552 A Baby in a Pickle

Background and Aims Abdominal distention and feeding difficulties are common in the preterm. Many infants receive treatment for non-proven necrotising enterocolitis (NEC) due to the devastating consequences if missed. Positive alternative diagnoses for abdominal distention are relevant. Methods We report a case of acute abdominal distension in a 29 week gestation, 750g infant receiving expressed breast milk from a mother who had a craving for pickled onions, and discuss the relevant literature. Results The infant had mild respiratory distress syndrome at birth. He reached full enteral feed volumes by day 10. On day 20 he developed distension of the abdomen and apparent abdominal pain. Abstract 552 Figure 1 Abdominal distention Feeds were stopped. Investigations ruled out NEC. After 2 days the infant improved clinically and feeding was recommenced. A further episode occurred, coinciding with reintroduction of full expressed breast milk feeds. Further maternal dietary history revealed an abnormally high intake of uncooked onions. After removing onion from her diet the problem resolved. Conclusions Onion is used in complementary medicine for antimicrobial, antifungal, glucose and lipid lowering properties. Human studies have associated high maternal intake with infantile colic in breastfeeding infants. The intestinal flora of premature infants is immature, hindering gut absorption and metabolism. Abdominal distension occurs as gas builds up in the bowel. A diet containing plentiful fruit and vegetables is advocated for breastfeeding mothers. In the case of onion and cruciferous vegetables awareness of the potential effect on the immature gut is important.