www.nestlemedicalhub.com
Open in
urlscan Pro
2620:12a:8001::2
Public Scan
Submitted URL: https://www.mydrugrep.com/mcm/click.asp?id=32680059&url=https://www.nestlemedicalhub.com/evidence/nutrition-case-report-al...
Effective URL: https://www.nestlemedicalhub.com/evidence/nutrition-case-report-alfamino-infant-formula?share_link_in_newsletter=true&utm_source=...
Submission: On February 07 via manual from US — Scanned from DE
Effective URL: https://www.nestlemedicalhub.com/evidence/nutrition-case-report-alfamino-infant-formula?share_link_in_newsletter=true&utm_source=...
Submission: On February 07 via manual from US — Scanned from DE
Form analysis 5 forms found in the DOM
POST /evidence/nutrition-case-report-alfamino-infant-formula?share_link_in_newsletter=true&utm_source=PANTHEON_STRIPPED&utm_medium=PANTHEON_STRIPPED&utm_campaign=PANTHEON_STRIPPED&utm_content=PANTHEON_STRIPPED
<form class="user-login-form" data-drupal-selector="user-login-form" autocomplete="off"
action="/evidence/nutrition-case-report-alfamino-infant-formula?share_link_in_newsletter=true&utm_source=PANTHEON_STRIPPED&utm_medium=PANTHEON_STRIPPED&utm_campaign=PANTHEON_STRIPPED&utm_content=PANTHEON_STRIPPED" method="post"
id="user-login-form" accept-charset="UTF-8" data-once="form-updated" data-drupal-form-fields="edit-name--2,edit-pass--2,rememberMe,edit-submit--2">
<div class="js-form-item form-group form-item js-form-type-email form-item-name js-form-item-name">
<label for="edit-name--2" class="js-form-required form-required">Email</label>
<input autocorrect="none" autocapitalize="none" spellcheck="false" autofocus="autofocus" data-drupal-selector="edit-name" aria-describedby="edit-name--2--description" type="email" id="edit-name--2" name="name" value="" size="60" maxlength="254"
class="form-email required form-control" required="required" aria-required="true" placeholder="Enter email">
<div id="edit-name--2--description" class="description"> Enter your email address. </div>
</div>
<div class="js-form-item form-group form-item js-form-type-password form-item-pass js-form-item-pass">
<label for="edit-pass--2" class="js-form-required form-required">Password</label>
<input autocomplete="off" data-drupal-selector="edit-pass" aria-describedby="edit-pass--2--description" type="password" id="edit-pass--2" name="pass" size="60" maxlength="128" class="form-text required form-control" required="required"
aria-required="true" placeholder="Enter Password">
<div id="edit-pass--2--description" class="description"> Enter the password that accompanies your email address. </div>
<div class="passwordToggle">
<svg width="24" height="24" viewBox="0 0 24 24" fill="none" xmlns="http://www.w3.org/2000/svg">
<path fill-rule="evenodd" clip-rule="evenodd"
d="M15.1628 12.0526C15.1628 13.7986 13.7468 15.2136 12.0008 15.2136C10.2548 15.2136 8.83984 13.7986 8.83984 12.0526C8.83984 10.3056 10.2548 8.89062 12.0008 8.89062C13.7468 8.89062 15.1628 10.3056 15.1628 12.0526Z" stroke="#D2D2D2"
stroke-width="1.5" stroke-linecap="round" stroke-linejoin="round"></path>
<path fill-rule="evenodd" clip-rule="evenodd"
d="M11.998 19.355C15.806 19.355 19.289 16.617 21.25 12.053C19.289 7.48898 15.806 4.75098 11.998 4.75098H12.002C8.194 4.75098 4.711 7.48898 2.75 12.053C4.711 16.617 8.194 19.355 12.002 19.355H11.998Z" stroke="#D2D2D2" stroke-width="1.5"
stroke-linecap="round" stroke-linejoin="round"></path>
</svg>
</div>
</div>
<div class="d-flex justify-content-between mb-3 pt-2">
<div class="custom-checkbox">
<input type="checkbox" name="remember" id="rememberMe">
<label for="rememberMe">Remember me</label>
</div>
<a href="https://www.nestlemedicalhub.com/user/password" class="color-dark-blue">Forgot Password</a>
</div>
<input autocomplete="off" data-drupal-selector="form-r3d44cgd2pyq-cmaqy8-zrrtbn2ek6cka3bm8wus0" type="hidden" name="form_build_id" value="form-R3D44CGD2pYQ_CMaqy8--_ZRrTBN2EK6CKA3Bm8WUS0">
<input data-drupal-selector="edit-user-login-form" type="hidden" name="form_id" value="user_login_form">
<div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions--2"><input data-drupal-selector="edit-submit" type="submit" id="edit-submit--2" name="op" value="Log in"
class="button js-form-submit form-submit btn btn-lg btn-template-1">
</div>
</form>POST /evidence/nutrition-case-report-alfamino-infant-formula?share_link_in_newsletter=true&utm_source=PANTHEON_STRIPPED&utm_medium=PANTHEON_STRIPPED&utm_campaign=PANTHEON_STRIPPED&utm_content=PANTHEON_STRIPPED
<form class="user-register-form user-form" data-user-info-from-browser="" data-drupal-selector="user-register-form" autocomplete="off"
action="/evidence/nutrition-case-report-alfamino-infant-formula?share_link_in_newsletter=true&utm_source=PANTHEON_STRIPPED&utm_medium=PANTHEON_STRIPPED&utm_campaign=PANTHEON_STRIPPED&utm_content=PANTHEON_STRIPPED" method="post"
id="user-register-form" accept-charset="UTF-8" data-once="form-updated user-info-from-browser"
data-drupal-form-fields="edit-field-name-0-value,edit-field-last-name-0-value,edit-mail,edit-pass-pass1,edit-pass-pass2,edit-field-practise-taxonomy,edit-field-clinical-profession,edit-field-what-patient-group-do-you,edit-field-i-certify-value,edit-submit">
<div class="field--type-string field--name-field-name field--widget-string-textfield js-form-wrapper form-wrapper" data-drupal-selector="edit-field-name-wrapper" id="edit-field-name-wrapper">
<div class="js-form-item form-group form-item js-form-type-textfield form-item-field-name-0-value js-form-item-field-name-0-value">
<label for="edit-field-name-0-value" class="js-form-required form-required">First Name</label>
<input class="js-text-full text-full form-text required form-control" data-drupal-selector="edit-field-name-0-value" type="text" id="edit-field-name-0-value" name="field_name[0][value]" value="" size="60" maxlength="255" placeholder=""
required="required" aria-required="true">
</div>
</div>
<input autocomplete="off" data-drupal-selector="form-c8jvhwfii-k-lvbk9pm0e-e63zmhdqyv-7tm9m-4gy0" type="hidden" name="form_build_id" value="form-C8JvHwfIi-k_LvBK9pM0e-E63zmhDqYV_7tm9m_4Gy0">
<input data-drupal-selector="edit-user-register-form" type="hidden" name="form_id" value="user_register_form">
<div class="field--type-string field--name-field-last-name field--widget-string-textfield js-form-wrapper form-wrapper" data-drupal-selector="edit-field-last-name-wrapper" id="edit-field-last-name-wrapper">
<div class="js-form-item form-group form-item js-form-type-textfield form-item-field-last-name-0-value js-form-item-field-last-name-0-value">
<label for="edit-field-last-name-0-value" class="js-form-required form-required">Last Name</label>
<input class="js-text-full text-full form-text required form-control" data-drupal-selector="edit-field-last-name-0-value" type="text" id="edit-field-last-name-0-value" name="field_last_name[0][value]" value="" size="60" maxlength="255"
placeholder="" required="required" aria-required="true">
</div>
</div>
<div data-drupal-selector="edit-account" id="edit-account" class="js-form-wrapper form-wrapper">
<div class="js-form-item form-group form-item js-form-type-email form-item-mail js-form-item-mail">
<label for="edit-mail" class="js-form-required form-required">Email</label>
<input data-drupal-selector="edit-mail" aria-describedby="edit-mail--description" type="email" id="edit-mail" name="mail" value="" size="60" maxlength="254" class="form-email required form-control" required="required" aria-required="true">
<div id="edit-mail--description" class="description"> The email address is not made public. It will only be used if you need to be contacted about your account or for opted-in notifications. </div>
</div>
<div id="edit-pass" class="js-form-item form-group form-item js-form-type-password-confirm form-item-pass js-form-item-pass form-no-label">
<div class="js-form-item form-group form-item js-form-type-password form-item-pass-pass1 js-form-item-pass-pass1 password-parent">
<label for="edit-pass-pass1" class="js-form-required form-required">Password</label>
<input class="password-field js-password-field form-text required form-control" autocomplete="new-password" data-drupal-selector="edit-pass-pass1" type="password" id="edit-pass-pass1" name="pass[pass1]" size="25" maxlength="128"
required="required" aria-required="true" data-once="password">
</div>
<div class="js-form-item form-group form-item js-form-type-password form-item-pass-pass2 js-form-item-pass-pass2 confirm-parent">
<label for="edit-pass-pass2" class="js-form-required form-required">Confirm password</label>
<input class="password-confirm js-password-confirm form-text required form-control" autocomplete="new-password" data-drupal-selector="edit-pass-pass2" type="password" id="edit-pass-pass2" name="pass[pass2]" size="25" maxlength="128"
required="required" aria-required="true">
<div aria-live="polite" aria-atomic="true" class="password-confirm js-password-confirm js-password-confirm-message" data-drupal-selector="password-confirm-message">Passwords match: <span data-drupal-selector="password-match-status-text"
class="replacedMarks"></span></div>
</div>
<div id="edit-pass--description" class="description"> Provide a password for the new account in both fields. </div>
</div>
</div>
<div class="field--type-entity-reference field--name-field-practise-taxonomy field--widget-options-select js-form-wrapper form-wrapper" data-drupal-selector="edit-field-practise-taxonomy-wrapper" id="edit-field-practise-taxonomy-wrapper">
<div class="js-form-item form-group form-item js-form-type-select form-item-field-practise-taxonomy js-form-item-field-practise-taxonomy">
<label for="edit-field-practise-taxonomy">Area of Practice</label>
<select data-drupal-selector="edit-field-practise-taxonomy" id="edit-field-practise-taxonomy" name="field_practise_taxonomy" class="form-select form-control">
<option value="_none">- None -</option>
<option value="21">Allergy</option>
<option value="50">Cardiology</option>
<option value="51">Dentistry</option>
<option value="52">Dermatology</option>
<option value="24">Diabetes / Endocrinology</option>
<option value="53">Ear, Nose and Throat</option>
<option value="25">Education</option>
<option value="26">Gastroenterology</option>
<option value="27">General Practice</option>
<option value="28">Geriatrics</option>
<option value="54">Hepatology</option>
<option value="29">Hospital Discharge Planning</option>
<option value="31">Intensive Care/Critical Care</option>
<option value="32">Internal Medicine</option>
<option value="55">Neurology</option>
<option value="33">NICU</option>
<option value="34">Nutrition Support</option>
<option value="35">OB/GYN</option>
<option value="37">Oncology</option>
<option value="90">Orthopedics</option>
<option value="38">Other</option>
<option value="57">Pediatric Allergy</option>
<option value="60">Pediatric Critical Care</option>
<option value="167" style="display: none;">Pediatric Endocrinology</option>
<option value="39">Pediatric Gastroenterology</option>
<option value="59">Pediatric Neurology</option>
<option value="56">Pediatric Oncology</option>
<option value="58">Pediatric Pulmonology</option>
<option value="40">Pediatrics</option>
<option value="92">Pharmacy</option>
<option value="91">Physical Therapy</option>
<option value="181">Psychiatry/Psychology</option>
<option value="61">Pulmonology</option>
<option value="63">Rehabilitation</option>
<option value="62">Renal</option>
<option value="169" style="display: none;">Research</option>
<option value="138">Sleep Specialist</option>
<option value="64">Speech Language Pathology</option>
<option value="41">Surgery (oral, general, other)</option>
<option value="162">Urgent Care/Walk-In Clinic</option>
<option value="42">Weight Loss / Bariatric</option>
<option value="43">Well-Baby Nursery / Breastfeeding Support</option>
<option value="36">WIC</option>
</select>
</div>
</div>
<div class="field--type-entity-reference field--name-field-clinical-profession field--widget-options-select js-form-wrapper form-wrapper" data-drupal-selector="edit-field-clinical-profession-wrapper" id="edit-field-clinical-profession-wrapper">
<div class="js-form-item form-group form-item js-form-type-select form-item-field-clinical-profession js-form-item-field-clinical-profession">
<label for="edit-field-clinical-profession">Clinical Profession</label>
<select data-drupal-selector="edit-field-clinical-profession" id="edit-field-clinical-profession" name="field_clinical_profession" class="form-select form-control">
<option value="_none">- None -</option>
<option value="65">Advanced Practice Nurse</option>
<option value="66">Clinical Nutrition Manager (CNM)</option>
<option value="67">Discharge Planner</option>
<option value="68">Food Service Director</option>
<option value="69">Hospital Administration</option>
<option value="70">Lactation Consultant/Specialist</option>
<option value="71">Nurse Practitioner (NP)</option>
<option value="72">Nursing Manager</option>
<option value="73">Occupational Therapist</option>
<option value="74">Other</option>
<option value="75">Pediatric Intensivist</option>
<option value="76">Pediatric Resident</option>
<option value="77">Pediatrician</option>
<option value="78">Pharmacist (RPh)</option>
<option value="79">Physical Therapist</option>
<option value="80">Physician (MD/DO)</option>
<option value="81">Physician Assistant (PA)</option>
<option value="82">Registered Dietitian (RD)</option>
<option value="83">Registered Nurse (RN)</option>
<option value="84">Resident/Fellow</option>
<option value="85">Social Worker/Case Worker</option>
<option value="86">Speech Language Pathologist (SLP)</option>
<option value="87">Student/Intern</option>
<option value="88">Surgeon</option>
<option value="89">Surgeon (Oral)</option>
</select>
</div>
</div>
<div class="field--type-list-string field--name-field-what-patient-group-do-you field--widget-options-select js-form-wrapper form-wrapper" data-drupal-selector="edit-field-what-patient-group-do-you-wrapper"
id="edit-field-what-patient-group-do-you-wrapper">
<div class="js-form-item form-group form-item js-form-type-select form-item-field-what-patient-group-do-you js-form-item-field-what-patient-group-do-you">
<label for="edit-field-what-patient-group-do-you">What patient group do you care for?</label>
<select data-drupal-selector="edit-field-what-patient-group-do-you" id="edit-field-what-patient-group-do-you" name="field_what_patient_group_do_you" class="form-select form-control">
<option value="_none">- None -</option>
<option value="Pediatrics">Pediatrics</option>
<option value="Adults">Adults</option>
<option value="Both">Both</option>
</select>
</div>
</div>
<div class="field--type-boolean field--name-field-i-certify field--widget-boolean-checkbox js-form-wrapper form-wrapper" data-drupal-selector="edit-field-i-certify-wrapper" id="edit-field-i-certify-wrapper">
<div class="js-form-item form-group form-item js-form-type-checkbox form-item-field-i-certify-value js-form-item-field-i-certify-value">
<input data-drupal-selector="edit-field-i-certify-value" type="checkbox" id="edit-field-i-certify-value" name="field_i_certify[value]" value="1" class="form-checkbox required" required="required" aria-required="true">
<label for="edit-field-i-certify-value" class="option js-form-required form-required">I certify that I am a U.S. health care professional</label>
</div>
</div>
<div data-drupal-selector="edit-captcha" class="captcha captcha-type-challenge--recaptcha">
<div class="captcha__element">
<input data-drupal-selector="edit-captcha-sid" type="hidden" name="captcha_sid" value="30805810">
<input data-drupal-selector="edit-captcha-token" type="hidden" name="captcha_token" value="sn5c7mHlMiOHDUAIfbnbyoDqirps4V4KrTcFqyF4YkI">
<input data-drupal-selector="edit-captcha-response" type="hidden" name="captcha_response" value="Google no captcha">
<div class="g-recaptcha" data-sitekey="6LeL738UAAAAANtBfN9LJJ7PKlKzlf8LZARmRyMC" data-theme="light" data-type="image">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-yig52mray4dy" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
src="https://www.recaptcha.net/recaptcha/api2/anchor?ar=1&k=6LeL738UAAAAANtBfN9LJJ7PKlKzlf8LZARmRyMC&co=aHR0cHM6Ly93d3cubmVzdGxlbWVkaWNhbGh1Yi5jb206NDQz&hl=en&type=image&v=MHBiAvbtvk5Wb2eTZHoP1dUd&theme=light&size=normal&cb=8o1jpafxw2ew"
data-gtm-yt-inspected-12371630_336="true"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe data-gtm-yt-inspected-12371630_336="true" style="display: none;"></iframe>
</div>
<noscript>
<div style="width: 302px; height: 352px;">
<div style="width: 302px; height: 352px; position: relative;">
<div style="width: 302px; height: 352px; position: absolute;">
<iframe src="https://www.recaptcha.net/recaptcha/api/fallback?k=6LeL738UAAAAANtBfN9LJJ7PKlKzlf8LZARmRyMC&hl=en" title="Google captcha" style="border: none; overflow: hidden; width: 302px; height:352px; border-style: none;"></iframe>
</div>
<div style="width: 250px; height: 80px; position: absolute; border-style: none; bottom: 21px; left: 25px; margin: 0px; padding: 0px; right: 25px;">
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 80px; border: 1px solid #c1c1c1; margin: 0px; padding: 0px; resize: none;" value=""></textarea>
</div>
</div>
</div>
</noscript>
<input data-drupal-selector="edit-captcha-cacheable" type="hidden" name="captcha_cacheable" value="1">
</div>
</div>
<div class="mt-3 mb-3">
<p class="color-light-gray replacedMarks">By clicking CREATE NEW ACCOUNT, I understand that the personal data provided in this registration form will be used to grant access to the Nestlé Medical Hub. I agree to receive information from Nestlé
Health Science including new webinars, studies, articles, educational resources and more. I certify that I have read and agree with
the <a href="/terms-conditions" target="_blank" class="color-dark-blue float-none">Terms & Conditions</a>, <a href="/privacy-notice" target="_blank" class="color-dark-blue float-none">Privacy Policy</a>, and
<a href="/about-our-ads" target="_blank" class="color-dark-blue float-none">About our Ads</a>.</p>
</div>
<div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions"><input data-drupal-selector="edit-submit" type="submit" id="edit-submit" name="op" value="Create new account"
class="button button--primary js-form-submit form-submit btn btn-lg btn-template-1">
</div>
</form>GET /search/all
<form class="search-form d-none d-lg-inline-block mr-3" action="/search/all" method="get" data-once="form-updated" data-drupal-form-fields="search">
<input id="search" type="search" name="q" placeholder="I’m looking for..." class="form-control" autocomplete="off">
<div class="search-box-wrapper">
<div id="dropdownResults" class="w100">
<div class="nav nav-tabs nav-fill" id="nav-tab" role="tablist">
<a class="nav-item nav-link nav-search active d-flex justify-content-center align-items-center" id="nav-all-menu-tab" data-context="all" data-toggle="tab" href="#nav-all" role="tab" aria-selected="true">All <span class="counter_all ml-1 replacedMarks"></span></a>
<a class="nav-item nav-link nav-search d-flex justify-content-center align-items-center" id="nav-products-menu-tab" data-context="products" data-toggle="tab" href="#nav-products" role="tab" aria-selected="true">Products <span class="counter_products ml-1 replacedMarks"></span></a>
<a class="nav-item nav-link nav-search d-flex justify-content-center align-items-center" id="nav-recipes-menu-tab" data-context="articles" data-toggle="tab" href="#nav-articles" role="tab" aria-selected="false">Product Support <span class="counter_articles ml-1 replacedMarks"></span></a>
<a class="nav-item nav-link nav-search d-flex justify-content-center align-items-center" id="nav-events-menu-tab" data-context="events" data-toggle="tab" href="#nav-events" role="tab" aria-selected="false">Events <span class="counter_events ml-1 replacedMarks"></span></a>
<a class="nav-item nav-link nav-search" id="nav-blog-menu-tab" data-context="webinars" data-toggle="tab" href="#nav-webinars" role="tab" aria-selected="false">Videos <span class="counter_webinars replacedMarks"></span></a>
<a class="nav-item nav-link nav-search d-flex justify-content-center align-items-center" id="nav-other-menu-tab" data-context="others" data-toggle="tab" href="#nav-others" role="tab" aria-selected="false">Other <span class="counter_others ml-1 replacedMarks"></span></a>
</div>
<div class="tab-content p-0" id="nav-tabContent">
<div class="tab-pane fade show active tab_all" id="nav-all" role="tabpanel">
</div>
<div class="tab-pane fade tab_products" id="nav-products" role="tabpanel">
</div>
<div class="tab-pane fade tab_articles" id="nav-articles" role="tabpanel">
</div>
<div class="tab-pane fade tab_events" id="nav-events" role="tabpanel">
</div>
<div class="tab-pane fade tab_webinars" id="nav-webinars" role="tabpanel">
</div>
<div class="tab-pane fade tab_others" id="nav-others" role="tabpanel">
</div>
</div>
<div class="resultsFooter mt-0">
<a href="#" class="btn btn-template-7 result_query_btn">See All Results</a>
</div>
<div class="loader-dots">
<div></div>
<div></div>
<div></div>
</div>
</div>
</div>
<button type="submit" class="search-form__btn">
<svg width="24" height="24" viewBox="0 0 24 24" fill="none" xmlns="http://www.w3.org/2000/svg">
<path
d="M21.7482 20.3691L16.0209 14.6364C17.0889 13.2658 17.664 11.5742 17.664 9.83948C17.664 5.51641 14.1509 2 9.83198 2C5.51304 2 2 5.51641 2 9.83948C2 14.1625 5.51304 17.679 9.83198 17.679C11.5807 17.679 13.2785 17.0955 14.6517 16.0147L20.375 21.7436C20.7701 22.1077 21.3804 22.0803 21.7442 21.6848C22.0846 21.3128 22.0846 20.7411 21.7482 20.3691ZM3.93648 9.83948C3.93648 6.58543 6.58104 3.94225 9.82806 3.94225C13.0751 3.94225 15.7196 6.58934 15.7196 9.83948C15.7196 13.0896 13.0751 15.7367 9.82806 15.7367C6.58104 15.7367 3.93648 13.0896 3.93648 9.83948Z"
fill="#012169"></path>
</svg>
</button>
</form>GET /search/all
<form class="mobile-search d-lg-none" action="/search/all" method="get" data-once="form-updated" data-drupal-form-fields="searchMobile">
<input id="searchMobile" type="search" name="q" placeholder="I’m looking for..." class="form-control">
<button type="submit" class="mobile-search__btn"> Search </button>
</form><form id="conversionHubForm" data-once="form-updated" data-drupal-form-fields="email-conversion-hub">
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NUTRITION CASE REPORT: ALFAMINO® INFANT FORMULA
*
*
*
COW’S MILK PROTEIN ALLERGY RESOLVED WITH THE USE OF ALFAMINO® INFANT FORMULA
AFTER OTHER NUTRITION REGIMENS FAILED
Catherine Brigman, MD1, Aimee Henrikson, MPH, RD, LDN2
1Pediatric Specialists of Texas, San Antonio, TX; 2Medical Scientific Liaison,
Nestlé Health Science
ABSTRACT:
Three month old female presented with reflux and skin rash after hospitalization
for apnea during feeding and was diagnosed with cow’s milk protein allergy
(CMPA), reflux and eczema. This patient also had a complicated history including
difficulty latching during breastfeeding, tongue tie (treated and resolved),
swallowing delay, failure to thrive, reflux and eczema. Feeding history, since
birth, included combination of breastmilk + Gentlease® for the first 11 weeks of
life, a switch to breastmilk + Nutramigen® (with the addition of Prevacid®) for
8 days up until hospital admission for apnea. During hospitalization, this
patient was switched to Neocate®. After experiencing worsening reflux and
continuing eczema on Neocate®, the patient was switched to Elecare®.
Dermatologist prescribed hydrocortisone, with no improvement of rash. A second
episode of apnea occurred while on Elecare® and the patient was switched to
Alfamino® Infant. With switch to Alfamino® Infant, rash resolved, reflux
improved, no additional episodes of apnea were reported and growth improved.
CASE REPORT
DETAILED DESCRIPTION OF PATIENT:
Patient was referred to the pediatric gastroenterologist at 3 months of age
after hospitalization for apnea. She was born full term and had a complicated
history, since birth, including difficulty latching during breastfeeding,
tongue-tie, swallowing delay, failure to thrive, reflux and eczema. At time of
referral, rash was noted on the patients face, trunk, arms and legs (over 90% of
her body) and reflux was reported multiple times per day.
Patient’s feeding history started with consuming a combination of breastmilk +
Enfamil Gentlease® (partially hydrolyzed formula; Mead Johnson Nutrition) for
the first 11 weeks of life and transitioned to breastmilk + Nutramigen®
(hypoallergenic extensively hydrolyzed formula (EHF); Mead Johnson Nutrition)
with daily intake of Prevacid® (one time per day). Patient was hospitalized
approximately one week later after an episode of apnea during feeding. During
hospitalization, patient was switched to Neocate® (hypoallergenic amino
acid-based formula (AAF); Nutricia North America) due to suspected cow’s milk
protein allergy that did not resolve with Nutramigen®. Post discharge, patient
continued to have reflux and eczema with Neocate®.
At 3 months of age when referred to the pediatric gastroenterologist, patient
weighed 4.4 kg (0.8% ile) and measured 56 cm in length (2% ile). Pediatric
gastroenterologist diagnosed patient with cow’s milk protein allergy, reflux and
eczema and recommended a switch from Neocate® to Elecare® (hypoallergenic, AAF;
Abbott Laboratories) due to continued symptoms. Patient was also referred to
dermatology and started using a topical hydrocortisone cream; however, her rash
did not improve. Patient then experienced another apnea episode while on
Elecare® and the pediatric gastroenterologist recommended a formula switch from
Elecare® to Alfamino® Infant formula (hypoallergenic, AAF; Nestle HealthCare
Nutrition). After the patient switched to Alfamino® Infant, her rash resolved,
she had no additional episodes of apnea and her growth improved.
At 4 months of age, patient started on rice cereal, supplemented by 2 oz of baby
food (squash and sweet potato) 3 times daily. She continued to consume
complementary foods and Alfamino® Infant formula, and saw continued growth with
no additional symptoms of allergy. At 13 months of age, Alfamino® Infant was
discontinued and almond milk was introduced. Since patient stopped consuming
Alfamino® Infant, her growth has slowed, she has been having diarrhea 3-4 times
per day and subsequent diaper rash. These issues are currently being evaluated
by her medical team.
GROWTH HISTORY:
Birth weight: 3.0 kg; birth length: 49.1 cm
3 months (Pediatric gastroenterologist appointment post-hospitalization): 4.4 kg
(.8% ile), 56 cm (2% ile)
4 months: 4.85 kg (.67% ile), 59.5 cm (6.8 % ile)
7 months: 6 kg (2.9% ile), 65 cm (21 % ile)
10 months: 6.85 kg (3.5% ile), 67 cm (3% ile)
13 months (no longer taking Alfamino®): 6.87 kg (.66% ile), 70.5 cm (2.9% ile)
GROWTH CHARTS:
NUTRITION INTERVENTION:
* Several nutrition interventions were attempted to alleviate allergy symptoms
* Prior to introduction of Alfamino® Infant, the following nutrition
interventions were attempted:
* Patient started with combination of breastmilk and partially hydrolyzed
formula (Gentlease®) for the first 11 weeks
* Patient then transitioned to a combination of breastmilk and hypoallergenic
extensively hydrolyzed formula (EHF) (Nutramigen®)
* Patient was then transitioned to hypoallergenic, amino acid formula (AAF)
(Neocate®)
* Patient was then transitioned to a different hypoallergenic AAF (Elecare®)
* Finally, due to persistence of symptoms on the previous nutrition
interventions, patient was transitioned to hypoallergenic AAF (Alfamino®
Infant)
* Alfamino® Infant was the only hypoallergenic formula that resulted in
alleviation of symptoms of CMPA
FINDINGS/ OUTCOME:
* With the use of Alfamino® Infant formula, eczema resolved, no additional
episodes of apnea occurred, reflux improved and growth improved until 13
months of age (at which point Alfamino® Infant had been discontinued for
several weeks)
DISCUSSION:
* The recommended treatment of CMPA in a formula fed infant is to switch from
an intact protein formula to a hypoallergenic, extensively hydrolyzed formula
(EHF). If symptoms persist, the recommendation is to then switch to a
hypoallergenic, amino-acid based formula (AAF)1,2. In this case, three HA
formulas (one EHF and two AAF) were attempted with no resolution of symptoms.
When Alfamino® Infant was consumed, the symptoms resolved.
CONCLUSION:
* A 3 month old infant diagnosed with CMPA had persistent unresolved allergy
symptoms on hypoallergenic extensively hydrolyzed and hypoallergenic amino
acid-based formulas, until she was switched to Alfamino®Infant
* The issues remained resolved, including during supplementary feeding, until
13 months of age when Alfamino® Infant had been discontinued for 4 weeks
References:
1. Koletzko S et al. Diagnostic approach and management of cow’s-milk protein
allegy in infants and children: ESPGHAN GI Committee practical guidelines. J
Pediatr Gastroenterol Nutr. 2012;55:221-229.
2. American Academy of Pediatrics Committee on Nutrition. Hypoallergenic infant
formulas. Pediatrics. 2000;106:346-349.
Download PDF of Case Report
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rights reserved.
Funding for this case study was provided by Nestlé Health Science.
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