疗是在饮食中避免牛乳蛋白，患者的结果和症状会立即改善。因此，我们讨论是否应该进一步讨论和实施替代途径来解决围产期便秘，以避免对患者进行有创性技术。这需要首先通过饮食改变进行安全、非侵入性的技术来排除 CMPA，如果不成功，则进一步进行诊断性检查。
