Fluid therapy in pyloric stenosis – assessment of the implementation of hospital guidelines

Introduction: The preoperative correction of the hypochloremic, hypokalemic metabolic alcalosis in children with infantile hypertrophic pyloric stenosis (IHPS) is essential to optimal outcome. Aim: The main aim of the study was the assessment of the implementation of hospital guidelines for intravenous fluid therapy in children with IHPS. Material and methods: In our Department, at the beginning of 2018 hospital guidelines for intravenous fluid therapy in children were implemented. Two internal audits were performed and surgeons’ compliance with the current recommendations was evaluated. We assessed: the type of fluid transfused, a rate of transfusion and whether saline bolus was given. The study group consisted of 50 patients. Results and discussion: After new guidelines were implemented, appropriate iv fluid was given to 68.7% of children compared to 5.1% before implementation (P = 0.0001). Proper transfusion rate was used in 44.1% of patients before introduction of new guidelines and in 81.2% after that (P = 0.01). Second audit showed that all children had received the recommended iv fluid (P = 0.007) at a good transfusion rate (P = 0.02). In patients who had received the recommended iv fluid, the length of hospital stay after surgery (P = 0.023) and the total length of stay (P = 0.018) were shorter. Conclusions: The new guidelines have raised the level of the whole care for children with pyloric stenosis. The internal audits played an important role in their implementation.

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A Delphi Analysis to Reach Consensus on Preoperative Care in Infants with Hypertrophic Pyloric Stenosis

European Journal of Pediatric Surgery ◽

10.1055/s-0039-3401987 ◽

2020 ◽

Vol 30 (06) ◽

pp. 497-504

Author(s):

Fenne A. I. M. van den Bunder ◽

Nigel J. Hall ◽

L. W. Ernest van Heurn ◽

Joep P. M. Derikx

Keyword(s):

Pyloric Stenosis ◽

Delphi Technique ◽

Base Excess ◽

Hypertrophic Pyloric Stenosis ◽

Preoperative Care ◽

Intravenous Fluid ◽

Infantile Hypertrophic Pyloric Stenosis ◽

Serum Concentrations ◽

Respiratory Complications ◽

International Consensus

Abstract Introduction Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal condition that can lead to metabolic alkalosis and, if uncorrected, to respiratory complications. A standardized approach to correct metabolic derangements and dehydration may reduce time until pyloromyotomy while preventing potential respiratory complications. Such an evidence-based policy regarding preoperative care is absent. We aim to formulate a recommendation about preoperative care for infants with IHPS using the Delphi technique. Materials and Methods The RAND/UCLA appropriateness method was used to reach international consensus in a panel of pediatric surgeons, pediatric anesthetists, and pediatricians. Statements on type and frequency of blood sampling, required serum concentrations before pyloromyotomy and intravenous fluid therapy, were rated online using a 9-point Likert scale. Consensus was present if the panel rated the statement appropriate/obligatory (panel median: 7–9) or inappropriate/unnecessary (panel median: 1–3) without disagreement according to the interpercentile range adjusted for symmetry formula. Results Thirty-three and twenty-nine panel members completed the first and second round, respectively. Consensus was reached in 54/74 statements (73%). The panel recommended the following laboratory tests and corresponding cutoff values prior to pyloromyotomy: pH ≤7.45, base excess ≤3.5, bicarbonate <26 mmol/L, sodium ≥132 mmol/L, potassium ≥3.5 mmol/L, chloride ≥100 mmol/L, and glucose ≥4.0 mmol/L. Isotonic crystalloid with 5% dextrose and 10 to 20 mEq/L potassium should be used for fluid resuscitation. Conclusion Consensus is reached in an expert panel about assessment of metabolic derangements at admission, cutoff serum concentrations to be achieved prior to pyloromyotomy, and appropriate intravenous fluid regime for the correction of dehydration and metabolic derangements in infants with IHPS.

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P72 Knowledge and application of the guidelines on intravenous fluid therapy in adult post op surgical patients amongst junior doctors in maidstone and tunrnbridge wells (mth) nhs trust

BJS Open ◽

10.1093/bjsopen/zrab032.071 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Ekowo Onyekachi ◽

Mark Cynk ◽

Onyekachi Ekowo

Keyword(s):

Hospital Stay ◽

Retrospective Analysis ◽

Fluid Therapy ◽

Length Of Hospital Stay ◽

Intravenous Fluid ◽

Surgical Patients ◽

Junior Doctors ◽

Intravenous Fluid Therapy ◽

Prolonged Length ◽

Poor Outcome

Abstract Introduction Foundation Year doctors and Senior House officers are commonly made responsible for fluid prescriptions. Errors could lead to significant poor outcome for the patient. Methodology A total of 36 FY1s and SHOs were asked 8 questions to check their knowledge of the guideline for intravenous fluid therapy in adult surgical patients (GIFTASUP). Following this, a retrospective analysis of fluid prescriptions received by 37 patients who had elective colorectal surgeries was analysed over a 3-month period to see if the fluids received met the GIFTASUP guideline and see how this affected the outcome of the patients. Results 33(92%) of doctors studied are not aware of any guidelines for fluid prescription post operatively. 38(22%) of prescriptions made exceeded 2500mls in 24 hours. Ileus was significant amongst those patients who received fluid volumes more than 2500 mls in 24 hours (p = 0.045). Also, all 4 patients who had pneumonia received fluid volumes exceeding 2500mls in the days preceding the pneumonia. In addition, the length of hospital stay was 15 days and 9 days in those with fluids volumes greater than 2500mls and less than 2500mls in 24 hours, respectively. Conclusion Majority of the Foundation year doctors in MTH are not aware of post-operative fluid guidelines which resulted in errors in the prescriptions made. This is associated with pneumonia, ileus and prolonged length of hospital stay.

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To Manage Infantile Hypertrophic Pyloric Stenosis by "Double-Y Pyloromyotomy" is a better Surgical Approach

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v1i2.19532 ◽

2014 ◽

Vol 1 (2) ◽

pp. 143-147

Author(s):

Md. Ansar Ali ◽

Kaniz Hasina ◽

Shahnoor Islam ◽

Md. Ashraf Ul Huq ◽

Md. Mahbub-Ul Alam ◽

...

Keyword(s):

Weight Gain ◽

Pyloric Stenosis ◽

Hypertrophic Pyloric Stenosis ◽

Treatment Modalities ◽

Infantile Hypertrophic Pyloric Stenosis ◽

Postoperative Vomiting ◽

Acid Base ◽

Feeding Regimes ◽

Acid Base Status ◽

Postoperative Feeding

Background: Different treatment modalities and procedures have been tried for the management of infantile hypertrophic pyloric stenosis. But surgery remains the mainstay for management of IHPS. Ramstedts pyloromyotomy was described almost over a hundred years ago and to date remains the surgical technique of choice. An alternative and better technique is the double-Y pyloromyotomy, which offer better results for management of this common condition.Methods: A prospective comparative interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. The study was designed that all patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy(DY) and the next by aRamstedts Pyloromyotomy (RP). Data on patient demographics, operative time, anesthesia complications, postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test.Results: From July 2008 through July 2010, fourty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group (1.21 ± 0.45days) vs Ramstedts pyloromyotomy (RP) group(3.03 ± 0.37days) p= 0.0001.Weight gain after 1st 10 days DY vs RP is ( 298 ± 57.94 gm vs193±19.8 gm p=0.0014), after 1 month (676.67±149.84 gm vs 466.67 ± 127.71 gm, p=0.0001), after 2months (741.33± 278.74 gm vs 490±80.62 gm, p=0.002) and after 3 months (582±36.01gm vs 453.33±51.64 gm, p=0.0001).No long-term complications were reported and no re-do yloromyotomy was needed.Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19532

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Per-oral Pyloromyotomy for Treating Infantile Hypertrophic Pyloric Stenosis

Case Medical Research ◽

10.31525/ct1-nct04148040 ◽

2019 ◽

Author(s):

Keyword(s):

Pyloric Stenosis ◽

Hypertrophic Pyloric Stenosis ◽

Infantile Hypertrophic Pyloric Stenosis ◽

Per Oral

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Faculty Opinions recommendation of Common variants near MBNL1 and NKX2-5 are associated with infantile hypertrophic pyloric stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14001975.793457612 ◽

2012 ◽

Author(s):

Deborah Gumucio ◽

Aaron Udager

Keyword(s):

Pyloric Stenosis ◽

Hypertrophic Pyloric Stenosis ◽

Infantile Hypertrophic Pyloric Stenosis ◽

Common Variants

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Integrating genetics with newborn metabolomics in infantile hypertrophic pyloric stenosis

Metabolomics ◽

10.1007/s11306-020-01763-2 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

João Fadista ◽

Line Skotte ◽

Julie Courraud ◽

Frank Geller ◽

Sanne Gørtz ◽

...

Keyword(s):

Pyloric Stenosis ◽

Hypertrophic Pyloric Stenosis ◽

Dried Blood Spots ◽

Population Based ◽

Case Control ◽

Infantile Hypertrophic Pyloric Stenosis ◽

Sphincter Muscle ◽

Feeding Patterns ◽

Matched Case ◽

Selection Of

Abstract Introduction Infantile hypertrophic pyloric stenosis (IHPS) is caused by hypertrophy of the pyloric sphincter muscle. Objectives Since previous reports have implicated lipid metabolism, we aimed to (1) investigate associations between IHPS and a wide array of lipid-related metabolites in newborns, and (2) address whether detected differences in metabolite levels were likely to be driven by genetic differences between IHPS cases and controls or by differences in early life feeding patterns. Methods We used population-based random selection of IHPS cases and controls born in Denmark between 1997 and 2014. We randomly took dried blood spots of newborns from 267 pairs of IHPS cases and controls matched by sex and day of birth. We used a mixed-effects linear regression model to evaluate associations between 148 metabolites and IHPS in a matched case–control design. Results The phosphatidylcholine PC(38:4) showed significantly lower levels in IHPS cases (P = 4.68 × 10−8) as did six other correlated metabolites (four phosphatidylcholines, acylcarnitine AC(2:0), and histidine). Associations were driven by 98 case–control pairs born before 2009, when median age at sampling was 6 days. No association was seen in 169 pairs born in 2009 or later, when median age at sampling was 2 days. More IHPS cases than controls had a diagnosis for neonatal difficulty in feeding at breast (P = 6.15 × 10−3). Genetic variants known to be associated with PC(38:4) levels did not associate with IHPS. Conclusions We detected lower levels of certain metabolites in IHPS, possibly reflecting different feeding patterns in the first days of life.

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