Delayed passage of meconium or
constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as
Hirschsprung's disease (HD),
meconium ileus due to
Cystic Fibrosis, etc. The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis, such as anorectal manometry or rectal suction biopsy. What if there was another etiology of perinatal
constipation, that is far lesser known?
Cow's milk protein allergy (CMPA) is often diagnosed in infants within the first few weeks of life, however, there are studies that show that the CMPA
allergen can be passed from mother to an infant in-utero, therefore allowing symptoms to show as early as day one of life. The presentation is more atypical, with perinatal
constipation rather than with bloody stools,
diarrhea, and
vomiting. The diagnosis and management would be avoidance of cow's milk
protein within the diet, with results and symptom improvement in patients immediately. Therefore, we discuss whether an alternative pathway to address perinatal
constipation should be further discussed and implemented to potentially avoid invasive techniques in patients. This entails first ruling out CMPA with safe, noninvasive techniques with
diet modification, and if unsuccessful, then moving forward with further diagnostic modalities.