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Bottle Fed Babies Face Stomach Obstruction Risk

Bottle fed babies face stomach obstruction risk

Babies who are bottle fed appear to be at an increased risk for a serious type of stomach obstruction called hypertrophic pyloric stenosis, according to a new study in JAMA Pediatrics. Some women are at greater risk than others of giving birth to an infant who develops this problem.

What is hypertrophic pyloric stenosis?

Hypertrophic pyloric stenosis (HPS) is a fairly common malady (about 2 to 3 out of every 1,000 births) whose cause is unknown. Until the findings of this latest study, suspected risk factors included being a firstborn male, parental history of pyloric stenosis, being white, use of erythromycin by infants during the first 2 weeks of life, and antibiotic use by mothers at the end of pregnancy or while breastfeeding.

Also known as infantile hypertrophic phyloric stenosis, this condition usually appears during the first 60 days of life although it most often occurs between 3 and 5 weeks. HPS is characterized by an enlargement or thickening (hypertrophy) of the smooth muscle layer located at the point between the stomach and the small intestine (pyloris) that narrows or blocks (stenosis) the passage of food between these two organs.

Symptoms of HPS include frequent spitting up that progresses to projectile vomiting, changes in stools (constipation or smaller, fewer stools that may have mucus), failure to gain weight or thrive, weight loss, lethargy, and stomach contractions. Parents should contact their physician as soon as possible if their child displays these symptoms.

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Diagnosis is typically made after review of symptoms, a physical examination, and an ultrasound of the abdomen or a barium swallow. Surgery (pyloromyotomy, cutting the pylorus) is the necessary treatment.

What the study showed
A team from Seattle Children’s Hospital evaluated data from 714 infants who had been admitted to hospital with HPS between 2003 and 2009 and who needed surgery. The researchers also used information on babies without HPS and on breastfeeding for all the study subjects.

Their analysis revealed the following:

  • HPS incidence declined from 14 per 10,000 births in 2003 to 9 per 10,000 births in 2009
  • Prevalence of breastfeeding increased from 80 percent in 2003 to 94 percent in 2009
  • HPS was more likely to occur in bottle fed infants (19.5%) than in breastfed infants (9.1%)
  • The chance of infants developing HPS was greater when their mothers were 35 years or older and they had given birth more than one time

For now, experts are not sure why bottle fed babies seem to be at an increased risk for this form of stomach obstruction. Further research will hopefully offer an explanation for this and other mechanisms associated with hypertrophic pyloric stenosis.

McAteer JP et al. Role of bottle feeding in the etiology of hypertrophic pyloric stenosis. JAMA Pediatrics published online 2013 Oct. 21. DOI:10.1001/jmapediatrics.2013.2857

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