Mo1193 Malnutrition Enteropathy, an Inflammatory Condition in Children With Severe Acute Malnutrition

Little is known about cow's milk protein intolerance (CMPI) in developing countries where alternate formulas are sparse. We report a survey of Indian pediatricians on their attitudes and practices with CMPI. Methods :15,000 members of the Indian Academy of Pediatrics were invited to take an online survey on their opinions about association of CMPI with different clincal conditions as well as their response to a clinical scenario of a healthy infant with rectal bleeding. The data was compiled and statistically analyzed. Result :165 responses, 26 partial were obtained (1.1%). 5 were in general practice while rest were pediatricians, 73.68% practiced in urban or suburban settings. Common manifestations of CMPI noted in practices were Diarrhea (85.9%), Colic (83.9%), abdominal pain (73.6%), vomiting (73.4%), Asthma (66.6%), hematochezia (64.2%), constipation (63.6%) and atopic dermatitis (63.6%). In infants with colic 48.4% of Pediatricians considered (50% of more times) CMPI as the cause, 70% were likely (50% of more) to change formula or diet and 50% or more success were reported by 75.7%. Similar figures for gastro esophageal reflux were 44.9%, 63% and 62.1% respectively. For diarrhea 54.3% physicians were likely to consider CMPI, 68.9% changed diet and 74.5% reported 50% or more success rate. In a healthy infant under 6 months with hematochezia, 63.5% considered CMPI as the cause. In breast fed infants, 91% would have continued the infant on breast feed, half of them would have taken milk out of the mother's diet. In formula fed babies, 65.9% were likely to change formula; 58.7% preferred soy based formula while 45.5% used rice based liquid or diet. Only 4.8% considered elemental or semi elemental formulas. The physicians collectively reported a median percentage of 30% of such hematochezia resolving spontaneously, 50% with treatment, 10% continuing without complications and 5% had complications. There was no statistically significant difference in responses from physicians practicing in urban/suburban and rural/mixed settings. Conclusion: Indian physicians were aware of CMPI as the cause of various GI and non GI symptoms. Though they less readily considered CMPI as the cause of infantile hematochezia, management with locally sourced dietary changes was successful. Population based studies are indicated to provide cost effective guideline for management of CMPI to these physicians.