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Severe Food Protein Induced Enterocolitis Syndrome (FPIES) in the Pediatric Intensive Care Unit (PICU): A Retrospective Chart Review

      Rationale

      FPIES is a diagnosis that is often missed and, if untreated, can lead to severe complications.

      Methods

      Patients from birth to 7 months admitted to the PICU at Mount Sinai Hospital from June 2012 to June 2014 with the diagnosis codes of failure to thrive, metabolic acidosis, hypovolemic shock, dehydration, vomiting, feeding problems in a newborn, and allergy to milk were selected for medical record review.

      Results

      Out of 100 infants, 10 were identified with likely FPIES; 5 males, 5 females; all presented with vomiting, stool containing blood or mucous, lethargy, pallor, or dehydration with the majority having 5 symptoms. Age of onset ranged from 3 days to 2 months and delay to admission from 2 days to 2 months. All patients had failure to thrive and had presented to a physician or emergency department prior to PICU admission. One patient was exclusively breastfed, 9 were fed cow’s milk formula. Eight patients had anion gap metabolic acidosis; all required fluid resuscitation, 8 underwent a sepsis workup, and one patient underwent a diagnostic laparotomy. Eight patients were switched to a hypoallergenic formula and demonstrated resolution of symptoms. One patient was re-admitted to the PICU 10 days later and was then placed on hypoallergenic formula with symptom resolution. One patient was never trialed on hypoallergenic formula and remains symptomatic at the age 9 months.

      Conclusions

      FPIES is a severe disease that if not promptly diagnosed requires admission to the PICU and must be recognized early in order to prevent complications.