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Evaluation of a fluid resuscitation protocol for patients with hypertrophic pyloric stenosis

  • James A. Fraser
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
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  • Obiyo Osuchukwu
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
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  • Kayla B. Briggs
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
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  • Wendy Jo Svetanoff
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
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  • Rebecca M. Rentea
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States

    University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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  • Pablo Aguayo
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States

    University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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  • David Juang
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States

    University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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  • Jason D. Fraser
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States

    University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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  • Charles L. Snyder
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States

    University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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  • Richard J. Hendrickson
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States

    University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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  • Shawn D. St. Peter
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States

    University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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  • Tolulope A. Oyetunji
    Correspondence
    Corresponding author at: Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States.
    Affiliations
    Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States

    University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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Published:November 06, 2021DOI:https://doi.org/10.1016/j.jpedsurg.2021.10.052

      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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