Related Experiment Videos

Predictive factors of negative outcome in initial atropine therapy for infantile hypertrophic pyloric stenosis

Yuhki Koike1, Keiichi Uchida, Makoto Nakazawa

  • 1Department of Pediatric Surgery, National Mie Hospital, Mie, Japan; Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Mie, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|May 25, 2013
PubMed

Insights

Projectile vomiting five or more times after starting atropine therapy indicates a negative outcome for infantile hypertrophic pyloric stenosis. This finding helps determine if surgery or initial atropine treatment is best for infants.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Neonatal Care

Background:

  • Infantile hypertrophic pyloric stenosis (IHPS) is often treated non-operatively with atropine to avoid surgical risks.
  • However, atropine therapy for IHPS can fail in some cases, necessitating further intervention.
  • Predictive factors for negative outcomes in initial atropine therapy for IHPS remain unclear.

Purpose of the Study:

  • To identify predictive markers for negative outcomes in initial intravenous atropine (IA) therapy for IHPS.
  • To provide insights for clinical decision-making regarding treatment strategies for IHPS.

Main Methods:

  • Retrospective analysis of 76 IHPS patients treated between 1998 and 2011.
  • Evaluation of potential risk factors associated with treatment failure in patients undergoing initial non-operative therapy.

Main Results:

  • Out of 31 patients receiving initial non-operative therapy, 18 (58%) responded successfully to IA and oral atropine.
  • Univariate analysis identified lack of weight gain, elevated urine potassium, and projectile vomiting (PV) ≥5 times in 3 days as risk factors for negative outcomes.
  • Multivariate analysis revealed PV ≥5 in 3 days as an independent predictor of atropine failure in IHPS.

Conclusions:

  • Frequent projectile vomiting (≥5 episodes in 3 days) after initiating IA therapy is a significant indicator of potential treatment failure in IHPS.
  • This finding aids clinicians in deciding between early surgical intervention and initial atropine therapy for IHPS management.
Abstract

Keywords:
atropine sulfateinfantile hypertrophic pyloric stenosisnon-operative managementpredictive factor

Related Concept Videos

Pyloric Obstruction01:11

Pyloric Obstruction

Pyloric obstruction, also referred to as gastric outlet obstruction, is a condition characterized by narrowing or blockage at the pylorus—the muscular valve regulating the flow of stomach contents into the duodenum. When this passage becomes impaired, the stomach cannot effectively empty its contents into the small intestine. This disruption leads to a range of gastrointestinal symptoms, including early satiety, bloating, epigastric pain, postprandial nausea, persistent vomiting, and...
Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
Gastritis II: Pathophysiology01:26

Gastritis II: Pathophysiology

The pathophysiology of gastritis begins with the colonization of the stomach lining by Helicobacter pylori (H. pylori). This bacterium spreads mainly via the oral-oral route through saliva or shared utensils, and can also be transmitted in overcrowded or unhygienic environments through contaminated water, despite its brief survival outside the body.ColonizationOnce ingested, H. pylori enters the stomach and begins colonization by navigating through the mucus layer lining the stomach wall. It...
Peptic Ulcer Disease V: Surgical Management and Nursing Care01:25

Peptic Ulcer Disease V: Surgical Management and Nursing Care

Surgical management and nursing care are crucial in treating Peptic Ulcer Disease (PUD). Here is an organized and enhanced overview of the surgical interventions and the associated nursing care for PUD:
Surgical Interventions for Peptic Ulcer Disease
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
Pathophysiology of Peptic Ulcer Disease: Mucosal Defense Factors01:24

Pathophysiology of Peptic Ulcer Disease: Mucosal Defense Factors

Peptic ulcer disease, commonly called PUD, represents a multifaceted condition characterized by disruptions in the lining of the gastrointestinal (GI)  tract. Central to the protection of the gastrointestinal lining is the mucosal-bicarbonate barrier. This physiological defense mechanism is a formidable shield against the corrosive effects of gastric acid and pepsin secretion in the stomach. Its role is pivotal in maintaining the structural integrity of the stomach's inner lining. Bicarbonate,...