Differential diagnosis of periodic fevers

Indian pediatrics, 2005

This study aimed to evaluate the effectiveness of oral atropine in the management of IHPS. Cases were diagnosed clinically and confirmed sonographically. Atropine was given orally from the outset at a dose of 0.18 mg/kg/day in eight divided doses, increased daily by 1/4th of the commencing dose till vomiting ceased. Ultrasonographic evaluation of pyloric muscle thickness and length was done at the commencement of treatment, after completion of treatment and at 3, 6, 9, 12 and 15 months follow up. Oral atropine was effective in 11/12 (91.06%) cases. Vomiting ceased in 14 to 21 days in all cases. One case required initial 7 days of i.v. treatment followed by 18 days oral treatment to stop vomiting. USG evidence of normalization of pylorus was observed in all these cases, 3-15 months after completion of treatment. We conclude that oral atropine proved to be a simple, effective, safe, very cheap and acceptable treatment option for IHPS.

Vojnosanitetski pregled, 2019

Introduction/Aim. Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of surgery in the newborn and young infant. Conservative treatment of IHPS is of a great importance because it saves a newborn from stress caused by surgery and general anesthesia. This study evaluates the impact of various oral administration regimens of atropine on its efficacy in treating IHPS. Methods. The study included 45 patients with IHPS, conservatively treated by atropine sulfate in the period from 2006-2016. Clinical examination, laboratory analysis and ultrasonography were performed for all patients on admission. We analyzed the efficacy of treatment, with different oral dosage regimens and definition of potential predictive factors of the negative outcome. Evaluation was statistically analyzed by the method of multivariate logistic regression model. Results. Group of patients, conservatively treated, included 45 patients, of whom 36 (80%, p=0,0008) were successfully cured, without need for surgery and without complications. It has been shown that in terms of sex prevalence, age, birth weight, body weight on admission, duration of symptoms, pyloric muscle thickness and length, there is no statistically significant individual effect on the success of atropine treatment. Patients who received progressively increased dose of atropine have an 18 times higher risk of surgery, patients who have hypochloremic alkalosis (HCA) have a 15 times higher risk, while others, who have more than 5 vomiting within the first three days of therapy are 9 times more likely to be surgically treated. Conclusion. High success rate and no side effects represent an orally administered atropine treatment as a valid alternative indication for non-operative management of IHPS. Administration of initially high doses has been shown to be more effective in relation to gradually increased oral doses of atropine sulfate. HCA and continued vomiting are considered as potential predictive factors of negative outcome of atropine treatment.

Archives of Disease in Childhood, 1979

An analysis of the factors which may predispose towards postoperative vomiting after pyloromyotomy for hypertrophic pyloric stenosis was carried out in 72 infants at this hospital. 26 (36%) infants experienced moderate to severe postoperative vomiting of sufficient intensity to cause the postoperative feeding regimen to be modified or interrupted. Only two parameters were found to be of statistical significance. These were the state of the oesophageal mucous membrane on endoscopical examination and the presence of haematemesis in the preoperative period. No evidence for a gastric mucosal lesion could be found. An advanced oesophageal mucosal lesion was found in 30% of patients, and this was the source of the haemorrhage in all 11 in whom haematemesis was noted preoperatively. The stay in hospital was prolonged (8 days) in those infants with troublesome vomiting postoperatively compared with those with lesser problems (3 days).

The Indian Journal of Pediatrics, 2013

Vomiting is a protective reflex that results in forceful ejection of stomach contents up to and out of the mouth. It is a common complaint and may be the presenting symptom of several life-threatening conditions. It can be caused by a variety of organic and nonorganic disorders; gastrointestinal (GI) or outside of GI. Acute gastritis and gastroenteritis (AGE) are the leading cause of acute vomiting in children. Important life threatening causes in infancy include congenital intestinal obstruction, atresia, malrotation with volvulus, necrotizing enterocolitis, pyloric stenosis, intussusception, shaken baby syndrome, hydrocephalus, inborn errors of metabolism, congenital adrenal hypoplasia, obstructive uropathy, sepsis, meningitis and encephalitis, and severe gastroenteritis, and in older children appendicitis, intracranial mass lesion, diabetic ketoacidosis, Reye's syndrome, toxic ingestions, uremia, and meningitis. Initial evaluation is directed at assessment of airway, breathing and circulation, assessment of hydration status and red flag signs (bilious or bloody vomiting, altered sensorium, toxic/septic/apprehensive look, inconsolable cry or excessive irritability, severe dehydration, concern for symptomatic hypoglycemia, severe wasting, Bent-over posture). The history and physical examination guides the approach in an individual patient. The diverse nature of causes of vomiting makes a "routine" laboratory or radiologic screen impossible. Investigations (Serum electrolytes and blood gases,renal and liver functions and radiological studies) are required in any child with dehydration or red flag signs, to diagnose surgical causes. Management priorities include treatment of dehydration, stoppage of oral fluids/feeds and decompression of the stomach with nasogastric tube in patients with bilious vomiting. Antiemetic ondansetron(0.2 mg/kg oral; parenteral 0.15 mg/kg; maximum 4 mg) is indicated in children unable to take orally due to persistent vomiting, post-operative vomiting, chemotherapy induced vomiting, cyclic vomiting syndrome and acute mountain sickness.

2015

Introduction: Hypertrophic pyloric stenosis (HPS) is among common GI disorders in young infants, with an incidence of 1-2:1000 live births in the world. In this study, we wanted to investigate the correlation between duration of symptoms before surgery and eradication of symptoms after pyloromyotomy in HPS. Materials and methods: One hundred and twenty five (102 boys and 23 girls) patients with suspected infantile HPS were treated surgically by Ramstedt pyloromyotomy between 2004 and 2014 at pediatric surgery ward of Tabriz Children’s Hospital, Iran. The demographic features, clinical findings, diagnostic work-up and postoperative specifications of the patients were studied retrospectively. Results: We studied 125 patients with HPS. Male to female ratio was 4:1. The patients were 16 to 90 days of old and the mean age was 39±1.42 days. The range of pyloric canal length was 7.60 to 29.00 mm and the mean length was 19.54±3.42 mm. Pyloric muscle diameter was 2.70 to 9.00 mm and the me...

2013

Journal of Taibah University Medical Sciences, 2013

Conclusion: Surgical treatment is superior to medical treatment in cases of infantile pyloric stenosis. The success rate of medical treatment with atropine sulfate nevertheless justifies its administration to infants in whom surgery is contraindicated and when medical treatment is preferred by the parents.

Journal of Gastrointestinal & Digestive System, 2016

Hypertrophic pyloric stenosis (HPS) is the most common cause of gastric outlet obstruction in infants. It commonly requires surgery. Its incidence is 0.17-4.4 cases per 1,000 live births. The clinical findings of pyloric stenosis typically appear within three to five weeks after birth. Its most important clinical finding is non-bilious projectile vomiting. If its diagnosis is missed in early period, the most common finding is dehydration (with hypochloremic hypokalemic metabolic alkalosis). However the findings of HPS might be frequently masked in infants hospitalized for longer periods in neonatal intensive care unit. Because vomiting is the one of most common symptoms, it may be related to the different etiological factors of vomiting (congenital or genetic causes, NEC, sepsis, nutritional intolerance), blockage of projectile vomiting with gastric drainage by previously inserted indwelling orogastric/nasogastric catheter which prevents development of excessive gastric dilatation. The accurate diagnosis delays with elimination of severe alkalosis and electrolyte disorder and prevention of malnutrition with administered parenteral nutrition. Herein we would like to draw attention the delayed diagnosis of HPS in five neonatal cases who were hospitalized in the neonatal intensive care unit (nicu) for longer periods.

Annals of Allergy, Asthma & Immunology, 2003

A 16-month-old boy was referred for persistent vomiting after extensive evaluation by his primary care pediatrician and a gastroenterologist.

The Journal of Pediatrics, 2019

Objectives To synthesize quantitative and qualitative data on pharmacologic interventions of pediatric cyclic vomiting syndrome and their effectiveness in disease management in the acute care setting. Study design Using keywords, 799 studies published up from December 1954 to February 2018 were extracted from MEDLINE via Pubmed, Embase via OVID, CINAHL via EBSCO, and Cochrane Controlled Trials Registry. Studies were evaluated for inclusion and exclusion by 2 independent reviewers using predetermined inclusion and exclusion criteria. Results The search yielded 84 studies for full review, of which 54 were included in the systematic review. Studies were subsequently separated into 1 group of 6 case series studies containing quantitative data on sumatriptan, ondansetron, phenothiazines, prokinetic agents, carbohydrate, isometheptene, and aprepitant; 1 one group consisting only of qualitative studies containing expert recommendations.