Disentangling Feeding Practices from Socioeconomic Risk Factors in Pyloric Stenosis Risk

Area of Science:

• Pediatric surgery
• Neonatal health
• Epidemiology

Background:

• Hypertrophic pyloric stenosis (HPS) is a common surgical condition in infants.
• Established risk factors for HPS include formula feeding, maternal tobacco use, and family history.
• The role of socioeconomic status (SES) in HPS etiology requires further clarification.

Purpose of the Study:

• To investigate the relationship between socioeconomic factors and known risk factors for HPS.
• To determine if SES independently predicts HPS risk.
• To understand the interplay between SES and established HPS risk factors.

Main Methods:

• Retrospective cohort study of 655 HPS cases and 725 matched controls.
• Data collected from patient charts at a high-volume children's hospital (2012-2025).
• Matched analysis by sex, gestational age, age, race, and ethnicity.

Main Results:

• Formula feeding, maternal tobacco use, family history, and public insurance were associated with HPS in univariate analysis.
• Only formula feeding, maternal tobacco use, and family history remained significant predictors in multivariable analysis.
• Child Opportunity Index (COI) and public insurance were not independent predictors of HPS.

Conclusions:

• Socioeconomic factors are associated with HPS but are not independent predictors.
• Infant feeding practices, particularly formula feeding, are a primary driver of HPS risk.
• The association between SES and HPS appears to be mediated by feeding practices.