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Perioperative apnea in infants with hypertrophic pyloric stenosis: A systematic review
Fenne A I M van den Bunder1, Lotte van Wijk1, Job B M van Woensel2
1Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
Insights
Infants with infantile hypertrophic pyloric stenosis (IHPS) face a risk of perioperative apnea. Further research is needed to confirm incidence rates and the role of metabolic alkalosis in IHPS-related apnea.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Critical Care Medicine
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) causes vomiting and metabolic alkalosis, potentially leading to apnea.
- The precise incidence of perioperative apnea in IHPS infants and its link to metabolic alkalosis remain unclear.
- Current surgical guidelines often assume metabolic correction is necessary to prevent apnea.
Purpose of the Study:
- To systematically review the incidence of perioperative apnea in infants with IHPS.
- To investigate the association between metabolic alkalosis and apnea in IHPS patients.
Main Methods:
- A systematic literature search was conducted across MEDLINE, Embase, and Cochrane Library.
- Studies involving infants with metabolic alkalosis, respiratory issues, and IHPS were identified.
- A descriptive synthesis of findings from 13 included studies was performed.
Main Results:
- The incidence of preoperative apnea was 27%, and postoperative apnea ranged from 0.2% to 16%.
- Six studies reported preoperative apnea, three postoperative, and four reported both.
- None of the included studies specifically examined the association between apnea and metabolic alkalosis in IHPS.
Conclusions:
- Infants with IHPS may be at risk for perioperative apnea, but current evidence is limited by low study quality and quantity.
- Further high-quality research is essential to accurately determine the incidence of perioperative apnea in IHPS.
- The underlying mechanisms of apnea in IHPS infants are not fully understood, and the role of metabolic alkalosis requires further investigation.
Background:
Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis.
Methods:
We searched MEDLINE, Embase, and Cochrane library to identify studies regarding infants with metabolic alkalosis, respiratory problems, and hypertrophic pyloric stenosis. We conducted a descriptive synthesis of the findings of the included studies.
Results:
Thirteen studies were included for analysis. Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. All studies were of low quality or had other research questions. We found an incidence of 27% of preoperative and 0.2%-16% of postoperative apnea, respectively. None of the studies examined the association between apnea and metabolic alkalosis in infants with IHPS.
Conclusions:
Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated.
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