{ "schemaVersion": 2, "eyebrow": "Pediatric Surgery", "title": "Infantile Hypertrophic Pyloric Stenosis", "summary": "In an infant with progressive nonbilious projectile emesis, rapidly distinguish pyloric obstruction from bilious or systemic emergencies, confirm suspected hypertrophic pyloric stenosis with ultrasound when needed, correct dehydration and metabolic alkalosis before anesthesia, then proceed to pyloromyotomy.", "seoDescription": "Point-of-care evaluation and management of infantile hypertrophic pyloric stenosis, from vomiting triage and ultrasound to resuscitation and pyloromyotomy.", "clinicalQuestion": "How should physicians evaluate, stabilize, and definitively manage an infant with suspected hypertrophic pyloric stenosis?", "specialty": "Pediatrics", "audience": "U.S. physicians and medical trainees", "tags": [ "infantile hypertrophic pyloric stenosis", "pyloric stenosis", "projectile vomiting", "pyloromyotomy", "infant vomiting" ], "keyTakeaways": [ "Treat bilious green or yellow-green emesis as possible intestinal obstruction rather than pyloric stenosis; arrange urgent pediatric surgical assessment. [24]", "Progressively worsening or forceful vomiting in an infant younger than 2 months warrants same-day assessment for hypertrophic pyloric stenosis. [24]", "Do not administer general anesthesia before dehydration, electrolyte abnormalities, and metabolic alkalosis are corrected; pyloromyotomy is definitive but not an immediate operation. [7][9]", "Abdominal ultrasound is the confirmatory test when examination and feeding assessment do not establish the diagnosis despite high clinical suspicion. [9][13]", "After preoperative optimization, pyloromyotomy has excellent outcomes, with long-term sequelae uncommon in developed settings. [8][9]" ], "sections": [ { "id": "triage-the-vomiting-infant", "eyebrow": "Immediate triage", "heading": "Separate pyloric stenosis from time-critical vomiting emergencies", "intro": "Vomitus color and systemic status determine the first pathway.", "paragraphs": [ "In an infant with forceful emesis, establish whether vomitus is nonbilious or bile stained before pursuing pyloric stenosis. Green or yellow-green vomiting suggests intestinal obstruction and requires pediatric surgical referral rather than a pyloric-stenosis pathway. [24] Abdominal distension, tenderness, hematemesis not attributable to swallowed blood, melena, dysphagia, and faltering growth are red flags for diagnoses other than uncomplicated reflux and should accelerate hospital assessment. [24]", "Suspect infantile hypertrophic pyloric stenosis (IHPS) when an infant, usually 3 to 8 weeks old, develops progressive projectile milky, nonbilious emesis and remains hungry after vomiting. [8] For infants younger than 2 months with progressively worsening or forceful post-feed vomiting, arrange same-day assessment for possible IHPS. [24] IHPS is a fixed hypertrophic narrowing of the pylorus that obstructs gastric emptying; pylorospasm is intermittent spasm without permanent luminal narrowing and should not be equated with IHPS. [13]", "Assess perfusion, hydration, weight trajectory, feeding tolerance, abdominal distension or tenderness, and electrolyte-related clinical risk at presentation. Obtain serum electrolytes and acid-base assessment when dehydration or repeated vomiting is present because the classic biochemical pattern is hypochloremic, hypokalemic metabolic alkalosis, although many contemporary presentations have normal electrolyte results. [7] A severe chloride deficit, including serum chloride below 100 mmol/L, has been identified as a marker of substantial preoperative metabolic derangement. [8]" ], "bullets": [ "Nonbilious, progressively forceful vomiting in a young infant: evaluate for IHPS on the same day. [8][24]", "Green or yellow-green vomitus: bypass the IHPS pathway and obtain urgent pediatric surgical assessment for intestinal obstruction. [24]", "Hematemesis, melena, abdominal distension, or tenderness: broaden beyond IHPS and escalate evaluation. [24]" ], "subsections": [], "table": { "caption": "Vomiting features that redirect the initial diagnostic pathway. [8][13][24]", "columns": [ "Finding", "Interpretation", "Immediate action" ], "rows": [ [ "Progressive forceful, nonbilious emesis at 3-8 weeks with persistent hunger", "Typical IHPS pattern. [8]", "Assess hydration and electrolytes; obtain abdominal ultrasound when diagnosis is not clinically secure. [9]" ], [ "Green or yellow-green emesis", "Possible intestinal obstruction rather than IHPS. [24]", "Urgent pediatric surgical referral. [24]" ], [ "Abdominal distension or tenderness", "Red flag for an alternative acute surgical process. [24]", "Urgent hospital-based evaluation and surgical input. [24]" ], [ "Hematemesis or melena not explained by swallowed blood", "Requires evaluation beyond routine reflux or uncomplicated IHPS. [24]", "Same-day specialist assessment when clinically indicated. [24]" ] ] } }, { "id": "confirm-the-diagnosis", "eyebrow": "Diagnosis", "heading": "Use ultrasound to confirm suspected pyloric obstruction", "intro": "Clinical suspicion should guide imaging rather than delay resuscitation.", "paragraphs": [ "IHPS can often be diagnosed from the clinical presentation and physical examination, but abdominal ultrasound or contrast gastric radiography may be required for conclusive diagnosis. [13] Use ultrasound when a feeding assessment and abdominal examination have not confirmed IHPS but the clinical pattern remains compelling. [9] A high-resolution study performed by an experienced pediatric sonographer or pediatric radiologist improves diagnostic specificity and sensitivity. [9]", "Interpret a negative or equivocal ultrasound in the clinical context. In premature infants, a reported pyloric muscle thickness of 2.0 mm was negative in a case with persistent feeding intolerance, illustrating that ongoing symptoms may require reassessment rather than diagnostic closure. [2] When a definitive ultrasound is not available or remains nondiagnostic, contrast radiography of the stomach is an established alternative diagnostic method. [13]", "Point-of-care ultrasound has an expanding role in pediatric emergency practice for identifying IHPS, with the primary clinical application being an infant with nonbloody, nonbilious projectile vomiting. [15][20] A positive bedside study should expedite surgical and anesthesia coordination; an indeterminate bedside study should not replace formal imaging when uncertainty remains." ], "bullets": [ "Use abdominal ultrasound as the preferred confirmatory study when clinical examination is not definitive. [9][13]", "Use contrast gastric radiography when ultrasound cannot conclusively establish the diagnosis. [13]", "Do not interpret persistent vomiting after a negative study as reassurance without reconsidering image quality, alternative diagnoses, and the need for repeat or alternative imaging. [2][13]" ], "subsections": [], "table": { "caption": "Diagnostic test selection for suspected IHPS. [9][13][15][20]", "columns": [ "Clinical situation", "Test", "Decision consequence" ], "rows": [ [ "Classic presentation and diagnostic examination", "Clinical diagnosis may be sufficient. [9][13]", "Begin resuscitation and coordinate pediatric surgical management. [7][9]" ], [ "High suspicion but nonconfirmatory examination or feeding assessment", "High-resolution abdominal ultrasound, ideally with pediatric imaging expertise. [9]", "Confirm IHPS and plan optimization before pyloromyotomy. [8][9]" ], [ "Ultrasound unavailable or not conclusive", "Contrast x-ray of the stomach. [13]", "Use the result to establish or exclude a structural gastric-outlet process. [13]" ], [ "Emergency department evaluation", "Point-of-care ultrasound may identify IHPS in the appropriate vomiting phenotype. [15][20]", "Obtain formal confirmation when bedside findings are indeterminate or discordant with the presentation. [9][13]" ] ] } }, { "id": "preoperative-resuscitation", "eyebrow": "Stabilization", "heading": "Correct fluid and electrolyte deficits before anesthesia", "intro": "Metabolic optimization, not speed to incision, determines operative readiness.", "paragraphs": [ "Once IHPS is diagnosed or strongly suspected, withhold further feeds, decompress with a nasogastric tube when used locally, and begin intravenous fluid and electrolyte replacement. [9] The operative priority is not immediate pyloromyotomy: anesthesia before correction of metabolic alkalosis poses substantial risk and has been described as potentially fatal. [9] This optimization may require several days in infants with significant deficits. [9]", "Reassess electrolyte and acid-base abnormalities during resuscitation and defer general anesthesia until dehydration and metabolic derangement are corrected. [7][9] The traditional pattern is hypochloremic, hypokalemic metabolic alkalosis; however, normal electrolyte results do not exclude IHPS or eliminate the need to assess hydration and anesthetic readiness. [7] Infants with more severe derangement, including serum chloride below 100 mmol/L, merit particular attention to correction before surgery. [8]", "Use a standardized institutional fluid-resuscitation pathway when available. In a single-center retrospective cohort of 319 infants with IHPS and electrolyte derangement, implementation of a severity-based protocol reduced preoperative laboratory draws, time to electrolyte correction, and total length of stay. [6] Protocols should specify repeat laboratory timing and planned fluid interventions by initial abnormality severity rather than rely on unstructured serial testing. [6]" ], "bullets": [ "Withhold oral feeds after diagnosis or high-grade suspicion and begin intravenous resuscitation. [9]", "Do not treat pyloromyotomy as an anesthetic emergency; postpone anesthesia until metabolic alkalosis and fluid/electrolyte deficits are corrected. [7][9]", "Track chloride, potassium, acid-base status, and hydration during correction; severe hypochloremia identifies infants with more substantial derangement. [7][8]" ], "subsections": [], "table": { "caption": "Preoperative priorities in confirmed IHPS. [6][7][8][9]", "columns": [ "Priority", "Action", "Reason to delay surgery" ], "rows": [ [ "Gastric management", "Withhold feeds; use nasogastric decompression as part of the resuscitation regimen. [9]", "Continued vomiting worsens volume and electrolyte loss. [9]" ], [ "Volume replacement", "Initiate intravenous fluids and reassess clinical hydration. [9]", "Dehydration increases anesthetic risk. [7][9]" ], [ "Electrolyte and acid-base correction", "Measure and correct chloride, potassium, and metabolic alkalosis before general anesthesia. [7][9]", "Anesthesia before correction of metabolic alkalosis is hazardous and may be fatal. [9]" ], [ "Operational monitoring", "Use a protocolized plan for repeat laboratories and fluid escalation when available. [6]", "Protocol implementation was associated with fewer laboratory draws, faster correction, and shorter hospitalization. [6]" ] ] } }, { "id": "definitive-surgical-treatment", "eyebrow": "Definitive treatment", "heading": "Proceed to pyloromyotomy after physiologic optimization", "intro": "Ramstedt pyloromyotomy relieves the obstruction while preserving mucosal integrity.", "paragraphs": [ "After adequate resuscitation, refer for pyloromyotomy, the definitive treatment for IHPS. The operation divides the hypertrophied pyloric muscle longitudinally while leaving the mucosa intact. [8] Operative access may be open or laparoscopic; both are established approaches, and a Cochrane review evaluates laparoscopic versus open pyloromyotomy in infants with IHPS. [16] Selection should reflect local pediatric surgical expertise and the infant's clinical condition rather than an attempt to shorten the preoperative correction interval.", "Expect surgery after, not before, correction of physiologic abnormalities. Although a retrospective two-hospital study found that many infants could safely undergo surgery on the admission day, only 43% did so, and an afternoon diagnosis was associated with a 4.2-fold greater likelihood of surgery being delayed to hospital day 2 or later. [7] Scheduling should therefore be driven by readiness for anesthesia, not an arbitrary same-day target. [7][9]", "Counsel families that early postoperative feeding can be performed safely. [8] Postoperative emesis may occur, but contemporary outcomes following preoperative optimization and pyloromyotomy are excellent; long-term sequelae are uncommon and mortality is almost unknown in developed settings. [8][9] Persistent or recurrent vomiting after surgery should prompt reassessment for an incomplete myotomy, mucosal injury-related complications, or an alternative diagnosis rather than automatic attribution to expected postoperative symptoms. Inadequate pyloromyotomy has been reported particularly at the duodenal end. [10]" ], "bullets": [ "Definitive procedure: longitudinal pyloromyotomy that divides muscle while preserving mucosa. [8]", "Open and laparoscopic approaches are both used; choose the approach within local pediatric surgical expertise. [16]", "Early feeding after pyloromyotomy can be achieved safely. [8]", "Persistent postoperative emesis requires clinical reassessment for technical or diagnostic failure. [10]" ], "subsections": [], "table": { "caption": "Operative timing and postprocedure decisions in IHPS. [7][8][9][10][16]", "columns": [ "Decision point", "Preferred action", "Rationale" ], "rows": [ [ "Confirmed IHPS with dehydration or alkalosis", "Continue correction before anesthesia and pyloromyotomy. [7][9]", "Pyloromyotomy is definitive, but preoperative metabolic optimization is essential. [7][9]" ], [ "Choice of operative access", "Use open or laparoscopic pyloromyotomy according to pediatric surgical expertise. [16]", "Both approaches are established treatment strategies. [16]" ], [ "Postoperative feeding", "Begin early feeding as clinically appropriate. [8]", "Early feeding can be achieved safely. [8]" ], [ "Ongoing vomiting after repair", "Reassess the infant and consider incomplete pyloromyotomy or another diagnosis. [10]", "Inadequate myotomy, particularly at the duodenal end, has been reported. [10]" ] ] } }, { "id": "risk-context-and-follow-up", "eyebrow": "Risk context", "heading": "Recognize medication-associated risk and maintain a low threshold in exposed infants", "intro": "Macrolide exposure changes vigilance, not the acute diagnostic pathway.", "paragraphs": [ "Ask specifically about infant macrolide exposure when evaluating vomiting in early infancy. Oral erythromycin has been associated with IHPS in infants younger than 6 weeks, and CDC guidance advises follow-up for IHPS symptoms in exposed infants. [22] Associations have also been reported with azithromycin and other macrolides. [21][23] New forceful nonbilious vomiting after such exposure should trigger the same urgent clinical assessment and imaging pathway used for any suspected IHPS.", "Avoid labeling all vomiting after macrolide therapy as medication intolerance. The diagnosis still requires assessment for fixed pyloric obstruction and exclusion of bilious obstruction or other red-flag conditions. [13][24] Conversely, a plausible medication association should not delay evaluation when the vomiting phenotype is progressive or projectile." ], "bullets": [ "Document erythromycin exposure in infants younger than 6 weeks and counsel caregivers to seek assessment for IHPS symptoms. [22]", "Treat progressive projectile vomiting after macrolide exposure as possible IHPS, not simply a drug adverse effect. [21][22][23]" ], "subsections": [], "table": { "caption": "Medication history that should heighten vigilance for IHPS. [21][22][23]", "columns": [ "Exposure history", "Clinical implication", "Next step" ], "rows": [ [ "Oral erythromycin in an infant younger than 6 weeks", "An association with IHPS has been reported. [22]", "Follow for IHPS symptoms; evaluate forceful vomiting urgently. [22][24]" ], [ "Azithromycin or other macrolide exposure", "Associations with IHPS have been reported. [21][23]", "Use the usual clinical and imaging evaluation for suspected pyloric obstruction. [9][13]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Evaluation of the Vomiting Infant", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamapediatrics/articlepdf/514628/archpedi_143_6_016.pdf?resultClick=1", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 2, "title": "Pyloric Stenosis in Premature Infants", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/PEDS/articlepdf/517839/archpedi_150_2_019.pdf", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 3, "title": "Primary Hypertrophic Pyloric Stenosis in the Adult", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=SURG&articleId=594863&pdfFileName=archsurg_125_9_025.pdf", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 4, "title": "Pyloric Stenosis\\p=m-\\A Timed Perspective", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/articlepdf/592559/archsurg_122_7_019.pdf?resultClick=", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 5, "title": "Index | Oxford Handbook of Clinical Specialties", "detail": "academic.oup.com", "url": "https://academic.oup.com/book/40211/chapter/343466282", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 6, "title": "Evaluation of a fluid resuscitation protocol for patients with hypertrophic pyloric stenosis - 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Evaluation of the Vomiting Infant", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamapediatrics/articlepdf/514628/archpedi_143_6_016.pdf?resultClick=1", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "Muscle thickness in hypertrophic ... Ultrasound diag- nosis of hypertrophic pyloric stenosis. ... diagnosis of infantile hypertrophic pyloric stenosis:.", "score": 0.6633424 }, { "number": 2, "title": "Pyloric Stenosis in Premature Infants", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/PEDS/articlepdf/517839/archpedi_150_2_019.pdf", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "Ultrasound findingswere negative (pyloric muscle thickness, 2.0 mm). Feeding in¬ tolerancepersisted,and transpyloric feedingswere instituted. Attempts to", "score": 0.60917604 }, { "number": 3, "title": "Primary Hypertrophic Pyloric Stenosis in the Adult", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=SURG&articleId=594863&pdfFileName=archsurg_125_9_025.pdf", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "with the thickness of the circular muscle ranging from 3 to 8 mm.8,10 … infantile variety). Clinical features include epigastric discomfort exacerbated by", "score": 0.58465123 }, { "number": 4, "title": "Pyloric Stenosis\\p=m-\\A Timed Perspective", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/articlepdf/592559/archsurg_122_7_019.pdf?resultClick=", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "postoperative emesis. ... postoperative drainage. References. 1. Spicer RD: Infantile hypertrophic pyloric stenosis: A review. BrJ Surg ... vomiting in hypertrophic", "score": 0.5227632 }, { "number": 5, "title": "Index | Oxford Handbook of Clinical Specialties", "detail": "academic.oup.com", "url": "https://academic.oup.com/book/40211/chapter/343466282", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "testing in children vital signs, hypertrophic pyloric stenosisInfantile hypertrophic pyloric stenosis. Diagnostic criteria for Kawasaki disease,", "score": 0.60274047 }, { "number": 6, "title": "Evaluation of a fluid resuscitation protocol for patients with hypertrophic pyloric stenosis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S002234682100765X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Evaluation of a fluid resuscitation protocol for patients with hypertrophic pyloric stenosis. Management protocols for hypertrophic pyloric stenosis commonly focus on postoperative feeding, with a paucity of data evaluating the benefits of preoperative fluid resuscitation protocols. Implementation", "score": 0.8138313 }, { "number": 7, "title": "Optimizing throughput of babies with infantile hypertrophic pyloric stenosis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002961024000151", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Original Research Article Optimizing throughput of babies with infantile hypertrophic pyloric stenosis. Patients with an afternoon diagnosis are 4.2 times more likely to have surgery delayed (hospital day 2+) than those diagnosed before noon. Definitive surgical care is often delayed in hypertroph", "score": 0.74251556 }, { "number": 8, "title": "Infantile hypertrophic pyloric stenosis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0263931922002010", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Paediatric Surgery II Infantile hypertrophic pyloric stenosis. Infantile hypertrophic pyloric stenosis (IHPS) is one of the most commonly encountered paediatric surgical conditions. It is estimated to affect between 1 and 4 infants per 1,000 births, representing the most common cause of surgical i", "score": 0.72395444 }, { "number": 9, "title": "Infantile hypertrophic pyloric stenosis", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0263931916301429", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "## Correction of fluid and electrolytes\n\nAdministering a general anaesthetic to an infant before correction of metabolic alkalosis poses significant risks to the infant and can prove fatal. Therefore, the clinical priority is to ensure careful replacement of fluid and electrolytes before surgery is ", "score": 0.71185225 }, { "number": 10, "title": "Trends and Surgical Outcomes of Laparoscopic vs...", "detail": "journals.lww.com", "url": "https://journals.lww.com/journalacs/fulltext/2017/10002/trends_and_surgical_outcomes_of_laparoscopic_vs.343.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "A prospective randomised controlled trial comparing open and laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis in a low-middle-income", "score": 0.7366474 }, { "number": 11, "title": "Laparoscopic Pyloromyotomy : Journal of Indian Association of Pediatric Surgeons", "detail": "journals.lww.com", "url": "https://journals.lww.com/00660436-201722010-00020", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Pediatricians have reached the corners of the country and with increased awareness the diagnosis of infantile pyloric stenosis is done early. Gone are the days when we would often see a baby in severe dehydration and electrolyte imbalance. With the growing pressures about the short hospital stay, et", "score": 0.7348247 }, { "number": 12, "title": "Gastric Peroral Endoscopic Pyloromyotomy for Infants With ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/_layouts/15/oaks.journals/downloadpdf.aspx?an=", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "by H Zhang · 2023 · Cited by 9 — Congenital hypertrophic pyloric stenosis (CHPS), the third most common neonatal and infantile gastric abnormality, is usually characterized by projectile", "score": 0.4413124 }, { "number": 13, "title": "Guidelines for Conducting Birth Defects Surveillance", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/13109/cdc_13109_DS1.pdf", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov", "snippet": "> Appendix 3.2 A3.2-36 Case Definition\n\n# Pyloric Stenosis Description Hypertrophy (thickening) of the muscles of the pylorus connecting the stomach to the duodenum, resulting in complete or partial obstruction of the passage of food and gastric contents. \n\nInclusions Infantile (congenital) hypertro", "score": 0.6659544 }, { "number": 14, "title": "Ultrasound Guidelines", "detail": "www.annemergmed.com", "url": "https://www.annemergmed.com/article/S0196-0644(23)00432-8/pdf", "authors": "www.annemergmed.com", "host": "www.annemergmed.com", "snippet": "Evaluation of hypertrophic pyloric stenosis by pediatric emergency physician sonography. point-of-care ultrasound for diagnosing hypertrophic pyloric stenosis", "score": 0.6342494 }, { "number": 15, "title": "Ultrasound Guidelines: Emergency, Point-of-Care, and ...", "detail": "www.annemergmed.com", "url": "https://www.annemergmed.com/article/S0196-0644(23)00432-8/fulltext", "authors": "www.annemergmed.com", "host": "www.annemergmed.com", "snippet": "Among pediatric patients, evidence has been growing regarding the role of clinical ultrasound in identifying intussusception and hypertrophic pyloric stenosis.", "score": 0.60133666 }, { "number": 16, "title": "Full All content", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012827.pub2/pdf/full/en", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com", "snippet": "Infantile hypertrophic pyloric stenosis (IHPS) is a disorder of young children (aged one year or less) and can be treated by laparoscopic (LP) or open (OP)", "score": 0.53181785 }, { "number": 17, "title": "Emergency, Point-of-Care, and Clinical Ultrasound ...", "detail": "www.annemergmed.com", "url": "https://www.annemergmed.com/article/S0196-0644(23)00432-8/abstract", "authors": "www.annemergmed.com", "host": "www.annemergmed.com", "snippet": "Evaluation of hypertrophic pyloric stenosis by pediatric emergency physician sonography Acad Emerg Med. point-of-care ultrasound for diagnosing hypertrophic", "score": 0.5066652 }, { "number": 18, "title": "Pyloric Stenosis: National Trends in the Incidence Rate ...", "detail": "hosppeds.aappublications.org", "url": "https://hosppeds.aappublications.org/content/early/2019/11/18/hpeds.2019-0112.full", "authors": "hosppeds.aappublications.org", "host": "hosppeds.aappublications.org", "snippet": "Infantile hypertrophic pyloric stenosis (IHPS) is the most common reason for abdominal surgery in infants; in the first 6 months of life.1,2.", "score": 0.44275752 }, { "number": 19, "title": "Guidelines for Preventing Health-Care--Associated Pneumonia, 2003", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "304. Cooper WO, Griffin MR, Arbogast P, Hickson GB, Gautam S, Ray WA. Very early exposures to erythromycin and infantile hypertrophic\npyloric stenosis. Arch Ped Adol Med 2002;156:647--50.\n\n305. Halperin SA, Bortolussi R, Langley JM, Miller B, Eastwood BJ. Seven days of erythromycin estolate is as ef", "score": 0.4338141 }, { "number": 20, "title": "Policy Statements", "detail": "www.annemergmed.com", "url": "https://www.annemergmed.com/article/S0196-0644(21)01531-6/fulltext", "authors": "www.annemergmed.com", "host": "www.annemergmed.com", "snippet": "by B Appendicitis · 2022 — Pediatric Hypertrophic Pyloric Stenosis. The primary indication for this application is in an infant with non-bilious, nonbloody projectile vomiting.", "score": 0.4017588 }, { "number": 21, "title": "Sexually Transmitted Diseases Treatment Guidelines, 2015", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/5174/cdc_5174_DS2.pdf", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov", "snippet": "by KA Workowski · 2002 — * An association between oral erythromycin and azithromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported in infants aged.", "score": 0.36861077 }, { "number": 22, "title": "Sexually Transmitted Diseases Treatment Guidelines, 2006", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "¶¶ An association between oral erythromycin and infantile hypertrophic pyloric stenosis has been reported in infants aged <6 weeks who were treated with this drug.\nInfants treated with erythromycin should be followed for signs and symptoms of idiopathic hypertrophic pyloric stenosis (IHPS).\n\n\\\\\\ Dat", "score": 0.3370513 }, { "number": 23, "title": "Prevention of Pertussis, Tetanus, and Diphtheria Among ...", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5704a1.htm", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": ".\n133. Hauben M, Amsden GW. The association of erythromycin and infantile hypertrophic pyloric stenosis: causal or coincidental? Drug\n Safety 2002;25:929--42.\n134. SanFilippo JA. Infantile hypertrophic pyloric stenosis related to ingestion of erythromycine estolate: a report of five cases. J Ped", "score": 0.32698074 }, { "number": 24, "title": "Appendix A: Summary of evidence from surveillance", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/ng1/evidence/appendix-a-summary-of-evidence-from-surveillance-pdf-6600947870", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "feeding difficulties or faltering growth ● there is persistent, frequent regurgitation beyond the first year of life. 1.1.5 In infants, children and young people with vomiting or regurgitation, look out for the 'red flags' in table 1, which may suggest disorders other than GOR. Investigate or refer ", "score": 0.32050273 } ], "publishedAt": "2026-08-21T02:06:42.285482+00:00", "updatedAt": "2026-08-21T02:06:42.285482+00:00", "readingMinutes": 6, "slug": "infantile-hypertrophic-pyloric-stenosis" }