AAP PaperHypertrophic pyloric stenosis in newborns younger than 21 days: remodeling the path of surgical intervention☆
Section snippets
Diagnosis of HPS
After approval from the institutional review board at the University of Pittsburgh Medical Center (Protocol #0608200), Pittsburgh, Pa, a chart review of patients admitted to the Children's Hospital of Pittsburgh, Pittsburgh, Pa, between January 1, 2001, and December 31, 2006, requiring surgical intervention for HPS, was performed. Patients were identified by discharge diagnosis of congenital pyloric stenosis (ICD-9 code 750.5) and the procedure code for pyloromyotomy (433). Standard controls
Demographics
Between 2001 and 2006, there were 314 patients between the ages of 0 and 42 days that presented to the Children's Hospital of Pittsburgh for surgical correction of HPS (Table 1). Of these, 96% were white and 83% were male, and 12% had a family history of HPS in a first-degree relative. There were 8 pairs of twins, in which the diagnosis of HPS was made in both twins on 2 occasions. Thirty patients (10%) had diagnostic imaging performed at outside hospitals before their admission to our
Discussion
Given the relative frequency with which newborns younger than 22 days present with HPS (and the paucity of diagnostic information relevant to this “young” population), we sought in the current study to investigate the pyloric thickness and channel length of newborns younger than 22 days, requiring surgical correction for HPS. We now describe that the pyloric MT was significantly smaller in these “younger” patients than in older counterparts. We also detected a linear relationship between
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Cited by (31)
Pediatric emergency gastrointestinal ultrasonography: pearls & pitfalls
2020, Clinical ImagingCitation Excerpt :However, the overall morphology of the pylorus may be more important than the measurements themselves in making the diagnosis of HPS. Several studies have shown that the muscle thickness and the channel length correlate with infant age and weight and that pyloric measurements for newborn infants younger than 21 days with intraoperatively proven HPS may be within the currently defined normal range [13–15]. In pylorospasm, the most common mimic of HPS, measurements can overlap with HPS although the muscle wall thickness will typically not exceed 3 mm [10].
A decision tree to guide long term venous access placement in children and adolescents undergoing surgery for renal tumors
2020, Journal of Pediatric SurgeryCitation Excerpt :Algorithms are frequently used in medicine to simplify issues and help with treatment plans across pediatric surgery, urology and oncology. Such examples include enhanced recovery pathways after surgery [24] and diagnosis and management of pyloric stenosis [25]. But beyond using frozen section pathology in determining margin positivity for tumor excision in a variety of malignancies, there are few decision trees used to guide intraoperative decision making.
Evaluation of ultrasonographic parameters in the diagnosis of pyloric stenosis relative to patient age and size
2012, Journal of Pediatric SurgeryCitation Excerpt :More than 2 decades later, these same criteria are still applied across the entire spectrum of infants being evaluated for PS regardless of age or weight. In fact, because more recent studies have correlated US measurements to age and weight, the applicability of decades-old criteria needs to be readdressed [8,9]. However, these reports demonstrating correlations between age and weight with US measurements have not looked at those infants who had negative ultrasounds and, therefore, have not been able to adequately assess the sensitivity and specificity of US in the diagnosis of PS to determine if new criteria based on age and weight are necessary.
Infantile Hypertrophic Pyloric Stenosis: Epidemiology, Genetics, and Clinical Update
2011, Advances in PediatricsCitation Excerpt :Although radiologists most often make the diagnosis, Copeland and colleagues [16] report that surgeons who have undergone focused training can diagnose the condition without confirmatory testing by a radiologist. Despite the high specificity and sensitivity of diagnostic methods, the current guidelines may not be sufficient for accurate diagnosis of IHPS in infants younger than 3 weeks because of the thin pyloric muscle thickness [19] and equivocal clinical and biochemical variables [14]. Young infants should be observed and reevaluated in 1 to 2 days when the lesion may be more clinically or radiologically evident [20].
Ultrasound diagnosis of hypertrophic pyloric stenosis – Time to change the criteria
2022, Australasian Journal of Ultrasound in Medicine
Presented at the 59th Annual Meeting of the Section on Surgery, American Academy of Pediatrics, San Francisco, CA, October 25-27, 2007.
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CLL is supported in part by the Loan Repayment Program for Pediatric Research of the National Institutes of Health.