Development of fatty acid calcium stone ileus after initiation of human milk fortifier
Article first published online: 14 FEB 2013
© 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society
Volume 55, Issue 1, pages 114–116, February 2013
How to Cite
Murase, M., Miyazawa, T., Taki, M., Sakurai, M., Miura, F., Mizuno, K., Itabashi, K. and Toki, A. (2013), Development of fatty acid calcium stone ileus after initiation of human milk fortifier. Pediatrics International, 55: 114–116. doi: 10.1111/j.1442-200X.2012.03630.x
- Issue published online: 14 FEB 2013
- Article first published online: 14 FEB 2013
- Received 4 September 2011; revised 31 January 2012; accepted 16 March 2012.
- extremely low-birthweight;
- fatty acid calcium stone;
- necrotizing enterocolitis
We report a case who was born with extremely low birth weight infant and had experienced abdominal operation for necrotizing enterocolitis, eventually developed ileus due to fatty acid calcium stones after giving human milk fortifier. He had developed necrotizing enterocolitis on day 30 of his age, such that we performed enterectomy and ileostomy. He could not tolerate enteral feeding fully, because intestinal fistula infection was repeated. Although we administered hindmilk, he grew up slowly and he suffered cholestasis as well. We performed end-to-end anastomosis to prevent fistula infections on day 87. After this operation, breast milk feeding volume was increased easily. However, we started to add HMF of half-strength on day 124, because his body weight gain remained very poor. And we confirmed to intensify the ratio of HMF full-strength on day 128. After that his abdomen had distended on day 131. As there is no effect of conservative therapy to occlusive ileus, we did emergency laparotomy on day 139. Intestinal calculi were impacted at anastomic portion. Although all stones were removed, he died on 144 days due to disseminated intravascular coagulation and renal failure. Calculi analysis revealed that all of them were fatty acid calcium stones. There is no report about like our case. We speculate that the construction of fatty acid calcium result from either high concentration of calcium/phosphorus or rapid increase in the fortification. We could have prevented this case happened by slower increment of fortification.