Why is pyloric stenosis dangerous for newborns?

2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14

Pyloric stenosis is called the narrowing of the pylorus - the sphincter, which separates the stomach and duodenum. The result of pyloric stenosis is a violation of the movement of food masses along the gastrointestinal tract, which occurs due to the lack of motor-evacuation function of the stomach. Food returns back to the stomach, which becomes the cause of the development of pathology.

Clinical manifestations

Pyloric stenosis in newborns begins to manifest itself at 2-4 weeks of a baby's life. Boys are more susceptible to it than girls - for 4 boys with pyloric stenosis, there is 1 girl with a similar diagnosis. The incidence statistics indicate that pyloric stenosis is the most common malformation in newborns.

The symptomatology of pyloric stenosis is quite pronounced. It is specific, and therefore the diagnosis is carried out quickly. It should be noted that the first signs do not appear immediately, but only from the second week of life, that is, when the baby has already been taken from the hospital.

It is worth immediately contacting the hospital for diagnosis if the following symptoms appear:

• Vomit. It differs from the usual gag reflex in that it beats with a fountain. Most often it occurs abruptly and repeatedly, constantly intensifying. It should be noted that the food masses are clean, without bile, since the food does not even have time to contact with it.
• The amount of vomit corresponds to the amount of food eaten or may be more.
• Vomit has a pronounced sour odor.
• Weight loss. Weight loss is due to the fact that the baby does not receive nutrients, since food is not digested and nutrients are not absorbed.
• Dehydration. Frequent vomiting leads to a violation of the water-salt balance in the newborn. This can result in dry skin and rapid weight loss.
• Change in urine. The amount of urine decreases due to dehydration of the body. The color of the urine becomes saturated, it acquires an unpleasant odor.
• Urination becomes infrequent.
• The stool becomes dry, scanty. Possible manifestations of constipation.
• The fontanelle may sink.
• Facial expression in newborns with pyloric stenosis is usually painful. Such children are often naughty, cry, rarely smile.
• Decreased skin elasticity. It can be spotted using a normal test. To do this, it is enough to squeeze the skin in one place and watch how it straightens. With pyloric stenosis, the skin slowly regains its initial shape, remains wrinkled.
• With prolonged absence of treatment, the child may enter a coma.

Causes of occurrence

The reasons for the appearance of pyloric stenosis in newborns are not exactly clear. But doctors have established a correlation between some factors and the presence of this disorder.

So, for example, it was found that pyloric stenosis is more common in those children whose bearing was accompanied by the following factors:

1. severe toxicosis, especially in the first trimester;
2. an unfavorable course of pregnancy and a high risk of fetal loss;
3. pathologies of viral origin, transferred by a woman in early pregnancy;
4. taking some medications;
5. endocrine disorders in mother and child;
6. neoplasms in a child.

Possible complications

In the absence of timely diagnosis and treatment, a newborn may develop severe complications. Inhalation of vomit can be fatal. Frequent gagging and vomiting can provoke aspiration pneumonia, asphyxia, otitis media.

On the part of the gastrointestinal tract, complications such as peptic ulcer disease of the gatekeeper, internal bleeding can occur. Nutrient deficiencies cause various types of anemia and can cause delays in the development of the newborn.

Diagnostics

The diagnosis is made in an inpatient unit. Diagnostics is based on the following methods:

• Collecting a clinical history. It is carried out by interviewing parents about complaints and symptoms identified earlier. The frequency of food intake, the presence of vomiting, its nature, the state of the stool and urine are assessed.
• General examination of the newborn. Includes palpation of the abdomen. When pyloric stenosis is characterized by the presence of manifestations of gastric motility, manifested in pulsation.
• Blood test. Includes an assessment of the content of trace elements, ESR, hemoglobin level.
• Ultrasound procedure. The most informative type of diagnostics in this case. Allows you to see the thickening and enlargement of the gatekeeper. A thickness of more than 4 mm and a length of more than 14 mm indicates the presence of pathology.
• Fibrogastroduodenoscopy. FGDS is carried out in the event that it is required to obtain the missing data that were not obtained during the ultrasound scan.
• X-ray examination of the stomach. At the moment, it is extremely rare, since EGD and ultrasound allow you to get more information with less exposure. But in some cases it can be used to further clarify the information.
• Surgical consultation. If an operation is required for treatment, consultation with a pediatric surgeon will be mandatory.

Treatment methods

1. Surgery is the only way to treat pyloric stenosis in newborns. This operation has no contraindications and can be performed by everyone without exception. It is performed 1-3 days after an accurate diagnosis has been made.
2. Preparing for surgery involves replenishing fluid levels through blood or plasma transfusions. Additionally, it is possible to administer saline or Ringer's solution through a dropper, enema. Oral rehydration is possible. If pyloric stenosis in newborns is complicated by inflammatory processes, antibiotics are additionally prescribed in preparation for the operation. Food and drink should not be given to the child 6 hours before the start of the operation.
3. The operation is performed under local anesthesia. The surgeon makes a small incision in the xiphoid process. The length of the incision is no more than 5 cm. Upon reaching the pylorus during the operation, the rough tissue of the pylorus is excised. At the same time, the mucous membrane is not opened. The edges of the incision are spread apart until the mucous membrane is released. The edges of the pylorus incision are not sewn together. The peritoneum is sutured with interrupted sutures, and the skin is twisted.
4. Recovery after surgery lasts for several days. For the first 2-3 hours, the baby is injected with a glucose solution intravenously. Later, after 3-4 hours, you can feed the baby with expressed milk. Feeding is carried out at intervals of 2 hours.
5. The first day after the operation, a single volume of milk should not be more than 30 ml, in the presence of vomiting - no more than 15 ml. An increase in a single dose occurs daily by 10 ml. From day 5, the baby is breastfed twice a day for 5 minutes. After 7 days, breastfeeding is carried out every 3 hours.

Prevention of the anomaly is impossible, since its causes have not been established. In preparation for carrying a child, it is recommended to give up bad habits and adjust your diet.