ATROPINE AS CONSERVATIVE MANAGEMENT OF HYPERTROPHIC PYLORIC STENOSIS IN NEWBORN, A CASE REPORT FROM LIMITED FACILITY HOSPITAL
Laila Fitri Ibbibah
Former pediatrician in Umbu Rara Meha Hospital and attending pediatrician in Naibonat Hospital
Background : Hypertrophic pyloric stenosis (HPS) is one of the most common gastrointestinal disorder in children that required surgery. In some condition surgery might not be able to perform, for example if the patient not fit for surgery or there is no pediatric surgeon available in limited facility hospital. Conservative management using atropine is one of the potential alternative for HPS therapy.
Case Presentation Summary : A four days old baby girl was referred from primary health care because of repetitive vomiting. She appears lethargic, icteric, and severely dehydrated. Initial fluid resuscitation and antibiotic therapy was given. From plain baby gram X-ray, there is a single bubble appearance on abdominal, which lead to diagnosis of HPS. The baby consulted to general surgeon, but assesed not fit for surgery because of sepsis. So conservative management with intravenous atropine administered to the patient with 0.12 mg once daily. On seventh day of atropine therapy, the patient was stable and second X-ray showed widely distributed gas in abdominal. The patient was started given expressed breastmilk with no repeated vomiting episode. Atropine therapy continued up to ten days. A week later patient discharged with stable condition.
Learning Points/Discussion : Atropine is a cholinergic drug with strong anti-muscarinic effect which temporarily suppresses spastic contraction of pyloric muscle. The intravenous dose for HPS range from 0.04-0.225 mg/kg/day given for 1-10 days. Successful rate among studies vary from 76-100% and the side effect relatively mild. So atropine can be used for conservative management in HPS in limited facility hospital.