Publication:

Cow’s milk protein intolerance unmasked by bovine-derived human milk fortifier and successfully rescued by human milk-based fortifier in a preterm infant

Preterm infants require human milk fortification to achieve adequate growth. Most fortifiers are bovine-derived and may trigger feeding intolerance or immunological reactions. We describe a 25+5 week, 720 g male infant who developed recurrent apnea, reflux, and dependence on respiratory support soon after initiation of bovine-based human milk fortifier (HMF). Investigations excluded sepsis and necrotizing enterocolitis. Stool calprotectin was markedly elevated, and eosinophilia was noted. Symptoms resolved rapidly after discontinuation of bovine HMF and initiation of a human milk-derived fortifier, with dramatic improvements in weight gain and respiratory stability. This case highlights cow’s milk protein intolerance (CMPI) precipitated by bovine fortifier and the therapeutic benefit of human milk-based HMF.