Maternal and pregnancy characteristics and risk of infantile hypertrophic pyloric stenosis

Svenningsson, Anna; Svensson, Tobias; Akre, Olof; Nordenskjöld, Agneta

doi:10.1016/j.jpedsurg.2014.01.053

Cited by 47 publications

(37 citation statements)

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“…Increased physiologic and therapeutic prostaglandin levels have been associated previously with reactive gastropathy and gastric outlet obstruction (24)(25)(26). Maternal smoking, a known risk factor for premature birth, also has been associated with increased risk of IHPS (16). Bottle-feeding status, inpatient medication exposures, and maternal smoking data were unavailable for the present study.…”

Section: Discussionmentioning

confidence: 90%

“…Few studies have appropriately large sample sizes to assess IHPS risk in premature infants. Studies of Australian and Scandinavian infants have found increased rates of IHPS in preterm infants (14,16). The Australian hospital study found that up to 19% of cases of IHPS occurred in infants born prematurely, while the population-wide Scandinavian study found that prematurity was a risk factor for IHPS (OR 2.54, 95% CI 2.06-3.14).…”

Section: Discussionmentioning

confidence: 99%

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Association of prematurity with the development of infantile hypertrophic pyloric stenosis

et al. 2015

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Background: Infantile hypertrophic pyloric stenosis (IHPS) has several known risk factors. The association between prematurity and IHPS and the timeline of presentation are poorly defined. Our aim was to evaluate the associations between IHPS and prematurity. Methods: We performed a retrospective cohort study of 1,074,236 children born between June 2001 and April 2012 in the US Military Health System. IHPS cases and gestational ages (GA) were identified using billing codes. Additional risk factors for IHPS were controlled for in a multivariable logistic regression model. results: The incidence of IHPS was 2.99 per 1,000 in preterm infants and 2.25 per 1,000 in full term (relative risk (RR) = 1.33, 95% confidence interval (CI) 1.16-1.54). The adjusted odds ratio for prematurity was 1.26 (95% CI 1.08-1.46). The median (interquartile range (IQR)) chronological age at presentation was 40 d (30-56) in preterm infants vs. 33 d (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) in full term (P < 0.001). Median postmenstrual age at presentation was 42 wk in preterm infants (40-42) vs. 45 wk (44-46) in full term (P < 0.001). conclusion: Prematurity is associated with IHPS. Premature infants develop IHPS at a later chronological age, but earlier postmenstrual age, than term infants. Providers should have an increased concern for IHPS development in premature infants. i nfantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in young infants. IHPS is a significant source of infant morbidity and, left untreated, can cause severe dehydration and life-threatening metabolic alkalosis. IHPS is now recognized earlier in its clinical course and is managed successfully with surgical pyloromyotomy (1-4). There are several established prenatal and perinatal risk factors for IHPS, including macrolide antibiotic use, bottle-feeding, male sex, family history, and birth order (5-8). The etiology of IHPS remains unclear, but current research suggests that it is caused by an interplay of environmental and genetic factors (9). Retrospective studies and post-hoc analysis with large populations continue to add important information about the potential causes and clinical course of IHPS.The rate of preterm birth in the United States, defined as delivery at <37 wk gestation, was around 11.7% in 2011 (10). The unique risks and clinical course of diseases in preterm populations are often underappreciated. The understanding of a relationship between IHPS and prematurity has evolved. Previous literature suggested that preterm infants rarely present with IHPS (11,12). Several recent epidemiological studies have found variable evidence that prematurity might be associated with increased risk of developing IHPS, although this association remains unclear (7,8,13,14).Full-term infants with IHPS typically present in the first 2-7 wk of life (7). The presentation age of preterm infants that develop IHPS is defined less clearly. Some studies suggest that preterm infants may present with ...

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Association of prematurity with the development of infantile hypertrophic pyloric stenosis

et al. 2015

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“…Another limitation was the lack of IHPS data for the entire study period from three of the 11 participating surveillance programs. Also, we lacked data on selected infant and parental characteristics from some surveillance programs, as well as data on maternal behavioral and medication exposures that may contribute to IHPS, including maternal cigarette smoking during pregnancy (Krogh et al, ; Leite, Albieri, Kjaer, & Jensen, ; Markel et al, ; Sorensen, Norgard, Pedersen, Larsen, & Johnsen, ; Svenningsson et al, ) and maternal use of medications during pregnancy, such as any macrolide (Ludvigsson, Lundholm, Ortqvist, & Almqvist, ; Lund et al, ), erythromycin (Cooper et al, ; Louik, Werler, & Mitchell, ), azithromycin (Eberly, Eide, Thompson, & Nylund, ), decongestants (Yau, Mitchell, Lin, Werler, & Hernandez‐Diaz, ), and bendectin (Eskenazi & Bracken, ). Nonetheless, more than 99% of data were available for each selected infant or parental characteristic, except maternal race/ethnicity, parity, and paternal race/ethnicity, for which only 80%, 75%, and 67% of data, respectively, were available.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, varying associations have been reported with maternal race/ethnicity with the highest risks observed among non‐Hispanic White mothers and lower risks for non‐Hispanic Blacks, Hispanics (Applegate & Druschel, ; Lammer & Edmonds, ; Markel et al, ; Schechter et al, ; Wang et al, ), and Asians (Markel et al, ; Schechter et al, ; Wang et al, ). Conversely, more consistent associations have been reported for maternal education at delivery with decreasing prevalence observed with increasing education (Applegate & Druschel, ; Markel et al, ; To et al, ; Wang et al, ) and for maternal parity with decreasing prevalence observed with increasing parity (Applegate & Druschel, ; Dodge, ; Krogh et al, ; Schechter et al, ; Svenningsson et al, ; Wang et al, ). Few previous studies of infant or parental characteristics examined associations stratified by IHPS phenotype (isolated vs. multiple birth defects) or by infant sex.…”

Section: Introductionmentioning

confidence: 88%

Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: A multistate, population‐based retrospective study, 1999–2010

Kapoor

Kancherla

Cao

et al. 2018

Birth Defects Research

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Background Antecedents for infantile hypertrophic pyloric stenosis (IHPS) vary across studies; therefore, we conducted a multistate, population‐based retrospective study of the prevalence and descriptive epidemiology of IHPS in the United States (US). Methods Data for IHPS cases (n = 29,554) delivered from 1999–2010 and enumerated from 11 US population‐based birth defect surveillance programs, along with data for live births (n = 14,707,418) delivered within the same birth period and jurisdictions, were analyzed using Poisson regression to estimate IHPS prevalence per 10,000 live births. Additional data on deliveries from 1999–2005 from seven of these programs were analyzed using multivariable logistic regression to estimate adjusted prevalence ratios (aPR)s and 95% confidence intervals (CI)s for selected infant and parental characteristics. Results Overall, IHPS prevalence from 1999–2010 was 20.09 (95% CI = 19.87, 20.32) per 10,000 live births, with statistically significant increases from 2003–2006 and decreases from 2007–2010. Compared to their respective referents, aPRs were higher in magnitude for males, preterm births, and multiple births, but lower for birth weights <2,500 g. The aPRs for all cases increased with decreasing parental age, maternal education, and maternal parity, but decreased for parental race/ethnicity other than non‐Hispanic White. Estimates restricted to isolated cases or stratified by infant sex were similar to those for all cases. Conclusions This study covers one of the largest samples and longest temporal period examined for IHPS in the US. Similar to findings reported in Europe, estimates suggest that IHPS prevalence has decreased recently in the US. Additional analyses supported associations with several infant and parental characteristics.

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“…Regardless of the etiological debates [17][18][19][20], typically infants with IHPS are clinically normal at birth but during the first few weeks of postnatal life, they develop nonbilious forceful vomiting mostly described as "projectile". Gastric outlet obstruction leads to emaciation and, if left untreated, may result in death [1,21,22].…”

Section: Discussionmentioning

confidence: 99%

The use of ultrasonography in infantile hypertrophic pyloric stenosis: do the patientâ€™s age and weight affect pyloric size and pyloric ratio?

et al. 2015

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Aims: We aimed to obtain pyloric measurements of our patients with infantile hypertrophic pyloric stenosis (IHPS) using ultrasonography (US) and to evaluate the correlations between age, weight and pyloric size, pyloric ratio (PR). Material and methods: We designed a retrospective study including 20 term infants with surgically proven IHPS and studied the ultrasonographically obtained pyloric muscle thickness (PMT), pyloric diameter (width) (PD), pyloric length (PL) and PR (PMT/PD) to determine if there were statistically significant associations between patient age/weight and pyloric measurements. Results: The mean age of the infants was 38.7±17.3 days (range, 9-76 days) and their mean weight was 3688.5±772.7 g (range, 2810-6000 g), at referral. Mean PMT was 4.98±1.04 mm (range, 3.5-6.8 mm). Mean PD was 14.04±2.39 mm (range, 10-18 mm). Mean PL was 22.16±4.02 mm (range, 16-31.5 mm) and mean PR was 0.35±0.04 (range, 0.29-0.42). The correlation between age and PMT (r=0.654, p<0.05) and the correlation between age and PD (r=0.747, p <0.05) were significant. Age and weight were not significantly correlated with PR (p>0.05). Conclusions: The PMT and PD are age dependent parameters. The PR is age and weight independent and therefore, when combined with PMT, PD and PL, it can be useful in the diagnosis of IHPS in infants with early onset disease and/or in those with a lower weight.

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Maternal and pregnancy characteristics and risk of infantile hypertrophic pyloric stenosis

Cited by 47 publications

References 37 publications

Association of prematurity with the development of infantile hypertrophic pyloric stenosis

Association of prematurity with the development of infantile hypertrophic pyloric stenosis

Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: A multistate, population‐based retrospective study, 1999–2010

The use of ultrasonography in infantile hypertrophic pyloric stenosis: do the patientâ€™s age and weight affect pyloric size and pyloric ratio?

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