Highlights
- •Management protocols for hypertrophic pyloric stenosis commonly focus on postoperative feeding, with a paucity of data evaluating the benefits of preoperative fluid resuscitation protocols.
- •Implementation of a fluid resuscitation protocol decreases unnecessary preoperative lab draws to monitor electrolyte correction while setting clear expectations and planned interventions for parents.
Abstract
Introduction
We previously developed an institutional, evidence-based fluid resuscitation protocol
for neonates with infantile hypertrophic pyloric stenosis (HPS) based on the severity
of electrolyte derangement on presentation. We aim to evaluate this protocol to determine
its efficacy in reducing the number of preoperative lab draws, time to electrolyte
correction, and overall length of stay.
Methods
A single center, retrospective review of 319 infants with HPS presenting with electrolyte
derangement from 2008 to 2020 was performed; 202 patients managed pre-protocol (2008–2014)
and 117 patients managed per our institutional fluid resuscitation algorithm (2016–2020).
The number of preoperative lab draws, time to electrolyte correction, and length of
stay before and after protocol implementation was recorded.
Results
Use of a fluid resuscitation algorithm decreased the number of infants who required
four or more preoperative lab draws (20% vs. 6%) (p < .01), decreased median time to electrolyte correction between the pre and post protocol
cohorts (15.1 h [10.6, 22.3] vs. 11.9 h [8.5, 17.9]) (p < .01), and decreased total length of hospital stay (49.0 h [40.3, 70.7] vs. 45.7 h [34.3,
65.9]) (p < .05).
Conclusion
Implementation of a fluid resuscitation algorithm for patients presenting with hypertrophic
pyloric stenosis decreases the frequency of preoperative lab draws, time to electrolyte
correction, and total length of hospital stay. Use of a fluid resuscitation protocol
may decrease discomfort through fewer preoperative lab draws and shorter length of
stay while setting clear expectations and planned intervention for parents.
Level of Evidence
III – Retrospective comparative study.
Keywords
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References
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Article info
Publication history
Published online: November 06, 2021
Accepted:
October 25,
2021
Received in revised form:
October 12,
2021
Received:
September 3,
2021
Footnotes
Original article – Poster presentation at the 22nd EUPSA Annual Congress, Athens, Greece, September 1–4, 2021.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
