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Infantile hypertrophic pyloric stenosis: maternal diabetes and perinatal exposure to non-macrolide antibiotics

Abstract

Objective

Infant exposure to macrolide antibiotics is a risk factor for infantile hypertrophic pyloric stenosis (IHPS). The aim of the study was to establish whether perinatal exposure to non-macrolide antibiotics was a risk factor for IHPS.

Study design

A retrospective matched case-control study was performed using a database including all children born at Soroka University Medical Centre between 2006 and 2018. Cases and controls were compared using Student T-test and multiple logistic regression.

Result

Of 189 461 children in the database, 63 infants were diagnosed with IHPS and underwent pyloromyotomy. There was no association between non-macrolide antibiotic exposure and IHPS. Maternal diabetes (DM) had an adjusted odds ratio for infants developing IHPS of 4.53 (p = 0.004).

Conclusion

The lack of association between exposure to non-macrolide antibiotics and IHPS suggests a quality unique to macrolides. An association between DM and IHPS may suggest elevated levels of IGF-1 have a role.

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Fig. 1: Figure 1 shows graphically the distribution of IHPS cases in the SUMC database per year.

Data availability

The data that support the findings of this study are available from KAM but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of KAM.

References

  1. Svenningsson A, Svensson T, Akre O, Nordenskjƶld A. Maternal and pregnancy characteristics and risk of infantile hypertrophic pyloric stenosis. J Pediatr Surg. 2014;49:1226–31.

    ArticleĀ  Google ScholarĀ 

  2. Lund M, Pasternak B, Davidsen RB, Feenstra B, Krogh C, Diaz LJ, et al. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: Nationwide cohort study. BMJ 2014;348:g1908.

    ArticleĀ  Google ScholarĀ 

  3. Krogh C, Biggar RJ, Fischer TK, Lindholm M, Wohlfahrt J, Melbye M. Bottle-feeding and the risk of pyloric stenosis. Pediatrics 2012;130:e943.

    ArticleĀ  Google ScholarĀ 

  4. Krogh C, GĆørtz S, Wohlfahrt J, Biggar RJ, Melbye M, Fischer TK. Pre-and perinatal risk factors for pyloric stenosis and their influence on the male predominance. Am J Epidemiol. 2012;176:24–31.

    ArticleĀ  Google ScholarĀ 

  5. Murchison L, De Coppi P, Eaton S. Post-natal erythromycin exposure and risk of infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis. Pediatr Surg Int. 2016;32:1147–52.

    ArticleĀ  CASĀ  Google ScholarĀ 

  6. LeppƤlehto E, PƤrtty A, KalliomƤki M, Lƶyttyniemi E, Isolauri E, Rautava S. Maternal intrapartum antibiotic administration and infantile colic: Is there a connection? Neonatology 2018;114:226–9.

    ArticleĀ  Google ScholarĀ 

  7. Tanaka M, Nakayama J. Development of the gut microbiota in infancy and its impact on health in later life. Allergol Int. 2017;66:515–22.

    ArticleĀ  CASĀ  Google ScholarĀ 

  8. Mahon BE, Rosenman MB, Kleiman MB. Maternal and infant use of erythromycin and other macrolide antibiotics as risk factors for infantile hypertrophic pyloric stenosis. J Pediatr. 2001;139:380–4.

    ArticleĀ  CASĀ  Google ScholarĀ 

  9. Azad MB, Konya T, Persaud RR, Guttman DS, Chari RS, Field CJ, et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: A prospective cohort study. BJOG: Int J Obstet Gynaecol. 2016;123:983–93.

    ArticleĀ  CASĀ  Google ScholarĀ 

  10. El-Gohary Y, Abdelhafeez A, Paton E, Gosain A, Murphy A. Pyloric stenosis: An enigma more than a century after the first successful treatment. Pediatr Surg Int. 2018;34:21–7.

    ArticleĀ  Google ScholarĀ 

  11. Ericson J, Arnold C, Cheeseman J, Cho J, Kaneko S, Wilson E, et al. Use and safety of erythromycin and metoclopramide in hospitalized infants. J Pediatr Gastroenterol Nutr. 2015;61:334–9.

    ArticleĀ  CASĀ  Google ScholarĀ 

  12. Pezzati M, Dani C, Biadaioli R, Gambi B, Lachina L, Rubaltelli F. Randomised controlled trial of the effect of cisapride on the pyloric muscle in preterm infants. Eur J Pediatr. 2001;160:572–5.

    ArticleĀ  CASĀ  Google ScholarĀ 

  13. Riskin A, Itzchaki O, Bader D, Iofe A, Toropine A, Riskin-Mashiah S. Perinatal outcomes in infants of mothers with diabetes in pregnancy. Isr Med Assoc J. 2020;22:569–75.

    Google ScholarĀ 

  14. Depla AL, De Wit L, Steenhuis TJ, Slieker MG, Voormolen DN, Scheffer PG, et al. Effect of maternal diabetes on fetal heart function on echocardiography: Systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2021;57:539–50.

    ArticleĀ  CASĀ  Google ScholarĀ 

  15. Kuemmerle JF, Zhou H, Bowers JG. IGF-I stimulates human intestinal smooth muscle cell growth by regulation of G1 phase cell cycle proteins. Am J Physiol - Gastrointest Liver Physiol. 2004;286:412–9.

    ArticleĀ  Google ScholarĀ 

  16. Jabłoński J, Gawrońska R, Gawłowska A, Kobos J, Andrzejewska E. Study of insulin-like growth factor-1 (IGF-1) and platelet-derived endothelial cell growth factor (PDEGF) expression in children with infantile hypertrophic pyloric stenosis. Med Sci Monit. 2006;12:CR27–CR30.

    Google ScholarĀ 

  17. Fang X-S, Zhang M-S, Guo J-Y, Zheng J. Effects of insulin-like growth factor-1 on endoplasmic reticulum stress and autophagy in rat smooth muscle cells at different glucose concentrations in vitro. Mol Cell Biochem. 2019;451:11–20.

    ArticleĀ  CASĀ  Google ScholarĀ 

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Authors and Affiliations

Authors

Contributions

SCE proposed the project idea as part of her medical school training at the Faculty of Health Sciences, Ben Gurion University of the Negev. She wrote the project proposal, performed the data collection, and was involved in data analysis, interpretation and writing the submitted paper. SY was the Statistical consultant for the project. She designed and performed the statistical analysis and the results tables. BY provided the SMC database set and contributed to the design of the project. ES contributed to the design of the project and the writing of the submitted paper. KAM developed the project proposal together with SCE and was involved in the data analysis, data interpretation and writing of the submitted paper.

Corresponding author

Correspondence to Kyla Anna Marks.

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Competing interests

There are no competing financial interests in relation to the work described. The Soroka University Medical Centre (SUMC) research ethics committee approved the study. The study was performed in accordance with the Declaration of Helsinki.

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Cohen Elias, S., Yarza, S., Yerushalmi, B. et al. Infantile hypertrophic pyloric stenosis: maternal diabetes and perinatal exposure to non-macrolide antibiotics. J Perinatol (2023). https://doi.org/10.1038/s41372-023-01619-2

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