Does valsalva retinopathy occur in infants? An initial investigation in infants with vomiting caused by pyloric stenosis

Sandra Herr, Mary C. Pierce, Rachel P. Berger, Henri Ford, Raymond D. Pitetti

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objective. Retinal hemorrhages (RHs) are 1 manifestation of child abuse, and although they often are considered to be diagnostic of abuse in a young child, there are other potential causes. RHs have been described in association with valsalva maneuver, such as forceful vomiting or coughing. Our aim was to describe the incidence of RH in infants with vomiting caused by pyloric stenosis. Methods. A prospective, descriptive study was conducted of infants who underwent pyloromyotomy for hypertrophic pyloric stenosis (HPS). Dilated retinal examinations were performed, and the findings were documented. Results. A total of 100 infants with HFS were evaluated. Eighty-four infants were male, 92 were white, and 21 had a family history of pyloric stenosis. Thirty-seven examinations were performed in the operating room. Eighteen examinations were confirmed by a second investigator, and 3 children had dilated eye examinations documented independently by a pediatric ophthalmologist. No RHs were identified (0 of 100; 95% confidence interval: 0%-3%). One patient had facial petechiae, and 2 had subconjunctival hemorrhage. Electrolyte levels were abnormal in 63 patients. In 89 cases, the emesis was described as projectile. Patients varied in the number of episodes of emesis, with 30% of patients having >100 episodes of emesis before diagnosis. One patient had a respiratory arrest associated with vomiting in the emergency department and required bag-valve mask ventilation. Conclusions. No RHs were identified in 100 infants with vomiting caused by HPS. These results suggest that RHs do not result from forceful vomiting in infants.

Original languageEnglish (US)
Pages (from-to)1658-1661
Number of pages4
JournalPediatrics
Volume113
Issue number6 I
DOIs
StatePublished - Jun 1 2004
Externally publishedYes

Fingerprint

Pyloric Stenosis
Retinal Hemorrhage
Vomiting
Hypertrophic Pyloric Stenosis
Valsalva Maneuver
Purpura
Child Abuse
Operating Rooms
Masks
Electrolytes
Hospital Emergency Service
Research Personnel
Prospective Studies
Confidence Intervals
Pediatrics
Hemorrhage

Keywords

  • Abusive head trauma
  • Pyloric stenosis
  • Retinal hemorrhages
  • Vomiting

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Does valsalva retinopathy occur in infants? An initial investigation in infants with vomiting caused by pyloric stenosis. / Herr, Sandra; Pierce, Mary C.; Berger, Rachel P.; Ford, Henri; Pitetti, Raymond D.

In: Pediatrics, Vol. 113, No. 6 I, 01.06.2004, p. 1658-1661.

Research output: Contribution to journalArticle

Herr, Sandra ; Pierce, Mary C. ; Berger, Rachel P. ; Ford, Henri ; Pitetti, Raymond D. / Does valsalva retinopathy occur in infants? An initial investigation in infants with vomiting caused by pyloric stenosis. In: Pediatrics. 2004 ; Vol. 113, No. 6 I. pp. 1658-1661.
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abstract = "Objective. Retinal hemorrhages (RHs) are 1 manifestation of child abuse, and although they often are considered to be diagnostic of abuse in a young child, there are other potential causes. RHs have been described in association with valsalva maneuver, such as forceful vomiting or coughing. Our aim was to describe the incidence of RH in infants with vomiting caused by pyloric stenosis. Methods. A prospective, descriptive study was conducted of infants who underwent pyloromyotomy for hypertrophic pyloric stenosis (HPS). Dilated retinal examinations were performed, and the findings were documented. Results. A total of 100 infants with HFS were evaluated. Eighty-four infants were male, 92 were white, and 21 had a family history of pyloric stenosis. Thirty-seven examinations were performed in the operating room. Eighteen examinations were confirmed by a second investigator, and 3 children had dilated eye examinations documented independently by a pediatric ophthalmologist. No RHs were identified (0 of 100; 95{\%} confidence interval: 0{\%}-3{\%}). One patient had facial petechiae, and 2 had subconjunctival hemorrhage. Electrolyte levels were abnormal in 63 patients. In 89 cases, the emesis was described as projectile. Patients varied in the number of episodes of emesis, with 30{\%} of patients having >100 episodes of emesis before diagnosis. One patient had a respiratory arrest associated with vomiting in the emergency department and required bag-valve mask ventilation. Conclusions. No RHs were identified in 100 infants with vomiting caused by HPS. These results suggest that RHs do not result from forceful vomiting in infants.",
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