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Pierro, A., De Coppi, P. and Eaton, S. (2012) Neonatal Physiology and Metabolic Considerations. In: Coran, A.G., Adzik, N.S., Krummel, T.M., et al., Eds., Pediatric Surgery, 7th Edition, Elsevier/Saunders, Philadelphia, 89-107. http://dx.doi.org/10.1016/B978-0-323-07255-7.00006-4

has been cited by the following article:

• TITLE: Pathophysiology of Hypertrophic Pyloric Stenosis Revisited: The Use of Isotonic Fluid for Preoperative Infusion Therapy Is Supported

  AUTHORS: Ralf-Bodo Troebs

  KEYWORDS: Infantile Pyloric Stenosis, Metabolic Alkalosis, Dehydration, Osmolality, Glucose, Lactate, Creatinine Clearance, Infusion Therapy

  JOURNAL NAME: Open Journal of Pediatrics, Vol.4 No.3, September 3, 2014

  ABSTRACT: Background: The aim of this study was to elucidate the preoperative clinical and biochemical profile of infants with IHPS to optimize infusion therapy. Patients and Method: We retrospectively analyzed data from 56 infants who were operated for IHPS. Our study includes growth and laboratory data prior to the initiation of therapy. Results: Median duration of propulsive vomiting was 4 d; the median age was 37 d (18 - 108), and the median body weight was 3840 g (2760 -5900). Metabolic alkalosis (MAlk) with a pH of 7.45 ± 0.06 and an stHCO3- of 28.7 ± 4.5 mmol/l was found. In a subgroup of the infants, negative base excess (BE) was observed. The sodium concentration was normal or reduced (mean/median of 137 mmol/l). There was a strong negative correlation between stHCO3- and K+. The carbon dioxide partial pressure tended to increase (5.72 ± 0.84 kPa). Calculations of osmolality revealed a normal osmolarity. Hypoglycemia did not occur. The creatinine clearance according to the Schwartz formula remained at a normal level (85.3 ± 24.3 ml/min/1.73 m2). Discussion: The presented case series is characterized by a short duration of preoperative vomiting. MAlk can be classified as a chloride deficiency syndrome. It is accompanied by normo- or hyponatremic dehydration with normal osmolality. Partial respiratory compensation occurred. A normal creatinine clearance indicated good glomerular renal function. Conclusion: The presented study supports the use of an isotonic infusion fluid with a low glucose concentration for preoperative infusion therapy.