Table 2 Pathogenetic factors reported/postulated with gastric lactobezoar

Exogenous

"Overconcentrated" formula

18 (18.8)

14 (35.0)

Calorie content > 80 kcal/100 ml

63 (65.6)

6 (15.0)

Special LBW formula

52 (54.2)

10 (25.0)

Breast milk fortifier

4 (4.2)

5 (12.5)

Protein concentration > DRI^#)

9 (9.4)

4 (10.0)

Casein predominance > 60%

52 (54.2)

8 (20.0)

Cow's milk protein

1 (1.0)

3 (7.5)

Medium chain triglycerides

52 (54.2)

11 (27.5)

Increased Ca-content of formula

-

3 (7.5)

Increased Ca/P ratio of formula

-

3 (7.5)

Silica (Gelopectose)

3 (3.1)

3 (7.5)

Alginate (Gaviscon)

2 (2.1)

1 (2.5)

Pectin-lignin-cellulose(Aroban)

1 (1.0)

2 (5.0)

Atropin (e.g. Eumydrin^®)

2 (2.1)

3 (7.5)

Antacids (Sucralfate^® Aluminium hydroxide etc.)

3 (3.1)

5 (12.5)

Modes of feeding - oral - gavage - bolus - continuous

29 (30.2)

7 (17.5)

Age < 14 days at start of > 80 kcal formula

35 (36.5)

6 (15.0)

Supine body position (poor gastric mixing)

9 (9.4)

3 (7.5)

Phototherapy prior to lactobezoar diagnosis

16 (16.7)

3 (7.5)

Increased sweating (due to hot weather)

1 (1.0)

2 (5.0)

Endogenous

Prematurity

54 (56.3)

21 (52.5)

Low birth weight (< 2500 gm)

52 (54.2)

8 (20.0)

Dehydration

12 (12.5)

11 (27.5)

Increased gastric absorption of fluids

-

3 (7.5)

Decreased global gastric secretion

3 (3.1)

2 (5.0)

Interaction of formula with gastric secretion

-

2 (5.0)

Increased osmolality of gastric content

1 (1.0)

1 (2.5)

Delayed gastric emptying

3 (3.1)

16 (40.0)

Postprandial time course of gastric acidity

-

1 (2.5)

Decreased "digestive capacity"

-

3 (7.5)

Decreased enzyme activity

-

2 (5.0)

Gastric Ca secretion

-

3 (7.5)

Gastric Ca+fat/protein precipitates

1 (1.0)

3 (7.5)

Respiratory distress syndrome

14 (14.6)

6 (15.0)

Birth asphyxia

9 (9.4)

4 (10.0)

Systemic infection

10 (10.4)

4 (10.0)