Association of prematurity with the development of infantile hypertrophic pyloric stenosis

Abstract

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 ...

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

“…Even so, the seemingly paradoxical findings we observed for low birth weight and preterm birth were observed when grouping birth weight and gestational age into meaningful categories considering small and large for gestational age. Additionally, our null findings for season of birth contrast with similar previous studies that reported seasonal variation in IHPS (Kwok & Avery, 1967;Zamakhshary et al, 2011), and our finding of increased prevalence among multiple births was consistent with two other recent studies (Rider et al, 2013;Stark et al, 2015). The results of a Texas study which used data that overlapped with those used in our study generally reported similar associations for infant sex and gestational age, although the Texas study did not observe the lower prevalence in IHPS with low birth weight observed in our study, but this may be because of differences in low birth weight categorizations used between studies (Wang et al, 2008).…”

“…The recurrence of IHPS in families suggests a genetic component for this defect (reviewed in MacMahon, 2006), and analyses of infant and parental characteristics suggest a role for non-inherited factors. Specifically, studies of infant characteristics report a fourfold or higher male excess of IHPS (Applegate & Druschel, 1995;Hedback et al, 2001;Krogh et al, 2012;Lammer & Edmonds, 1987;Markel et al, 2015;Schechter et al, 1997;To, Wajja, Wales, & Langer, 2005;Vermes, Laszlo, Czeizel, & Acs, 2016;Wang, Waller, Hwang, Taylor, & Canfield, 2008) and largely positive associations with preterm birth (Krogh et al, 2012;Schechter et al, 1997;Stark, Rogers, Eberly, & Nylund, 2015;Svenningsson, Svensson, Akre, & Nordenskjold, 2014;Wang et al, 2008), but inconclusive findings for birth weight (Applegate & Druschel, 1995;Lammer & Edmonds, 1987;Schechter et al, 1997;Wang et al, 2008), multiple births (Applegate & Druschel, 1995;Markel et al, 2015;Rider, Stevenson, Rinsky, & Feldkamp, 2013;Schechter et al, 1997;Stark et al, 2015), and month or season of birth (Dodge, 1975;Kwok & Avery, 1967;Lammer & Edmonds, 1987;Schechter et al, 1997;Zamakhshary et al, 2011).…”

Randomised trial of azithromycin to eradicate Ureaplasma in preterm infants

“…Azithromycin side effects are infrequent in adults and children 37. A recent study demonstrated an association of IHPS with oral azithromycin exposure in the first 14d of life in term38 and preterms 33–36 weeks’ gestation but not ≤32 weeks’ gestation 39. In addition, azithromycin is proarrhythmogenic with prior reports of occurrences of QT-interval prolongation and torsades de pointes in adults 40.…”

The Dutch Incidence of Infantile Hypertrophic Pyloric Stenosis and the Influence of Seasons

“…[12][13][14][26][27][28][29][30] Most recent incidence rates of IHPS in Europe are 0.6 per 1,000 LB in Sweden (2014) and 2.02 per 1,000 LB in Germany (2012). 12,14 In the United States and Israel, 30,31 We found a lower incidence of IHPS in the Netherlands of 1.28 per 1,000 LB compared with other countries. It is unknown why this difference in incidence exists.…”