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Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study

M A Honein1, L J Paulozzi, I M Himelright

  • 1Division of Birth Defects, Child Development, and Disability and Health, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. mrh7@cdc.gov

Lancet (London, England)
|December 28, 1999
PubMed

Insights

Oral erythromycin use in neonates was linked to a significant increase in infantile hypertrophic pyloric stenosis (IHPS) cases. This study suggests a potential risk, urging a re-evaluation of erythromycin for pertussis prophylaxis in newborns.

Area of Science:

  • Neonatal Medicine
  • Pediatric Surgery
  • Infectious Disease Epidemiology

Background:

  • A cluster of pertussis cases in neonates prompted erythromycin prophylaxis at a community hospital in February 1999.
  • Seven cases of infantile hypertrophic pyloric stenosis (IHPS) occurred in neonates who received erythromycin post-exposure.

Purpose of the Study:

  • To investigate the association between erythromycin exposure and the development of IHPS in neonates.
  • To evaluate the risk of IHPS following oral erythromycin administration for pertussis prophylaxis.

Main Methods:

  • Independent review of IHPS ultrasonography diagnoses.
  • Calculation of monthly IHPS incidence rates.
  • Retrospective cohort study of infants born in January and February 1999 to assess erythromycin exposure and IHPS development.

Main Results:

  • All seven index IHPS cases had received erythromycin, unlike historical controls.
  • IHPS incidence in February 1999 was 32.3 per 1000 live births, a nearly seven-fold increase.
  • Erythromycin exposure was significantly associated with IHPS (absolute risk 4.5%, RR infinity).

Conclusions:

  • Neonates treated with oral erythromycin may face an elevated risk of IHPS.
  • The risk-benefit profile of erythromycin for neonatal pertussis prophylaxis requires re-evaluation.
  • Caution is advised when defining risk groups for neonatal prophylaxis.
Abstract

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