Treatment regimen for hypertrophic pyloric stenosis in neonates

This article is professionally consulted by Resident Doctor, Doctor Nguyen Hung Tien - Resident Doctor of Pediatrics - Neonatology - Department of Pediatrics - Neonatology - Vinmec Hai Phong International General Hospital. The doctor has more than 8 years of experience in the field of Pediatrics - Neonatology.

Hypertrophic pyloric stenosis is a congenital pathology in the gastrointestinal tract due to the hypertrophy of the pyloric smooth muscle layers, especially the sphincter layer, causing narrowing of the pyloric lumen. This is the most common cause of gastric outlet obstruction in neonates. The cause of hypertrophic pyloric stenosis is still unknown.

Gender: Hypertrophic pyloric stenosis occurs more often in boys than in girls Premature birth Smoking during pregnancy: Almost doubles the risk of pyloric stenosis in babies after birth Use of antibiotics Early: Newborns who receive antibiotic therapy early in the first week of life, such as erythromycin for whooping cough, are at increased risk of pyloric stenosis. Besides, if mothers use antibiotics during pregnancy, there is also an increased risk of pyloric stenosis in the baby.

Children with vomiting after eating: Vomiting is often from 4 to 8 weeks postpartum, the frequency of vomiting appears more and more, vomiting often occurs after meals, vomiting milk, after vomiting, children are often hungry and ask for food right away. . Sometimes vomiting bloody or yellow-green fluid If the symptoms persist for a long time, untreated, it can lead to dehydration, weight loss, malnutrition, metabolic disorders, coma. Constipation . If you see that your child has unusual signs such as vomiting after eating, being inactive or irritable, urinating less, not gaining weight or losing weight, you should immediately take the child to the doctor.

Blood tests to check for dehydration and electrolytes Ultrasound evaluates the condition of the pylorus and confirms the diagnosis of pyloric stenosis X-ray of the digestive system, if the ultrasound is inconclusive

Principles of treatment of hypertrophic pyloric stenosis in neonates are medical resuscitation and extramucosal pyloromyotomy. For medical resuscitation, the doctor will perform gastric bypass, intravenous feeding, and electrolyte replacement.
Surgery to open the pylorus extramucosa includes the following steps:
5.1 Preoperative preparation Preoperative testing. Prophylactic use of antibiotics (intravenously) 5.2 Surgery can be done through laparoscopic or open surgery: Laparoscopic surgery: Open the extramucosal pylorus. Open surgery: Horizontal line below right flank or arc line above navel. 5.3 Postoperative treatment Remove the nasogastric tube as soon as the baby is awake. In case of duodenal perforation, continue gastric drainage after surgery and antibiotic therapy. Continue parenteral nutrition until the baby is fully oral again. Start eating again 4 hours after surgery with 15ml of milk, gradually increasing until the required amount (if the patient is not vomiting).