{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:31:54Z","timestamp":1785760314595,"version":"3.56.0"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Introduction\u2003Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal condition that can lead to metabolic alkalosis and, if uncorrected, to respiratory complications. A standardized approach to correct metabolic derangements and dehydration may reduce time until pyloromyotomy while preventing potential respiratory complications. Such an evidence-based policy regarding preoperative care is absent. We aim to formulate a recommendation about preoperative care for infants with IHPS using the Delphi technique.<\/jats:p><jats:p>Materials and Methods\u2003The RAND\/UCLA appropriateness method was used to reach international consensus in a panel of pediatric surgeons, pediatric anesthetists, and pediatricians. Statements on type and frequency of blood sampling, required serum concentrations before pyloromyotomy and intravenous fluid therapy, were rated online using a 9-point Likert scale. Consensus was present if the panel rated the statement appropriate\/obligatory (panel median: 7\u20139) or inappropriate\/unnecessary (panel median: 1\u20133) without disagreement according to the interpercentile range adjusted for symmetry formula.<\/jats:p><jats:p>Results\u2003Thirty-three and twenty-nine panel members completed the first and second round, respectively. Consensus was reached in 54\/74 statements (73%). The panel recommended the following laboratory tests and corresponding cutoff values prior to pyloromyotomy: pH \u22647.45, base excess \u22643.5, bicarbonate &lt;26\u2009mmol\/L, sodium \u2265132\u2009mmol\/L, potassium \u22653.5\u2009mmol\/L, chloride \u2265100\u2009mmol\/L, and glucose \u22654.0\u2009mmol\/L. Isotonic crystalloid with 5% dextrose and 10 to 20\u2009mEq\/L potassium should be used for fluid resuscitation.<\/jats:p><jats:p>Conclusion\u2003Consensus is reached in an expert panel about assessment of metabolic derangements at admission, cutoff serum concentrations to be achieved prior to pyloromyotomy, and appropriate intravenous fluid regime for the correction of dehydration and metabolic derangements in infants with IHPS.<\/jats:p>","DOI":"10.1055\/s-0039-3401987","type":"journal-article","created":{"date-parts":[[2020,1,20]],"date-time":"2020-01-20T23:54:08Z","timestamp":1579564448000},"page":"497-504","source":"Crossref","is-referenced-by-count":14,"title":["A Delphi Analysis to Reach Consensus on Preoperative Care in Infants with Hypertrophic Pyloric Stenosis"],"prefix":"10.1055","volume":"30","author":[{"given":"Fenne A. I. M.","family":"van den Bunder","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel J.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. W. Ernest","family":"van Heurn","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joep P. M.","family":"Derikx","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,1,20]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1001\/archpedi.159.6.520","article-title":"Population demographic indicators associated with incidence of pyloric stenosis","volume":"159","author":"T To","year":"2005","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1586\/17474124.2014.903799","article-title":"Advances in infantile hypertrophic pyloric stenosis","volume":"8","author":"B Peters","year":"2014","journal-title":"Expert Rev Gastroenterol Hepatol"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1053\/j.sempedsurg.2016.05.004","article-title":"Contemporary management of pyloric stenosis","volume":"25","author":"M Jobson","year":"2016","journal-title":"Semin Pediatr Surg"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.jpedsurg.2017.01.024","article-title":"Corrected to uncorrected? 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Surg"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1053\/j.sempedsurg.2006.10.004","article-title":"Current management of hypertrophic pyloric stenosis","volume":"16","author":"G Aspelund","year":"2007","journal-title":"Semin Pediatr Surg"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/00000542-199401000-00031","article-title":"Postanesthetic apnea in full-term infants after pyloromyotomy","volume":"80","author":"D B Andropoulos","year":"1994","journal-title":"Anesthesiology"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/PEC.0b013e318209af50","article-title":"Alkalosis-induced respiratory depression from infantile hypertrophic pyloric stenosis","volume":"27","author":"D Pappano","year":"2011","journal-title":"Pediatr Emerg Care"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.amj.2011.06.009","article-title":"Hypertrophic pyloric stenosis: it can take your breath away","volume":"31","author":"C R Tigges","year":"2012","journal-title":"Air Med J"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-201435","article-title":"Infantile Hypertrophic pyloric stenosis (IHPS): it can take away your breath, alertness, wee and poo","author":"R V Patel","year":"2013","journal-title":"BMJ Case Rep"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jss.2017.10.022","article-title":"Current perioperative care of infants with pyloric stenosis: comparison of survey results","volume":"223","author":"R S Cartabuke","year":"2018","journal-title":"J Surg Res"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s00383-010-2813-0","article-title":"Hypertrophic pyloric stenosis: predicting the resolution of biochemical abnormalities","volume":"27","author":"D J Wilkinson","year":"2011","journal-title":"Pediatr Surg Int"},{"issue":"08","key":"ref15","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1002\/bjs.1800770827","article-title":"Plasma chloride and alkalaemia in pyloric stenosis","volume":"77","author":"D W Goh","year":"1990","journal-title":"Br J Surg"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1002\/bjs.1800790322","article-title":"Serum electrolytes and capillary blood gases in the management of hypertrophic pyloric stenosis","volume":"79","author":"L K Shanbhogue","year":"1992","journal-title":"Br J Surg"},{"issue":"08","key":"ref17","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1016\/j.jpedsurg.2016.01.013","article-title":"Optimizing fluid resuscitation in hypertrophic pyloric stenosis","volume":"51","author":"B G Dalton","year":"2016","journal-title":"J Pediatr 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Med"},{"issue":"12","key":"ref22","first-page":"CD009457","article-title":"Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children","author":"S McNab","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1136\/bmj.304.6836.1218","article-title":"Hyponatraemia and death or permanent brain damage in healthy children","volume":"304","author":"A I Arieff","year":"1992","journal-title":"BMJ"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1136\/bmj.322.7289.780","article-title":"Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution","volume":"322","author":"M Halberthal","year":"2001","journal-title":"BMJ"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.suc.2012.03.006","article-title":"Pyloric stenosis in pediatric surgery: an evidence-based review","volume":"92","author":"S Pandya","year":"2012","journal-title":"Surg Clin North Am"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"h6388","DOI":"10.1136\/bmj.h6388","article-title":"Intravenous fluids in children and young people: summary of NICE guidance","volume":"351","author":"J Neilson","year":"2015","journal-title":"BMJ"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1213\/ANE.0000000000003805","article-title":"Retrospective cohort study on the optimal timing of orogastric tube\/nasogastric tube insertion in infants with pyloric stenosis","volume":"129","author":"L K Lee","year":"2019","journal-title":"Anesth Analg"},{"issue":"05","key":"ref28","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/j.jpedsurg.2010.02.026","article-title":"Investigating the use of preoperative nasogastric tubes and postoperative outcomes for infants with pyloric stenosis: a 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