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Rogers IM. Pyloric Stenosis of Infancy(PS): Discovering the Cause. J Pediatr Surg 2023; 58:2066-2067. [PMID: 36907772 DOI: 10.1016/j.jpedsurg.2023.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
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2
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Obaid YY, Toubasi AA, Albustanji FH, Al-Qawasmeh AR. Perinatal risk factors for infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis. J Pediatr Surg 2023; 58:458-466. [PMID: 36137827 DOI: 10.1016/j.jpedsurg.2022.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/15/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is one of the most common diseases that require surgical intervention amongst the paediatric population. Although the treatment and the diagnosis of pyloric stenosis are well established, the perinatal risk factors associated with it still need further investigation. METHODS We searched the following databases: Cochrane, Google Scholar, PubMed, and Scopus. Studies were included if they were case-control or cohort in design and studied the perinatal risk factors associated with IHPS. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). RESULTS Twenty-one articles were included in this meta-analysis, including 18,104,753 participants. Our analysis showed a significant association between IHPS and male sex (RR=2.71, 95% CI:1.93-3.78), maternal smoking (RR=1.75, 95% CI: 1.54 - 2.00), bottle-feeding (RR=1.68, 95% CI: 1.42 - 1.98), being first born (RR=1.23, 95% CI:1.07-1.40), African ethnicity (RR=0.51, 95% CI: 0.35-0.75), and cesarean section (RR=1.57, 95% CI: 1.49-1.66). On the contrary, there was no significant association between IHPS and multiple gestations, preterm labour, being born in summer, and small for gestational age (SGA). CONCLUSION In conclusion, our analysis showed that male sex, bottle feeding, maternal smoking and African ethnicity were significantly associated with the risk of IHPS. However, most of the included articles were retrospective in design which necessitates conducting future prospective well-designed studies to further investigate the risk factors of IHPS.
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Affiliation(s)
- Yazan Y Obaid
- Faculty of Medicine, University of Jordan, Amman, Jordan, 11962.
| | - Ahmad A Toubasi
- Faculty of Medicine, University of Jordan, Amman, Jordan, 11962
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Factors associated with pyloric hypertrophy severity and post-operative feeding and nutritional recovery in infantile hypertrophic pyloric stenosis. Biomed J 2022; 45:948-956. [PMID: 34995820 PMCID: PMC9795358 DOI: 10.1016/j.bj.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To examine factors that affect the severity of pyloric hypertrophy, post-operative feeding and nutritional recovery in infantile hypertrophic pyloric stenosis (IHPS). METHODS Medical records of infants diagnosed with IHPS at a single tertiary center between 2009 and 2018 were retrospectively reviewed. Clinical characteristics, biochemistry data and outcome were assessed for their association with the severity of pyloric hypertrophy and post-operative recovery. Nutritional recovery was assessed using weight-for-age status improvement after surgery. RESULTS Eighty-five patients were recruited in this study. The mean pre-operative weight-for-age percentile was 18.2. Elevated bicarbonate was positively correlated with symptom duration (p = 0.007). Pyloric muscle thickness was significantly correlated with age, weight, and symptom duration (p = 0.004, 0.003, 0.008, respectively). The mean weight-for-age percentile increased to 41.6 by post-operative weeks 6-8. Pyloric muscle thickness was negatively correlated with nutritional recovery by post-operative weeks 6-8 (p = 0.003). In multivariable analysis, pyloric length related to nutritional recovery at week 1-2 postoperatively (OR = 1.42, p = 0.030, 95% CI = 0.03-1.94), and pyloric muscle thickness related to nutritional recovery at week 6-8 postoperatively (OR = 4.08, p = 0.032, 95% CI = 1.13-14.7). CONCLUSION Our study indicated that favorable nutritional outcome and successful weight gain was observed 6-8 weeks after surgery in children with IHPS. Pyloric muscle thickness positively correlated with age, weight, symptom duration, and favorable nutritional recovery. Serum bicarbonate showed a positive correlation with symptom duration.
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Danko ME, Evans PT, Upperman JS. Current management of pyloric stenosis. Semin Pediatr Surg 2022; 31:151145. [PMID: 35305799 DOI: 10.1016/j.sempedsurg.2022.151145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kobayashi J. Nitrite in breast milk: roles in neonatal pathophysiology. Pediatr Res 2021; 90:30-36. [PMID: 33173179 DOI: 10.1038/s41390-020-01247-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/03/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
Dietary nitrate has beneficial effects on health maintenance and prevention of lifestyle-related diseases in adulthood by serving as an alternative source of nitric oxide (NO) through the enterosalivary nitrate-nitrite-NO pathway, particularly when endogenous NO generation is lacking due to vascular endothelial dysfunction. However, this pathway is not developed in the early postnatal period due to a lack of oral commensal nitrate-reducing bacteria and less saliva production than in adults. To compensate for the decrease in nitrite during this period, colostrum contains the highest amount of nitrite compared with transitional, mature, and even artificial milk, suggesting that colostrum plays an important role in tentatively replenishing nitrite, in addition to involving a nutritional aspect, until the enterosalivary nitrate-nitrite-NO pathway is established. Increasing evidence demonstrates that breast milk rich in nitrite can be effective in the prevention of neonatal infections and gastrointestinal diseases such as infantile hypertrophic pyloric stenosis and necrotizing enterocolitis, suggesting that breastfeeding is advantageous for newborns at risk, given the physiological role of nitrite in the early postnatal period. IMPACT: The aim of this review is to discuss the physiological roles of nitrite in breast milk and its implications for neonates. Nitrite in breast milk may compensate for the decrease in nitrite during the early neonatal period until the enterosalivary nitrate-nitrite-nitric oxide pathway is established. Breast milk rich in nitrite may be effective in the prevention of neonatal infections and gastrointestinal diseases by providing nitric oxide bioavailability.
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Affiliation(s)
- Jun Kobayashi
- Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Saitama, Japan.
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Does Maternal Omega 3 Supplementation Protect Against Infantile Hypertrophic Pyloric Stenosis? J Pediatr Gastroenterol Nutr 2020; 70:652-656. [PMID: 31990865 DOI: 10.1097/mpg.0000000000002648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Infantile hypertrophic pyloric stenosis (IHPS) is potentially life threatening. The etiology of IHPS remains unknown and many risk factors have been reported. We aimed to assess the prevalence of known risk factors and investigate maternal nutrition and habits as possible additional risk factors for IHPS. METHODS This case-control study includes mothers of infants diagnosed with IHPS and control mothers of infants, age 2 to 11 months, hospitalized in the pediatric department due to other conditions. Cases of IHPS were identified by review of all infants diagnosed with IHPS and operated upon in 2010 to 2016 at 2 major hospitals in central Israel. Data regarding potential risk factors were collected via questionnaires in both study groups. RESULTS Sixty-six cases and 67 controls were included in the study. Maternal omega 3 supplement consumption during pregnancy was significantly less common among cases of IHPS as compared with controls (P = 0.031). Consumption of omega 3 supplement was defined as consumption of at least 1 to 2 per week during the pregnancy period. Following adjustment for known risk factors, including male sex and maternal smoking, maternal omega 3 supplement consumption remained associated with a significantly lower risk of developing IHPS (odds ratio = 0.303, 95% confidence interval 0.111-0.828, P = 0.02). CONCLUSIONS Maternal omega 3 supplement consumption during pregnancy was associated with a significantly reduced risk of IHPS. Further studies are needed to support these results and investigate possible mechanisms of the effect of omega 3.
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Mowrer AR, Esparaz JR, Hwang EH, Chakraborty SR, Nierstedt RT, Wolfe DJ, Jaroenpuntaruk V, Robertson DJ. Low socioeconomic status and formula feeding directly correlate with increased incidence of hypertrophic pyloric stenosis. J Pediatr Surg 2019; 54:2498-2502. [PMID: 31757506 DOI: 10.1016/j.jpedsurg.2019.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/24/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this analysis was to determine if a correlation exists between socioeconomic status (SES) and pyloric stenosis (PS) as well as between PS and feeding method. METHODS Data was collected retrospectively from the electronic medical record. Patients were included if they resided in a county in Illinois where our institution maintains >10% visit share, were < 1 year in age, and received a pyloromyotomy from January 2011 to May 2018. Patient addresses were geocoded and merged with county and tract-level census data. A control group was matched on gender, race, tract level, median household income (MHI), and age. Feeding method for each group was collected. Univariate analysis and multivariate analyses were employed. RESULTS SES was explored using MHI. After controlling for gender, age, race, and institution adjusted tract size, the association between MHI and pyloromyotomy remained significant. As MHI decreased, the odds of having a PS case increased. Additionally, the PS incidence rate increased as MHI decreased. Patients who were exclusively formula fed were more likely to have PS. CONCLUSION Pyloric stenosis had a direct correlation with SES as defined by MHI. As MHI decreased, the rates of PS increased. In addition, breastfeeding was protective, independent of MHI. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Alyssa R Mowrer
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA.
| | - Joseph R Esparaz
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
| | - Elise H Hwang
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
| | - Shawn R Chakraborty
- Children's Hospital of Illinois at OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Ryan T Nierstedt
- Children's Hospital of Illinois at OSF Saint Francis Medical Center, Peoria, IL, USA
| | - David J Wolfe
- Jump Trading Simulation and Education Center, Peoria, IL, USA
| | | | - Daniel J Robertson
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA; Children's Hospital of Illinois at OSF Saint Francis Medical Center, Peoria, IL, USA
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Donda K, Asare-Afriyie B, Ayensu M, Sharma M, Amponsah JK, Bhatt P, Hesse MA, Dapaah-Siakwan F. Pyloric Stenosis: National Trends in the Incidence Rate and Resource Use in the United States From 2012 to 2016. Hosp Pediatr 2019; 9:923-932. [PMID: 31748239 DOI: 10.1542/hpeds.2019-0112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Infantile hypertrophic pyloric stenosis (IHPS) is the most common reason for abdominal surgery in infants; however, national-level data on incidence rate and resource use are lacking. We aimed to examine the national trends in hospitalizations for IHPS and resource use in its management in the United States from 2012 to 2016. METHODS We performed a retrospective serial cross-sectional study using data from the National Inpatient Sample, the largest health care database in the United States. We included infants aged ≤1 year assigned an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for IHPS who underwent pyloromyotomy or pyloroplasty. We examined the temporal trends in the incidence rate (cases per 1000 live births) according to sex, insurance status, geographic region, and race. We examined resource use using length of stay (LOS) and hospital costs. Linear regression was used for trend analysis. RESULTS Between 2012 and 2016, there were 32 450 cases of IHPS and 20 808 149 live births (incidence rate of 1.56 per 1000). Characteristics of the study population were 82.7% male, 53% white, and 63.3% on Medicaid, and a majority were born in large (64%), urban teaching hospitals (90%). The incidence of IHPS varied with race, sex, socioeconomic status, and geographic region. In multivariable regression analysis, the incidence rate of IHPS decreased from 1.76 to 1.57 per 1000 (adjusted odds ratio 0.93; 95% confidence interval 0.92-0.93). The median cost of care was $6078.30, whereas the median LOS was 2 days, and these remained stable during the period. CONCLUSIONS The incidence rate of IHPS decreased significantly between 2012 and 2016, whereas LOS and hospital costs remained stable. The reasons for the decline in the IHPS incidence rate may be multifactorial.
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Affiliation(s)
- Keyur Donda
- Division of Neonatology, Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Barbara Asare-Afriyie
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Marian Ayensu
- Department of Medicine, The Trust Hospital, Accra, Ghana
| | - Mayank Sharma
- Batchelor Children's Research Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Parth Bhatt
- Department of Pediatrics, Health Sciences Center, Texas Tech University, Amarillo, Texas
| | | | - Fredrick Dapaah-Siakwan
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut
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Sie A, Bountogo M, Nebie E, Ouattara M, Coulibaly B, Bagagnan C, Zabre P, Lebas E, Brogdon J, Godwin WW, Lin Y, Porco T, Doan T, Lietman TM, Oldenburg CE. Neonatal azithromycin administration to prevent infant mortality: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e031162. [PMID: 31488494 PMCID: PMC6731835 DOI: 10.1136/bmjopen-2019-031162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Biannual mass azithromycin distribution to children aged 1-59 months has been shown to reduce all-cause mortality. Children under 28 days of age were not treated in studies evaluating mass azithromycin distribution for child mortality due to concerns related to infantile hypertrophic pyloric stenosis (IHPS). Here, we report the design of a randomised controlled trial to evaluate the efficacy and safety of administration of a single dose of oral azithromycin during the neonatal period. METHODS AND ANALYSIS The Nouveaux-nés et Azithromycine: une Innovation dans le Traitement des Enfants (NAITRE) study is a double-masked randomised placebo-controlled trial designed to evaluate the efficacy of a single dose of azithromycin (20 mg/kg) for the prevention of child mortality. Newborns (n=21 712) aged 8-27 days weighing at least 2500 g are 1:1 randomised to a single, directly observed, oral dose of azithromycin or matching placebo. Participants are followed weekly for 3 weeks after treatment to screen for adverse events, including IHPS. The primary outcome is all-cause mortality at the 6-month study visit. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Boards at the University of California, San Francisco in San Francisco, USA (Protocol #18-25027) and the Comité National d'Ethique pour la Recherche in Ouagadougou, Burkina Faso (Protocol #2018-10-123). The findings of this trial will be presented at local, regional and international meetings and published in open access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03682653; Pre-results.
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Affiliation(s)
- Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | - Eric Nebie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | | | - Cheik Bagagnan
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Jessica Brogdon
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - William W Godwin
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Ying Lin
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Travis Porco
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| | - Thuy Doan
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
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Safety of azithromycin in infants under six months of age in Niger: A community randomized trial. PLoS Negl Trop Dis 2018; 12:e0006950. [PMID: 30419040 PMCID: PMC6258425 DOI: 10.1371/journal.pntd.0006950] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/26/2018] [Accepted: 10/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mass azithromycin distribution reduces under-5 child mortality. Trachoma control programs currently treat infants aged 6 months and older. Here, we report findings from an infant adverse event survey in 1-5 month olds who received azithromycin as part of a large community-randomized trial in Niger. METHODS AND PRINCIPAL FINDINGS Active surveillance of infants aged 1-5 months at the time of treatment was conducted in 30 randomly selected communities from within a large cluster randomized trial of biannual mass azithromycin distribution compared to placebo to assess the potential impact on child mortality. We compared the distribution of adverse events reported after treatment among azithromycin-treated versus placebo-treated infants. From January 2015 to February 2018, the caregivers of 1,712 infants were surveyed. Approximately one-third of caregivers reported at least one adverse event (azithromycin: 29.6%, placebo: 34.3%, risk ratio [RR] 0.86, 95% confidence interval [CI] 0.68 to 1.10, P = 0.23). The most commonly reported adverse events included diarrhea (azithromycin: 19.3%, placebo: 28.1%, RR 0.68, 95% CI 0.49 to 0.96, P = 0.03), vomiting (azithromycin: 15.9%, placebo: 21.0%, RR 0.76, 95% CI 0.56 to 1.02, P = 0.07), and skin rash (azithromycin: 12.3%, placebo: 13.6%, RR 0.90, 95% CI 0.59 to 1.37, P = 0.63). No cases of infantile hypertrophic pyloric stenosis were reported. CONCLUSIONS Azithromycin given to infants aged 1-5 months appeared to be safe. Inclusion of younger infants in larger azithromycin-based child mortality or trachoma control programs could be considered if deemed effective. TRIAL REGISTRATION ClinicalTrials.gov NCT02048007.
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Oldenburg CE, Arzika AM, Maliki R, Kane MS, Lebas E, Ray KJ, Cook C, Cotter SY, Zhou Z, West SK, Bailey R, Porco TC, Keenan JD, Lietman TM. Safety of azithromycin in infants under six months of age in Niger: A community randomized trial. PLoS Negl Trop Dis 2018. [PMID: 30419040 DOI: 10.7910/dvn/mqym5s.funding] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Mass azithromycin distribution reduces under-5 child mortality. Trachoma control programs currently treat infants aged 6 months and older. Here, we report findings from an infant adverse event survey in 1-5 month olds who received azithromycin as part of a large community-randomized trial in Niger. METHODS AND PRINCIPAL FINDINGS Active surveillance of infants aged 1-5 months at the time of treatment was conducted in 30 randomly selected communities from within a large cluster randomized trial of biannual mass azithromycin distribution compared to placebo to assess the potential impact on child mortality. We compared the distribution of adverse events reported after treatment among azithromycin-treated versus placebo-treated infants. From January 2015 to February 2018, the caregivers of 1,712 infants were surveyed. Approximately one-third of caregivers reported at least one adverse event (azithromycin: 29.6%, placebo: 34.3%, risk ratio [RR] 0.86, 95% confidence interval [CI] 0.68 to 1.10, P = 0.23). The most commonly reported adverse events included diarrhea (azithromycin: 19.3%, placebo: 28.1%, RR 0.68, 95% CI 0.49 to 0.96, P = 0.03), vomiting (azithromycin: 15.9%, placebo: 21.0%, RR 0.76, 95% CI 0.56 to 1.02, P = 0.07), and skin rash (azithromycin: 12.3%, placebo: 13.6%, RR 0.90, 95% CI 0.59 to 1.37, P = 0.63). No cases of infantile hypertrophic pyloric stenosis were reported. CONCLUSIONS Azithromycin given to infants aged 1-5 months appeared to be safe. Inclusion of younger infants in larger azithromycin-based child mortality or trachoma control programs could be considered if deemed effective. TRIAL REGISTRATION ClinicalTrials.gov NCT02048007.
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Affiliation(s)
- Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | | | | | | | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Kathryn J Ray
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Catherine Cook
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Sun Y Cotter
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Zhaoxia Zhou
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Sheila K West
- The Dana Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Robin Bailey
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
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12
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Zhu J, Zhu T, Lin Z, Qu Y, Mu D. Perinatal risk factors for infantile hypertrophic pyloric stenosis: A meta-analysis. J Pediatr Surg 2017; 52:1389-1397. [PMID: 28318599 DOI: 10.1016/j.jpedsurg.2017.02.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/28/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of nonbilious vomiting in infancy. The etiology of IHPS is not completely understood. Hence, we performed a meta-analysis to investigate the association between perinatal factors and IHPS onset. METHODS The MEDLINE, EMBASE, PubMed and Cochrane Library databases were searched for studies published in English before December 2016. The combined odd ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. RESULTS Fifteen studies were included. Several perinatal factors, including first-born (OR 1.19, 95% CI: 1.07-1.33), cesarean section delivery (OR 1.63, 95% CI: 1.53-1.73), preterm birth (OR 1.37, 95% CI: 1.12-1.67), and bottle-feed (OR 2.46, 95% CI: 1.76-3.43), were significantly associated with the IHPS onset. Among these, bottle-feed was the most significantly risk factor for IHPS onset. Although few studies have evaluated the relationship between perinatal factors and IHPS, they have major limitations including retrospective collection of data on perinatal events and testing of multiple hypotheses without appropriate statistical corrections. CONCLUSIONS First-born, cesarean section delivery, preterm birth, and bottle-feed are associated with the development of IHPS. Well-designed future studies are needed to help understand the etiology of IHPS. TYPE OF STUDY Systematic reviews and meta-analyses. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jianghu Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China; Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Tingting Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China; Department of Pediatrics, University of California, San Francisco, USA
| | - Zhenlang Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China; Department of Pediatrics, University of California, San Francisco, USA
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China; Department of Pediatrics, University of California, San Francisco, USA.
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Li J, Gao W, Zhu JM, Zuo W, Liu X. Epidemiological and clinical characteristics of 304 patients with infantile hypertrophic pyloric stenosis in Anhui Province of East China, 2012-2015. J Matern Fetal Neonatal Med 2017; 31:2742-2747. [PMID: 28701060 DOI: 10.1080/14767058.2017.1355361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the clinical and epidemiological features of patients with infantile hypertrophic pyloric stenosis (IHPS) so as to provide scientific evidence for diagnosis and prevention of IHPS. METHODS We performed a retrospective study of infants with IHPS diagnosed from 2012 to 2015 at Anhui Provincial Children's Hospital. Demographic characteristics and clinical data were collected. RESULTS Three hundred four patients (264 males and 40 females) were studied, of which 94.7% were full term and 75.7% were bottle fed or mixed fed; 16.8% of the patients had other congenital malformations in combination with IHPS. The proportion of IHPS cases with hyponatremia, hypokalemia, and hypochloremia was 18.4%, 12.5%, and 53.9%. A negative correlation was found between duration of disease and serum electrolytes. The mean pyloric muscle thickness, pyloric length, and diameter were 4.8 ± 0.7 mm, 19.4 ± 2.5 mm, and 13.3 ± 1.8 mm, respectively. There were significant differences in muscle thickness, pyloric length, and diameter between short (≤14 d) and long (>14 d) durations of disease. All patients underwent pyloromyotomy, and postoperative recovery was good. CONCLUSIONS IHPS occurs mainly in male, full-term, bottle-fed or mixed-fed infants. Patients with long duration of disease were more likely to develop electrolyte disorder and thicker muscle layer. More attention should be paid to early discovery and diagnosis, which will help to improve the curative effect and prognosis of IHPS.
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Affiliation(s)
- Jing Li
- a Department of Public Health and General Medicine , Anhui University of Chinese Medicine , Hefei , Anhui , China
| | - Wei Gao
- b Department of Pediatric Surgery , Anhui Provincial Children's Hospital , Hefei , Anhui , China
| | - Ji-Min Zhu
- a Department of Public Health and General Medicine , Anhui University of Chinese Medicine , Hefei , Anhui , China
| | - Wei Zuo
- b Department of Pediatric Surgery , Anhui Provincial Children's Hospital , Hefei , Anhui , China
| | - Xiang Liu
- b Department of Pediatric Surgery , Anhui Provincial Children's Hospital , Hefei , Anhui , China
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