Perinatal risk factors for infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis

J Pediatr Surg. 2023 Mar;58(3):458-466. doi: 10.1016/j.jpedsurg.2022.08.016. Epub 2022 Aug 24.


Background: Infantile hypertrophic pyloric stenosis (IHPS) is one of the most common diseases that require surgical intervention amongst the paediatric population. Although the treatment and the diagnosis of pyloric stenosis are well established, the perinatal risk factors associated with it still need further investigation.

Methods: We searched the following databases: Cochrane, Google Scholar, PubMed, and Scopus. Studies were included if they were case-control or cohort in design and studied the perinatal risk factors associated with IHPS. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS).

Results: Twenty-one articles were included in this meta-analysis, including 18,104,753 participants. Our analysis showed a significant association between IHPS and male sex (RR=2.71, 95% CI:1.93-3.78), maternal smoking (RR=1.75, 95% CI: 1.54 - 2.00), bottle-feeding (RR=1.68, 95% CI: 1.42 - 1.98), being first born (RR=1.23, 95% CI:1.07-1.40), African ethnicity (RR=0.51, 95% CI: 0.35-0.75), and cesarean section (RR=1.57, 95% CI: 1.49-1.66). On the contrary, there was no significant association between IHPS and multiple gestations, preterm labour, being born in summer, and small for gestational age (SGA).

Conclusion: In conclusion, our analysis showed that male sex, bottle feeding, maternal smoking and African ethnicity were significantly associated with the risk of IHPS. However, most of the included articles were retrospective in design which necessitates conducting future prospective well-designed studies to further investigate the risk factors of IHPS.

Keywords: Human; Meta-analysis; Pyloric stenosis; Risk factors.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Cesarean Section / adverse effects
  • Child
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Parturition
  • Pregnancy
  • Pyloric Stenosis, Hypertrophic* / epidemiology
  • Pyloric Stenosis, Hypertrophic* / etiology
  • Retrospective Studies
  • Risk Factors