529 - Neonatal Gastric Bezoars, an Underrecognized Cause of Feeding Intolerance within the Neonatal Intensive Care Unit

Poster Number: 529
Publication Number: 529.2056

Background: A gastric lactobezoar is an acid-insoluble conglomerate of undigested milk and mucous which may lead to gastric outlet obstruction. This is thought to be a rare condition with 26 cases reported since 1985, however the true incidence is unknown. Little contemporary data exists regarding factors associated with bezoar formation, their management, or outcome.

Objective: To describe the institutional experiences with the presenting signs and symptoms, diagnostic methods, and therapeutic strategies for neonatal gastric bezoars.

Design/Methods: A retrospective cohort study of infants with radiographically diagnosed gastric bezoars at the Methodist Children’s Hospital and CHRISTUS Children’s Hospital neonatal intensive care units (NICUs) over a 16-year period. We collected data regarding patient demographics, diet, presenting signs and symptoms, methods of diagnosis, treatment and hospital outcomes.

Results: During the study period, we identified 58 NICU infants diagnosed with a gastric bezoar. The cohort had a median gestational age at birth of 38 (IQR 36, 39) weeks and birth weight of 3069 grams (IQR 2554, 3491). Overall, 37 (64%) of diagnosed infants were on an exclusively formula diet and 12 (21%) were receiving hypercaloric feeds. Presenting signs and symptoms included gastrointestinal with emesis 29 (50%), diminished oral intake 18 (31%), and abdominal distention 4 (7%) as well as respiratory with respiratory distress in 26 (45%).

The median day of symptom onset was 4 days of age (IQR 2, 8 days) and of diagnosis 5 days of age (IQR 4, 9 days). A total of 4 (7%) infants lost more than 10% from their birth weight at time of diagnosis. The diagnosis was determined most frequently by abdominal ultrasound in 5 (9%, Figure 1) and Upper GI series in 47 (81%, Figure 2)

Management consisted of NPO status with IV fluids in 10 (17%) patients. Most commonly management consisted of halting milk feedings with transition to Pedialyte in 48 infants (83%) or an elemental formula in 3 (5%). In total 10 (17%) of patients were made NPO with IV fluids. The median length of therapy was 1 days (IQR 1, 3 days) with documented resolution of the bezoar by ultrasound in 23 (40%) and upper GI series in 10 (17%). Recurrence was uncommon but occurred in 7 (12%) of patients during the hospital stay.

Conclusion(s): Neonatal gastric bezoars may be more common than typically recognized. Characteristic patients are term, feeding predominately formula, and present with gastrointestinal and respiratory symptoms. Treatment with a clear liquid diet is rapidly effective and avoids the need for IV fluids while largely avoiding recurrence.