Very early onset perinatal constipation: Can it be cow’s milk protein allergy?

Figure 1 How cow’s milk protein allergen from maternal diet passes into the fetus causing distal colon spasm or failure to relax leading to Hirschsprung’s disease-like constipation. As mentioned in the text, the suspected mechanism involves neuromodulation of the enteric nervous system, with increased anal pressure at rest. CMP: Cow’s milk protein.

Figure 2 Two algorithms for clinical management of patients with intractable early onset perinatal constipation. A: Top-down approach and current guideline for management of perinatal constipation. B: Bottom-up approach; new guideline to consider which suspects cow’s milk protein allergy as a diagnosis. CMP: Cow’s milk protein; CMPA: Cow’s milk protein allergy.