Neonatal Parenteral Nutrition Hypersensitivity: A Case Report Implicating Bisulfite Sensitivity in a Newborn Infant

This report describes a case of parenteral nutrition hypersensitivity in a 37 weeks' gestation infant with congenital diaphragmatic hernia complicated by bowel necrosis and functional short bowel syndrome. The patient developed a rash with subsequent urticaria beginning on the 50th day of life....

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Bibliographic Details
Published in:JPEN. Journal of parenteral and enteral nutrition 2009-11, Vol.33 (6), p.691-693
Main Authors: Huston, Robert K., Baxter, Louise M., Larrabee, Paige B.
Format: Article
Language:English
Subjects:
allergy
Amino Acids - administration & dosage
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
bisulfite
Colon - pathology
Dietary Proteins - administration & dosage
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Emergency and intensive care: neonates and children. Prematurity. Sudden death
Exanthema - etiology
Female
Hernia, Diaphragmatic - complications
Humans
hypersensitivity
Infant, Newborn
Intensive care medicine
Lipids - chemistry
Medical sciences
Necrosis - complications
neonate
parenteral nutrition
Parenteral Nutrition - adverse effects
Short Bowel Syndrome - complications
Short Bowel Syndrome - therapy
Sulfites - adverse effects
Sulfites - chemistry
Urticaria - etiology
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Summary:This report describes a case of parenteral nutrition hypersensitivity in a 37 weeks' gestation infant with congenital diaphragmatic hernia complicated by bowel necrosis and functional short bowel syndrome. The patient developed a rash with subsequent urticaria beginning on the 50th day of life. The reactions were confirmed with a positive rechallenge. After the amino acid solution was replaced with a non–bisulfite-containing product, the infant was able to continue to receive nutrition support through parenteral nutrition without recurrence of symptoms. It is speculated that the bisulfite additive in the amino acid solution may have interacted with the lipid emulsion to sensitize the patient.
ISSN:0148-6071
1941-2444
DOI:10.1177/0148607109347643