Risk factors for unsuccessful atropine therapy in hypertrophic pyloric stenosis

Abstract

Background I.v. atropine (IA) for infantile hypertrophic pyloric stenosis (IHPS) is a good alternative to pyloromyotomy but has not been broadly accepted. The lower success rate is one of the greatest disadvantages of IA. We investigated the risk factors for unsuccessful results following IA for IHPS. Methods Medical records of patients with IHPS who were admitted to Kimitsu Chuo Hospital between 2002 and 2016 and were initially given atropine sulfate were retrospectively reviewed. Atropine was given i.v. (0.1 mg/kg/day in eight divided doses). Oral feeding of milk was started with a small amount and increased in a stepwise fashion to full feed. IA therapy was defined as unsuccessful in the presence of projectile vomiting more than three times a day or intolerance to a predetermined amount of milk. Results Of the 48 patients with IHPS, 33 patients were successfully treated with IA and 15 patients needed surgical intervention. On univariate analysis the risk factors for unsuccessful IA therapy were younger age, lower bodyweight, and shorter duration of symptoms before diagnosis. On multivariate analysis age at diagnosis < 30 days was the only significant risk factor for unsuccessful IA therapy (OR, 5.7 l P = 0.03). Conclusions Age at diagnosis < 30 days is a risk factor for unsuccessful IA therapy in IHPS. This might be considered when IA therapy is used for neonates with IHPS.

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

“…Nowadays, despite several reports of conservative treatment with atropine, surgical treatment (pyloromyotomy) is still the method of choice for infants suffering from hypertrophic pyloric stenosis [11][12][13][14]23]. Traditional open pyloromyotomy was initially introduced by German surgeon Ramstedt who described the first successful cases of pyloromyotomy [24].…”

“…Although there are reports in literature of treatment of hypertrophic pyloric stenosis with atropine-sulfate, in most centers the standard approach to treatment of this condition is surgery, i.e., pyloromyotomy. The success rates of conservative treatment with atropinesulfate varies between 68 and 87% [11][12][13][14]. The surgical approach involves pyloromyotomy, which can be performed in the traditional open way or, more recently, by laparoscopic approach [6,11].…”