-
Journal of Pediatric Surgery Nov 2018Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature... (Review)
Review
PURPOSE
Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature involving PSPBUS.
METHODS
PSPBUS practices reviewed in this paper include central venous catheter placement, physiologic assessment (volume status and echocardiography), hypertrophic pyloric stenosis diagnosis, appendicitis diagnosis, the Focused Assessment with Sonography for Trauma (FAST), thoracic evaluation, and soft tissue infection evaluation.
RESULTS
There are no standards for the practice of PSPBUS.
CONCLUSIONS
As the role of the pediatric surgeon continues to evolve, PSPBUS will influence practice patterns, disease diagnosis, and patient management.
TYPE OF STUDY
Review Article.
LEVEL OF EVIDENCE
Level III.
Topics: Appendicitis; Catheterization, Central Venous; Child; Humans; Point-of-Care Systems; Pyloric Stenosis, Hypertrophic; Surgeons; Ultrasonography
PubMed: 29807830
DOI: 10.1016/j.jpedsurg.2018.04.040 -
Journal of Pediatric Surgery Sep 2017Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of nonbilious vomiting in infancy. The etiology of IHPS is not completely understood.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of nonbilious vomiting in infancy. The etiology of IHPS is not completely understood. Hence, we performed a meta-analysis to investigate the association between perinatal factors and IHPS onset.
METHODS
The MEDLINE, EMBASE, PubMed and Cochrane Library databases were searched for studies published in English before December 2016. The combined odd ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models.
RESULTS
Fifteen studies were included. Several perinatal factors, including first-born (OR 1.19, 95% CI: 1.07-1.33), cesarean section delivery (OR 1.63, 95% CI: 1.53-1.73), preterm birth (OR 1.37, 95% CI: 1.12-1.67), and bottle-feed (OR 2.46, 95% CI: 1.76-3.43), were significantly associated with the IHPS onset. Among these, bottle-feed was the most significantly risk factor for IHPS onset. Although few studies have evaluated the relationship between perinatal factors and IHPS, they have major limitations including retrospective collection of data on perinatal events and testing of multiple hypotheses without appropriate statistical corrections.
CONCLUSIONS
First-born, cesarean section delivery, preterm birth, and bottle-feed are associated with the development of IHPS. Well-designed future studies are needed to help understand the etiology of IHPS.
TYPE OF STUDY
Systematic reviews and meta-analyses.
LEVEL OF EVIDENCE
Level III.
Topics: Cesarean Section; Female; Humans; Infant; Infant, Newborn; Male; Parity; Parturition; Perinatal Care; Pregnancy; Premature Birth; Pyloric Stenosis, Hypertrophic; Retrospective Studies; Risk Factors
PubMed: 28318599
DOI: 10.1016/j.jpedsurg.2017.02.017 -
Pediatric Surgery International Jun 2024We sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile...
INTRODUCTION
We sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile hypertrophic pyloric stenosis (IHPS).
MATERIALS AND METHODS
Twenty-three infants were included in the study, 13 in the IHPS group and 10 in the control group (CG). Preoperative B-mode ultrasonography measurements (longitudinal length and single-wall thickness of the pylorus) and 2D-SW-SE measurements (pylorus tissue stiffness and shear-wave propagation speed) were compared between the groups. The infants with IHPS then underwent Ramstedt pyloromyotomy and were invited for follow-ups on the tenth day and the first, third, and sixth months postoperatively. Measurements taken at the follow-ups were compared with the preoperative values.
RESULTS
No differences were found between the groups regarding age, gender, body weight, or week of birth. The pyloric lengths in the IHPS group were longer than in the CG (p < 0.001), and the single-wall thicknesses were thicker (p < 0.001). The pylorus in the IHPS group was four times stiffer than in the CG (27.4 kPa versus 7.66 kPa), and the shear-wave propagation speed in the tissue was higher (1.34 m/s versus 2.69 m/s; p < 0.001). Both values decreased over time in the IHPS group and were normal by the third postoperative month.
CONCLUSIONS
2D-SW-SE can be used as an assistive imaging tool alongside B-mode ultrasound for diagnosing IHPS. It can also be used to identify inadequate surgery by detecting whether the pyloric tissue has softened at follow-up.
Topics: Humans; Pyloric Stenosis, Hypertrophic; Elasticity Imaging Techniques; Male; Female; Infant; Follow-Up Studies; Infant, Newborn; Pylorus; Pyloromyotomy; Treatment Outcome
PubMed: 38916663
DOI: 10.1007/s00383-024-05738-5 -
Archives of Women's Mental Health Dec 2021The etiology of pediatric abdominal disorders is poorly understood, and the relationship with maternal mental health is understudied. We sought to determine the...
The etiology of pediatric abdominal disorders is poorly understood, and the relationship with maternal mental health is understudied. We sought to determine the association between maternal psychiatric disorders and abdominal conditions in childhood. We performed a retrospective cohort study of 1,080,518 newborns in Quebec, Canada, between 2006 and 2020. We identified maternal mental disorders before or during pregnancy and computed the incidence of abdominal disorders in offspring before 1 year of age. Outcomes included Hirschsprung disease; hypertrophic pyloric stenosis; and esophageal, intestinal, and biliary atresia. We calculated adjusted risk ratios (RR) with 95% confidence intervals (CI) for the association of maternal mental disorders with these pediatric abdominal disorders. Among 51,371 children exposed to maternal mental disorders, 200 children had an abdominal condition, for a rate of 38.9 cases per 10,000 children (95% CI 33.6-44.3) compared with 27.7 per 10,000 for children who were unexposed to maternal mental disorders (95% CI 26.7-28.7). Compared with no mental disorder, maternal mental disorders were associated with hypertrophic pyloric stenosis (RR 1.39, 95% CI 1.16-1.68). Associations were stronger for severe mental disorders and were more marked for depression and stress and anxiety disorders. Maternal mental disorders are associated with the risk of hypertrophic pyloric stenosis in offspring. The origin of hypertrophic pyloric stenosis may relate to maternal mental disorders that were present during pregnancy.
Topics: Anxiety Disorders; Child; Female; Humans; Incidence; Infant, Newborn; Mental Disorders; Mental Health; Pregnancy; Retrospective Studies
PubMed: 33834267
DOI: 10.1007/s00737-021-01126-3 -
Journal of Pediatric Surgery Dec 2019
PubMed: 31718866
DOI: 10.1016/j.jpedsurg.2019.08.010 -
Biomedical Journal Dec 2022To examine factors that affect the severity of pyloric hypertrophy, post-operative feeding and nutritional recovery in infantile hypertrophic pyloric stenosis (IHPS).
BACKGROUND
To examine factors that affect the severity of pyloric hypertrophy, post-operative feeding and nutritional recovery in infantile hypertrophic pyloric stenosis (IHPS).
METHODS
Medical records of infants diagnosed with IHPS at a single tertiary center between 2009 and 2018 were retrospectively reviewed. Clinical characteristics, biochemistry data and outcome were assessed for their association with the severity of pyloric hypertrophy and post-operative recovery. Nutritional recovery was assessed using weight-for-age status improvement after surgery.
RESULTS
Eighty-five patients were recruited in this study. The mean pre-operative weight-for-age percentile was 18.2. Elevated bicarbonate was positively correlated with symptom duration (p = 0.007). Pyloric muscle thickness was significantly correlated with age, weight, and symptom duration (p = 0.004, 0.003, 0.008, respectively). The mean weight-for-age percentile increased to 41.6 by post-operative weeks 6-8. Pyloric muscle thickness was negatively correlated with nutritional recovery by post-operative weeks 6-8 (p = 0.003). In multivariable analysis, pyloric length related to nutritional recovery at week 1-2 postoperatively (OR = 1.42, p = 0.030, 95% CI = 0.03-1.94), and pyloric muscle thickness related to nutritional recovery at week 6-8 postoperatively (OR = 4.08, p = 0.032, 95% CI = 1.13-14.7).
CONCLUSION
Our study indicated that favorable nutritional outcome and successful weight gain was observed 6-8 weeks after surgery in children with IHPS. Pyloric muscle thickness positively correlated with age, weight, symptom duration, and favorable nutritional recovery. Serum bicarbonate showed a positive correlation with symptom duration.
Topics: Infant; Child; Humans; Pyloric Stenosis, Hypertrophic; Retrospective Studies; Bicarbonates; Pylorus; Hypertrophy
PubMed: 34995820
DOI: 10.1016/j.bj.2021.12.011 -
RoFo : Fortschritte Auf Dem Gebiete Der... Nov 2020
Topics: Choristoma; Diagnosis, Differential; Follow-Up Studies; Gastroscopy; Humans; Magnetic Resonance Imaging; Male; Pancreas; Pyloric Stenosis; Stomach Diseases; Young Adult
PubMed: 32349129
DOI: 10.1055/a-1157-9681 -
Tidsskrift For Den Norske Laegeforening... Apr 2018Pyloric stenosis is one of the most common surgical conditions in infants. This study aims to investigate diagnostics and results of surgical treatment for pyloric...
BACKGROUND
Pyloric stenosis is one of the most common surgical conditions in infants. This study aims to investigate diagnostics and results of surgical treatment for pyloric stenosis at Oslo University Hospital Ullevål.
MATERIAL AND METHOD
A retrospective review of patient records for those undergoing surgery for pyloric stenosis in the period 2004-2016 was conducted. Preoperative symptoms and findings, diagnostics, treatment and postoperative results were recorded. Postoperative complications were classified according to the Clavien-Dindo classification.
RESULTS
We identified 140 patients, 123 boys and 17 girls. The sensitivity for ultrasound examination at Oslo University Hospital was 96 % (135/140). Pyloromyotomy was curative in all the patients. A total of 12 perioperative and 12 postoperative complications were determined in 22 patients (16 %). There were four serious postoperative complications (grade IIIb and grade IVa), none of which caused sequelae. Mucosal perforation occurred in two patients and was diagnosed and sutured postoperatively. Postoperative wound infection occurred in seven patients.
INTERPRETATION
The diagnosis of pyloric stenosis was confirmed by ultrasound examination in 96 % of the patients who underwent surgery for pyloric stenosis. Pyloromyotomy was curative in all the patients and there were few serious complications.
Topics: Female; Humans; Infant; Infant, Newborn; Intraoperative Complications; Male; Norway; Postoperative Complications; Pyloric Stenosis, Hypertrophic; Pyloromyotomy; Retrospective Studies; Sex Distribution; Treatment Outcome
PubMed: 29663766
DOI: 10.4045/tidsskr.17.0619 -
Journal of Perioperative Practice Mar 2020
Topics: Digestive System Surgical Procedures; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pyloric Stenosis, Hypertrophic
PubMed: 32116120
DOI: 10.1177/1750458920903246 -
The British Journal of Radiology Oct 2022Although infantile hypertrophic pyloric stenosis (IHPS) is a well-known disease, there is no systematic review regarding the optimal diagnostic strategy. We conducted a... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Although infantile hypertrophic pyloric stenosis (IHPS) is a well-known disease, there is no systematic review regarding the optimal diagnostic strategy. We conducted a systematic review and meta-analysis to obtain diagnostic accuracy of all methods to diagnose IHPS.
METHODS
According to the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, we searched MEDLINE and Embase to identify studies reporting sensitivity and specificity of all methods used to diagnose IHPS. Inclusion criteria were infants with suspicion of/or diagnosed with IHPS who underwent pyloromyotomy or had clinical follow-up. A random-effects model was used to obtain pooled estimates of sensitivity, specificity and area under the receiver operating characteristic curve.
RESULTS
After screening 5364 studies, we included 43 studies with in total 6085 infants ( = 4241 IHPS; = 1844 controls). The diagnostic sensitivity of palpation ranged from 10.0 to 93.4% and decreased over time. Different parameters for ultrasonography were found. Most used parameters were pyloric muscle thickness (PMT) ≥ 3 mm (pooled sensitivity 97.6% and specificity 98.8%), PMT ≥ 4 mm (pooled sensitivity 94.0% and specificity 98.0%) or a combination of PMT ≥ 4 mm and/or pyloric canal length ≥16 mm (pooled sensitivity 94.0% and specificity 91.7%). The AUC showed high diagnostic accuracy (0.997, 0.966 and 0.981 respectively), but large heterogeneity exists. Due to the large differences in cut-off values no meta-analysis could be conducted for pyloric canal length and pyloric diameter.
CONCLUSION
Palpation has limited sensitivity in diagnosing IHPS. We showed that ultrasonography has highest diagnostic accuracy to diagnose IHPS and we advise to use PMT ≥ 3 mm as cut-off.
ADVANCES IN KNOWLEDGE
This is the first systematic review and meta-analysis on diagnosing IHPS, which summarizes the available literature and may be used as a guideline.
Topics: Humans; Infant; Pyloric Stenosis, Hypertrophic; Ultrasonography; Palpation; Sensitivity and Specificity
PubMed: 36043474
DOI: 10.1259/bjr.20211251