Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin

A case review and cohort study

M. A. Honein, L. J. Paulozzi, I. M. Himelright, B. Lee, J. D. Cragan, L. Patterson, A. Correa, S. Hall, J. D. Erickson

Research output: Contribution to journalArticle

139 Citations (Scopus)

Abstract

Background. In February, 1999, a local US health department identified a cluster of pertussis cases among neonates born at a community hospital and recommended oral erythromycin for post-exposure prophylaxis for about 200 neonates born at that hospital between Feb 1 and Feb 24, 1999. We investigated a cluster of seven cases of infantile hypertrophic pyloric stenosis (IHPS) that occurred the following month among the neonates who had received erythromycin. Methods. We obtained a masked, independent review of the IHPS ultrasonography diagnoses, calculated the monthly IHPS incidence, and compared index and historical (1998-99) IHPS cases with respect to several characteristics including erythromycin exposure. We used a retrospective cohort of infants born in January and February, 1999, to investigate further erythromycin exposure and development of IHPS. Findings. An independent review confirmed the ultrasonographic diagnoses of all seven index IHPS cases. All index cases versus none of the historical IHPS cases had been given erythromycin for pertussis prophylaxis. The IHPS rate for infants born in the hospital in February, 1999, was 32.3 per 1000 liveborn infants, representing nearly a seven-fold increase over 1997-98 (relative risk 6.8 [95% CI 3.0-15.7]). Among infants born in January and February, 1999, erythromycin was associated with IHPS (absolute risk 4.5%, relative risk ∞ [1.7-∞). Interpretation. Neonates receiving oral erythromycin may have an increased risk of IHPS. The risks and benefits of erythromycin for neonatal pertussis prophylaxis should be re-evaluated, and caution should be used in defining risk groups for prophylaxis.

Original languageEnglish (US)
Pages (from-to)2101-2105
Number of pages5
JournalLancet
Volume354
Issue number9196
DOIs
StatePublished - Dec 18 1999
Externally publishedYes

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Whooping Cough
Erythromycin
Cohort Studies
Newborn Infant
Post-Exposure Prophylaxis
Infantile Hypertrophic 1 Pyloric Stenosis
Community Hospital
Ultrasonography

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Honein, M. A., Paulozzi, L. J., Himelright, I. M., Lee, B., Cragan, J. D., Patterson, L., ... Erickson, J. D. (1999). Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin: A case review and cohort study. Lancet, 354(9196), 2101-2105. https://doi.org/10.1016/S0140-6736(99)10073-4

Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin : A case review and cohort study. / Honein, M. A.; Paulozzi, L. J.; Himelright, I. M.; Lee, B.; Cragan, J. D.; Patterson, L.; Correa, A.; Hall, S.; Erickson, J. D.

In: Lancet, Vol. 354, No. 9196, 18.12.1999, p. 2101-2105.

Research output: Contribution to journalArticle

Honein, MA, Paulozzi, LJ, Himelright, IM, Lee, B, Cragan, JD, Patterson, L, Correa, A, Hall, S & Erickson, JD 1999, 'Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin: A case review and cohort study', Lancet, vol. 354, no. 9196, pp. 2101-2105. https://doi.org/10.1016/S0140-6736(99)10073-4
Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al. Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin: A case review and cohort study. Lancet. 1999 Dec 18;354(9196):2101-2105. https://doi.org/10.1016/S0140-6736(99)10073-4
Honein, M. A. ; Paulozzi, L. J. ; Himelright, I. M. ; Lee, B. ; Cragan, J. D. ; Patterson, L. ; Correa, A. ; Hall, S. ; Erickson, J. D. / Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin : A case review and cohort study. In: Lancet. 1999 ; Vol. 354, No. 9196. pp. 2101-2105.
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T2 - A case review and cohort study

AU - Honein, M. A.

AU - Paulozzi, L. J.

AU - Himelright, I. M.

AU - Lee, B.

AU - Cragan, J. D.

AU - Patterson, L.

AU - Correa, A.

AU - Hall, S.

AU - Erickson, J. D.

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N2 - Background. In February, 1999, a local US health department identified a cluster of pertussis cases among neonates born at a community hospital and recommended oral erythromycin for post-exposure prophylaxis for about 200 neonates born at that hospital between Feb 1 and Feb 24, 1999. We investigated a cluster of seven cases of infantile hypertrophic pyloric stenosis (IHPS) that occurred the following month among the neonates who had received erythromycin. Methods. We obtained a masked, independent review of the IHPS ultrasonography diagnoses, calculated the monthly IHPS incidence, and compared index and historical (1998-99) IHPS cases with respect to several characteristics including erythromycin exposure. We used a retrospective cohort of infants born in January and February, 1999, to investigate further erythromycin exposure and development of IHPS. Findings. An independent review confirmed the ultrasonographic diagnoses of all seven index IHPS cases. All index cases versus none of the historical IHPS cases had been given erythromycin for pertussis prophylaxis. The IHPS rate for infants born in the hospital in February, 1999, was 32.3 per 1000 liveborn infants, representing nearly a seven-fold increase over 1997-98 (relative risk 6.8 [95% CI 3.0-15.7]). Among infants born in January and February, 1999, erythromycin was associated with IHPS (absolute risk 4.5%, relative risk ∞ [1.7-∞). Interpretation. Neonates receiving oral erythromycin may have an increased risk of IHPS. The risks and benefits of erythromycin for neonatal pertussis prophylaxis should be re-evaluated, and caution should be used in defining risk groups for prophylaxis.

AB - Background. In February, 1999, a local US health department identified a cluster of pertussis cases among neonates born at a community hospital and recommended oral erythromycin for post-exposure prophylaxis for about 200 neonates born at that hospital between Feb 1 and Feb 24, 1999. We investigated a cluster of seven cases of infantile hypertrophic pyloric stenosis (IHPS) that occurred the following month among the neonates who had received erythromycin. Methods. We obtained a masked, independent review of the IHPS ultrasonography diagnoses, calculated the monthly IHPS incidence, and compared index and historical (1998-99) IHPS cases with respect to several characteristics including erythromycin exposure. We used a retrospective cohort of infants born in January and February, 1999, to investigate further erythromycin exposure and development of IHPS. Findings. An independent review confirmed the ultrasonographic diagnoses of all seven index IHPS cases. All index cases versus none of the historical IHPS cases had been given erythromycin for pertussis prophylaxis. The IHPS rate for infants born in the hospital in February, 1999, was 32.3 per 1000 liveborn infants, representing nearly a seven-fold increase over 1997-98 (relative risk 6.8 [95% CI 3.0-15.7]). Among infants born in January and February, 1999, erythromycin was associated with IHPS (absolute risk 4.5%, relative risk ∞ [1.7-∞). Interpretation. Neonates receiving oral erythromycin may have an increased risk of IHPS. The risks and benefits of erythromycin for neonatal pertussis prophylaxis should be re-evaluated, and caution should be used in defining risk groups for prophylaxis.

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