A280 SPECIALIZED FORMULA USE FOR THE TREATMENT OF COW MILK PROTEIN ALLERGY
Bibliographic record
Abstract
Cow milk protein allergy (CMPA) is a common condition of infancy, with an incidence of between 2–5% amongst formula fed infants. Despite the regularity with which this condition is encountered, there is a paucity of data, in part due to the diverse clinical presentation and lack of definitive diagnostic tests. Current management beyond dietary exclusion of cow’s milk protein involves the use of a semi-elemental or elemental formula. A retrospective chart review of applications made to the Home Enteral Nutrition (HEN) program for CMPA was undertaken. The HEN program is a provincial service co-ordinating the allocation of formula to children requiring specialised formula. From 2004 - 2014, 210 patients were provided semi-elemental or elemental formula on the basis of suspected CMPA. Overall, an increasing trend in referrals was seen. In 2004 only 3 patients were provided specialized specialised formula vs 41 in 2013. The median age at application was 3.5 months (IQR: 2.0; 6.3) with 51.4% being male. Symptoms at presentation indicated that bloody diarrhoea with or without emesis was present in 53.4% of patients, with other presentations including isolated emesis in 16.2%, non-bloody diarrhoea in 13.3%, and a combination of vomiting and diarrhoea in 8.6%. Miscellaneous symptoms including failure to thrive, irritability, and others make up the remaining 8.6%. The median weight-age Z score at baseline was -0.81 (IQR: -1.85; 0.02), indicative of an underweight for age population. The referral pathway most commonly utilised included pediatric gastroenterologist in 49.6% and paediatricians in 45.2% of referrals. Family doctor referrals accounted for only 5.2% of the cases. Elemental formula was used in 66.7% of cases. Feed administration was achieved orally in 96% of patients, with only 4% of children requiring ng tube feeds. The median duration for utilisation of specialised formula was 10.5 months (IQR: 6; 12), with a median age at termination of HEN support at 13 months (IQR: 12; 18), indicative of successful transition to milk protein containing diet at one year of age in the majority of patients. The duration of formula use did not differ depending on the formula type or presentation (bloody diarrhea or not) (p=0.577). 100% of patients had discontinued the use of the specialized formula by three years of age. An increased trend was seen for the number of children utilizing specialized formula for CMPA, however the duration of formula supplementation is in keeping with other international centres. Our group did have a higher use of elemental formula (vs. semi-elemental) however this may be on account of the incremental cost of elemental formula. Presenting symptoms did not highlight a differential duration of formula use and all patients improved with time. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".