Risk Of Pyloric Stenosis Research Articles

Spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia: spatial and multi-level analysis based on 2016 EDHS

BackgroundBottle feeding is associated with diarrheal disease morbidity and mortality and risk of pyloric stenosis, especially in developing countries. Even though, World Health Organization (WHO) recommended avoiding bottle feeding among children, still higher magnitude was reported in developing countries. This study aimed to assess the spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia.MethodsThis study was conducted based on Ethiopian Demographic and Health Surveys data (EDHS). The data were weighted using sampling weight for probability sampling and non-response to restore the representativeness of the data and get valid statistical estimates. Then a total of 4,275 weighted samples of under two years children were used to investigate the study. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. A multilevel binary logistic regression model was fitted. P-value < 0.05 was taken to declare statistical significance. A spatial analysis was done using ArcGIS and SaTScan software.ResultsThe prevalence of bottle feeding practice among under two years children in Ethiopia were 13.5% (95%CI: 11.16, 15.29) and ranges from the lowest 5.16% (95% CI: 3.28, 78.73) Amhara region to the highest 55.98% (95% CI: 47.98, 61.46) Addis Ababa region. Women with secondary and above education status [AOR=2.49; 95%CI; 1.66, 3.74], women from richest household [AOR=1.33; 95%CI; 1.01, 1.78], child 12-23 months age [AOR= 1.59; 95%CI; 1.23, 2.05], multiple birth [AOR=4.30; 95%CI; 1.88, 9.84], rural residence [AOR=0.49; 95%CI; 0.16, 0.82] and large central region [AOR= 0.15; 95%CI; 0.08, 0.27] have significantly associated with bottle feeding. Addis Ababa, Central Oromia, Dire Dewa, Somali and Harari regions were the hot spot areas for bottle feeding practice among under two years children.Conclusion and recommendationsThe prevalence of bottle feeding practices in Ethiopia is relatively moderate. Maternal education, wealth index, child age, multiple births, residence and region were significant predictors of bottle feeding. These findings highlight that, the Ministry of Health Ethiopia (MOH), policymakers, and other stakeholders had better give prior attention to preventable factors such as empowering women, enhancing household wealth status to decreasing bottle feeding practice in Ethiopia.

Azithromycin is associated with increased risk of pyloric stenosis in infants

Azithromycin is associated with increased risk of pyloric stenosis in infants

Does Azithromycin Increase Risk for Pyloric Stenosis in Infants

Oral erythromycin administration to neonates increases their risk for developing infantile hypertrophic pyloric stenosis (IHPS), likely due to the

Testosterone Levels in Umbilical-Cord Blood and Risk of Pyloric Stenosis

The risk of infantile hypertrophk pylonc stenosis is ∼5 times more common in male than female infants. It has been hypothesized that the higher risk among male infants is associated with high levels of testosterone causing hypertrophy of the pylorus muscle. To test this hypothesis, we examined the association between the testosterone levels in the umbilical-cord blood and the risk of infantile hypertrophic pyloric stenosis. We conducted a matched case-control study nested in the Danish National Birth Cohort using risk-set sampling. From a cohort of 101 042 pregnancies, we identified umbilical-cord blood samples from 46 case subjects (43 male and 3 female infants) who developed infantile hypertrophic pyloric stenosis in the first year of life and 150 gender- and gestational age-matched control subjects. The testosterone levels were measured by liquid chromatography-tandem mass spectrometry. Rate ratios were estimated by using conditional logistic regression. In male infants, the mean testosterone level at birth was 0.78 nmol/L in case subjects and 0.91 nmol/L in control subjects. The rate of infantile hypertrophic pyloric stenosis was inversely, albeit insignificantly, associated with the testosterone levels in male infants; there was a 29% (95% confidence interval: -46% to 65%; P = 35) lower rate per nmol/L. The association was not modified according to age, gestational age, or birth order. We found no support for the hypothesis that high testosterone levels in the umbilical-cord blood are strongly associated with a subsequently higher risk for infantile hypertrophic pyloric stenosis in male infants.

Testosterone Levels in Umbilical-Cord Blood and Risk of Pyloric Stenosis

Testosterone Levels in Umbilical-Cord Blood and Risk of Pyloric Stenosis

Vomiting in a 22-day-old firstborn male

A 22-day-old healthy appearing male infant presented with persistent vomiting after feeding with onset shortly after birth. This is the father’s second child and the mother’s first. Switching formulas had been unsuccessful. Abdominal X-ray (AXR) revealed a dilated air-filled stomach with a nonspecific bowel gas pattern (Fig. 1). Ultrasound (US) demonstrated a thick and elongated pylorus, confirming the diagnosis (Figs. 2 and ​and33). Fig. 1 AXR showing a dilated and air-filled stomach Fig. 2 US showing an elongated and thickened pylorus Fig. 3 US view from a slightly different angle confirms the measurements Pyloric stenosis is an important cause of gastric outlet obstruction and vomiting in infants. Peak incidence occurs between 2 and 5 weeks of age with an incidence of 1–8 per 1,000 live births. Male infants are predominantly affected 4:1 over female infants [1]. There is a familial component, with sons of affected fathers carrying a 5% risk of pyloric stenosis [2]. The cardinal feature of this disorder is projectile, nonbilious vomiting that occurs anywhere from the end of feeding up to 30 min after. Afterwards the infant exhibits a desire to feed more. Persistent emesis results in hypokalemic hypochloremic metabolic alkalosis with dehydration. Palpation of an olive-shaped, muscular, mobile, and nontender mass in the left upper quadrant is pathognomonic of this condition. During feeding, gastric peristaltic waves can sometimes be observed from left to right upper abdominal quadrants. Radiographic signs of pyloric stenosis include gastric distension with air, a maximal gastric diameter of 7 cm or greater, and thick walled gastric antrum [3]. Abdominal US confirms the diagnosis by illustrating the increased length and thickness of the pyloric muscle. Before surgical treatment, correction of dehydration and serum electrolytes is necessary. Definitive therapy is pyloromyotomy with an excellent outcome [4].

Treatment strategy for early gastric cancer with the risk of pyloric stenosis after endoscopic resection

We read with great interest the study by Dr. Coda and his colleagues, ”Risk factors for cardiac or pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment,” regarding early gastric cancer (EGC) [1].

A question that won't go away.

Maternal and Infant Use of Erythromycin and Other Macrolide Antibiotics as Risk Factors for Infantile Hypertrophic Pyloric Stenosis Mahon BE, Rosenman MB, Kleiman MB. J Pediatr 2001;139:380–4. Summary: The charts were reviewed of infants born at a large urban hospital between 1993 and 1999 for evidence of macrolide antibiotic use either by their mothers during pregnancy or by the infants themselves during the first 3 months of life and for the incidence of infantile hypertrophic pyloric stenosis (IHPS). Prescriptions from the hospital pharmacy records for erythromycin, azithromycin, or clarithromycin were viewed as proof of medication use. Single-dose prophylaxis and topical use, including erythromycin ophthalmic ointment used at delivery, were recorded. Hospital records were then searched electronically for the diagnosis of IHPS using several key words. The study eventually included 14,876 infants (and their mothers) of whom 469 received prescriptions for oral or intravenous erythromycin. Pyloric stenosis was found in 43 of these infants (0.29%). The risk of pyloric stenosis was increased in only the infants who had prescriptions for oral or intravenous erythromycin (not topical). Pyloric stenosis developed in none of the infants who received erythromycin after the first 2 weeks of life. Pyloric stenosis developed in 3% of the 201 infants with prescriptions for more than 2 weeks of use, whereas IHPS developed in none of 215 with prescriptions for fewer than 14 days. Only six infants in the study received azithromycin, and none received clarithromycin; therefore, no conclusions about the risk of these macrolides could be reached. Erythromycin ophthalmic ointment use did not increase the incidence of IHPS. Findings suggest that from the 3,346 mothers who received macrolide antibiotics during pregnancy, erythromycin use during the last 10 weeks of pregnancy was a possible risk factor for IHPS, but no increase in risk was associated with use earlier in pregnancy. Comment: During the years, studies have suggested that early infant exposure to erythromycin is associated with increased risk of IHPS. Most of the studies have been either brief case reports or have been from institutions in which a modest cohort of newborn infants exposed to pertussis before immunization received the medication as prophylaxis. The oversimplified explanation for the association between IHPS and erythromycin is that erythromycin, a potent motilin agonist, causes muscular hypertrophy in the antrum or pylorus by prolonged overstimulation of the antral musculature. The current study does not speak to cause. Its strength is the large number of patients included and the obvious care expended on the record review. The risk of IHPS in the general population of infants is only 0.25%. Thus, a large number of study infants are needed to statistically support what prior studies have suggested. The risk estimated by this large study is that 2.65% of infants treated with erythromycin in the first 2 weeks of life will develop IHPS, a 10-fold increase over the general population. This study also clarifies the timing of erythromycin administration (before 2 weeks of age seems to be the period of risk), the risk of topical erythromycin ointment (none), and the duration of use (higher risk with use for more than 14 days). The dosages of erythromycin prescribed were appropriate, and no dosage-related effect was detected in the affected infants. Unfortunately, the numbers were not large enough to determine whether maternal use was a risk factor, although use late in pregnancy may prove, in bigger future studies, to be a factor. The authors did not extend their study to look at the incidence of IHPS in the infants of breast-feeding mothers who received erythromycin postnatally. The weakness of this study is obvious. Using prescription records to define actual antibiotic use may be unreliable; however, the large number of neonates involved in this study decreases that concern somewhat. The increase in incidence of IHPS was the same in infants receiving drug therapy in the hospital as for outpatients. This finding supported the use of pharmacy records as being synonymous with drug administration in the outpatients. Ninety-seven percent of the infants treated with erythromycin did not develop IHPS. This suggests that other factors relating to IHPS remain to be identified. It would have been interesting to see whether there were any differences in erythromycin dosage or duration of use in the 97% of treated infants who did not develop IHPS. We congratulate the authors for their effort in extracting so much information in this retrospective study. Their findings will have an impact on several aspects of general pediatric care of the newborn, and will also have an impact on gastrointestinal care. Specifically, in the young infant with blood-streaked stool, we should wait for Campylobacter culture results before starting erythromycin therapy.