title: Early pyloric stenosis: a case control study.
abstract: OBJECTIVE
  Pyloric stenosis (PS) is rare in the first 2 weeks of life, often leading to delays in diagnosis and treatment. We conducted a case control study to delineate the characteristics of patients with early PS (EPS). In addition, we tested the hypothesis that patients with EPS present with a smaller pylorus than older patients.
  
  
  METHODS
  A database of all patients presenting with PS to a children's hospital over a 5-year period (2002-2006) was obtained. Each patient admitted during the first 2 weeks of life (subject) was matched to a patient admitted after 4 weeks of age (control), with the same gender, electrolyte status, and treating surgeon. A single pediatric radiologist, blinded to patient age, reviewed all available ultrasounds retrospectively. Demographic, clinical, diagnostic, therapeutic, and outcome data were compared.
  
  
  RESULTS
  During the study period, 278 pyloromyotomies were performed for PS. Sixteen patients (5.8%) presented with EPS between 2 and 14 days of life. EPS patients had a higher prevalence of positive family history (31 vs. 0%, P = 0.043), and breast milk feeding (75 vs. 31%, P = 0.045). Sonographic measurements showed a pylorus that was of significantly less length (17.1 +/- 0.6 vs. 20.5 +/- 0.9 mm, P = 0.006) and muscle thickness (3.5 +/- 0.2 vs. 4.9 +/- 0.2 mm, P < 0.001) in patients with EPS. Hospital stay was significantly longer for EPS patients (4.3 +/- 0.9 vs. 2.0 +/- 0.1 days, P = 0.19).
  
  
  CONCLUSIONS
  Babies presenting with EPS are more likely to be breast fed and to have a positive family history. EPS is associated with a longer hospital stay. Use of sonographic diagnostic measurements specific to this age group may prevent delays in diagnosis and treatment, and improve outcomes.
authors.affiliation: Division of Pediatric Surgery, Miller Children's Hospital, Long Beach, California & University of California, Irvine School of Medicine, Orange, CA, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Demian
authors.forename: Son
authors.initials: S
authors.lastname: Nguyen
authors.forename: Sherif
authors.initials: S
authors.lastname: Emil
mesh_terms: D001942:Breast Feeding; D016022:Case-Control Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D046248:Pyloric Stenosis, Hypertrophic / Q000175:diagnosis* / Q000601:surgery; D011708:Pylorus / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology
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