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Postoperative apnea after pyloromyotomy for infantile hypertrophic pyloric stenosis
Anna Camporesi1, Veronica Diotto1, Elena Zoia1
1Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children's Hospital, Milano, Italy.
Insights
Infantile hypertrophic pyloric stenosis (IHPS) in infants increases the risk of postoperative apnea. Postoperative anemia was identified as a significant risk factor, suggesting it contributes to apnea in these vulnerable patients.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Anesthesiology
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) can lead to gastric outlet obstruction and metabolic disturbances.
- IHPS patients may be at increased risk for postoperative complications, including apnea.
- Understanding these risks is crucial for optimizing perioperative management in neonates.
Purpose of the Study:
- To determine the incidence of postoperative apnea in infants with IHPS.
- To identify risk factors associated with postoperative apnea in this cohort.
- To inform clinical practice regarding apnea risk in IHPS patients.
Main Methods:
- Retrospective observational cohort study of 122 infants diagnosed with IHPS.
- Data collected included demographics, surgical variables, and blood gas parameters.
- Postoperative apnea defined by respiratory pauses with associated bradycardia, desaturation, cyanosis, or hypotonia.
Main Results:
- 12 out of 122 infants (9.84%) experienced postoperative apnea.
- Univariate analysis revealed postoperative hemoglobin levels as the only significant difference between infants with and without apnea (p=0.03).
- No multivariable model improved prediction accuracy over the univariate finding.
Conclusions:
- Postoperative anemia, potentially from hemodilution, is linked to an increased risk of apnea in IHPS patients.
- Anemia may be an additional factor contributing to apnea in infants with IHPS.
- Further investigation into anemia as an apnea risk factor is warranted.
Objective:
Infantile hypertrophic pyloric stenosis (IHPS), which causes gastric outlet obstruction and hypochloremic hypokalemic metabolic alkalosis, could pose a risk of postoperative apnea in patients. The aim of this study is to evaluate the incidence of postoperative apnea in babies admitted to a tertiary-level pediatric surgical center in Milano, Italy with diagnosis of IHPS in 2010-2019. The secondary objective is to evaluate the risk factors for postoperative apnea.
Methods:
This is a single-center, retrospective, observational cohort study. All patients admitted to our institution with diagnosis of IHPS during the study period were enrolled. Demographic and surgical variables, along with blood gas parameters, were obtained from the population. Postoperative apnea was defined as a respiratory pause longer than 15 s or a respiratory pause lasting less than 15 s, but associated with either bradycardia (heart rate <120 per minute), desaturation (SatO2 <90%), cyanosis, or hypotonia. Occurrence was obtained from nursing charts and was recorded as a no/yes dichotomous variable.
Results:
Of 122 patients, 12 (9.84%) experienced apnea and 110 (90.16%) did not. Using univariate analysis, we found that only postoperative hemoglobin was significantly different between the groups (p=0.03). No significant multivariable model was better than this univariate model for prediction of apnea.
Conclusions:
Postoperative anemia, possibly due to hemodilution, increased the risk of postoperative apnea. It could be hypothesized that anemia can be added as another apnea-contributing factor in a population at risk due to metabolic changes.
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