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Growth restricted twins were born at 29+2 weeks gestation. They were managed with empirical antibiotics, surfactant therapy and respiratory support. Both received total parenteral nutrition (TPN) until fully enterally fed.
By day 5 of life, they were commenced on expressed breast milk, using a feeding protocol standardised for babies at high risk of complications. Both had large gastric aspirates and commenced prokinetic erythromicin. They were fully fed by day 15. On day 16, feeds were increased for failure to gain weight. Gaviscon was added due to concerns regarding gastro-oesophageal reflux and phosphate supplements for rising alkaline phosphatase.
By day 18, twin 1 developed desaturations. Concomitantly, difficulty in prefeed aspiration of the nasogastric tube (NGT) and a full, tender epigastrium was noted. As part of a partial septic …
Footnotes
Contributors DS and PD drafted the manuscript and collected and analysed data from the reviewed literature. TP provided insights into the pathophysiological mechanisms of lactobezoar formation. DS revised the manuscript and corrected for submission criteria. All authors read and approved the final manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.