• More common in boys (4:1)
• Often a maternal family history
• Increased risk if siblings were affected
• Erythromycin exposure in first few weeks of life

Pathology

Clinical features

Presents at 2-7 weeks of age – and is not related to gestational age

Projectile vomiting (non-bile stained), in an otherwise well child

• Typically occurs after each feed
• This increases in severity and frequency as the child continues to grow
• It really is projectile! – hits the walls / ceiling in some cases
• The child is usually otherwise well – in contrast to other causes of vomiting in neonates
• Obvious continued hunger despite vomiting. Only in the later stages when they are severely dehydrated will the child lose interest in feeding.

• Hypochloraemic alkalosis (metabolic acidosis due to vomiting), and Hypokalaemia
• Failure to thrive / weight loss / poor weight gain
• Dehydration< Check for: 
  
  • Skin turgor
  • Sunken eyes
  • Moist mucous membranes

• When dehydration is marked and severe, the child may not be keen to feed

Diagnosis

• Milk Test - Give the child a normal milk feed. A wave of peristalsis should be visible across the abdomen from left to right
• Examination
• Pyloric olive – a 2-3cm mass that can sometimes be felt in the URQ. Usually mobile
• USS - Often used to confirm diagnosis of sphincter hyperplasia. Pylroci muscle usually >4mm thick (normal <2cm)
• Barium Meal - may be rarely used in cases when diagnosis is not certain. It will shows the string sign of an elongated and narrowed pyloric sphincter.

• Initial Management - Correct fluid and electrolyte imbalances (if present)
• Surgery – Ramstedt pyloromyotomy – the excessive muscle is removed, but all gastric mucosa is left intact. Post-operatively the baby can usually feed normally within 24 hours of surgery

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