Maternal and Child Health Journal

, Volume 18, Issue 7, pp 1721–1727 | Cite as

Similarities and Differences in the Epidemiology of Pyloric Stenosis and SIDS

  • Sarka LisonkovaEmail author
  • K. S. Joseph


Similar temporal declines in infantile hypertrophic pyloric stenosis (IHPS) and sudden infant death syndrome (SIDS) and other common features have led to hypotheses about a shared etiology. We carried out a population-based study to highlight similarities and differences between IHPS and SIDS. We used vital statistics and hospitalization data on all live births in Washington State, USA (1987–2009). Changes in IHPS and SIDS rates over time were quantified using rate ratios with 95 % confidence intervals (CI). The duration between birth and diagnosis of IHPS or SIDS was examined as a function of gestational age at birth. Logistic regression analysis was used to identify risk factors and quantify adjusted temporal trends (2000–2008). Although both IHPS and SIDS rates declined significantly between 1987 and 2008, the patterns and magnitude of the declines (40 and 74 %, respectively) were different. IHPS and SIDS shared risk factors such as maternal smoking and single parent status but other factors showed qualitatively or and quantitatively different associations. Primiparity was a risk factor for IHPS [odds ratio (OR) 1.24, 95 % CI 1.09–1.41], and a protective factor for SIDS (OR 0.44, 95 % CI 0.36–0.55), while male sex had a stronger association with IHPS (OR 4.51, 95 % CI 3.85–5.28 vs 1.36, 95 % CI 1.13–1.64). Both IHPS and SIDS showed significant inverse associations between gestational age at birth and chronologic age at diagnosis/death. IHPS and SIDS share some epidemiologic features and risk factors but other risk factors have qualitatively or quantitatively different effects and recent temporal trends in the two diseases are dissimilar.


Infantile hypertrophic pyloric stenosis Trend Epidemiology Sudden infant death syndrome 



Infantile hypertrophic pyloric stenosis


Confidence interval


Sudden infant death syndrome



S.L. is supported by a post-doctoral fellowship award from the Michael Smith Foundation for Health Research (MSFHR) and Rare Disease Foundation, and K.S.J.’s work is supported by an award from the Child and Family Research Institute and a Chair award from the Canadian Institutes of Health Research.

Conflict of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    MacMahon, B. (2006). The continuing enigma of pyloric stenosis of infancy. Epidemiology, 17, 195–201.CrossRefPubMedGoogle Scholar
  2. 2.
    Persson, S., Ekbom, A., Granath, F., & Nordenskjold, A. (2001). Parallel incidences of sudden infant death syndrome and infantile hypertrophic pyloric stenosis: A common cause? Pediatrics, 108, e70.CrossRefPubMedGoogle Scholar
  3. 3.
    Sommerfield, T., Chalmers, J., Youngson, G., Heely, C., Fleming, M., & Thomson, G. (2008). The changing epidemiology of infantile hypertrophic pyloric stenosis in Scotland. Archives of Disease in Childhood, 93, 1007–1011.CrossRefPubMedGoogle Scholar
  4. 4.
    Mitchell, A. A. (2006). Prone to sleep, prone to pyloric stenosis? Epidemiology, 17, 136–137.CrossRefPubMedGoogle Scholar
  5. 5.
    Pedersen, R. N., Garne, E., Loane, M., Korsholm, L., & Husby, S. (2008). Infantile hypertrophic pyloric stenosis: A comparative study of incidence and other epidemiological characteristics in seven European regions. Journal of Maternal-Fetal and Neonatal Medicine, 21, 599–604.CrossRefPubMedGoogle Scholar
  6. 6.
    Krogh, C., Gortz, S., Wohlfahrt, J., Biggar, R. J., Melbye, M., & Fischer, T. K. (2012). Pre- and perinatal risk factors for pyloric stenosis and their influence on the male predominance. American Journal of Epidemiology, 176, 24–31.CrossRefPubMedGoogle Scholar
  7. 7.
    Laffolie, J., Turial, S., Heckmann, M., Zimmer, K. P., & Schier, F. (2012). Decline in infantile hypertrophic pyloric stenosis in Germany in 2000–2008. Pediatrics, 129, e901.CrossRefPubMedGoogle Scholar
  8. 8.
    Halloran, D. R., & Alexander, G. R. (2006). Preterm delivery and age of SIDS death. Annals of Epidemiology, 16, 600–606.CrossRefPubMedGoogle Scholar
  9. 9.
    Washington State Department of Health, Centre for Health Statistics. Hospital data. Comprehensive Hospital Abstract Reporting System (CHARS) 987 to 2011Q2. Accessed May 25, 2012.
  10. 10.
    Washington State Department of Health, Centre for Health Statistics. Birth data; tables for selected years. Accessed May 25, 2012.
  11. 11.
    Hohner, V. (1999). BERD to CHARS linkage rate. Olympia: Washington State Dept of Health, Office of Hospital and Patient Data Systems.Google Scholar
  12. 12.
    Alexander, G. R., Himes, J. H., Kaufman, R. B., Mor, J., & Kogan, M. (1996). A United States national reference for fetal growth. Obstetrics and Gynecology, 87, 163–168.CrossRefPubMedGoogle Scholar
  13. 13.
    Mustafa, G., & David, R. J. (2001). Comparative accuracy of clinical estimate versus menstrual gestational age in computerized birth certificates. Public Health Reports, 116, 15–21.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Ananth, C. V. (2007). Menstrual versus clinical estimate of gestational age dating in the United States: Temporal trends and variability in indices of perinatal outcomes. Paediatric and Perinatal Epidemiology, 21(S2), 22–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Rannells, J. D., Carver, J. D., & Kirby, R. S. (2011). Infantile hypertrophic pyloric stenosis: Epidemiology, genetics, and clinical update. Advances in Pediatrics, 58, 195–206.CrossRefGoogle Scholar
  16. 16.
    Wang, J., Waller, D. K., Hwang, L. Y., Taylor, L. G., & Canfield, M. A. (2008). Prevalence of infantile hypertrophic pyloric stenosis in Texas, 1999–2002. Birth Defect Research (Part A), 82, 736–767.CrossRefGoogle Scholar
  17. 17.
    Sorensen, H. T., Norgard, B., Pedersen, L., Larsen, H., & Johnsen, S. P. (2002). Maternal smoking and risk of hypertrophic pyloric stenosis: 10 year population based cohort study. British Medical Journal, 325, 1011–1012.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Applegate, M. S., & Druschel, C. M. (1995). The epidemiology of infantile hypertrophic pyloric stenosis in New York State, 1983 to 1990. Archives of Pediatrics and Adolescent Medicine, 149, 1123–1129.CrossRefPubMedGoogle Scholar
  19. 19.
    Hauck, F. R., & Tanabe, K. O. (2008). International trends in sudden infant deaths syndrome: Stabilization of rates requires further action. Pediatrics, 122, 660–666.CrossRefPubMedGoogle Scholar
  20. 20.
    Blair, P. S., Sidebotham, P., Berry, P. J., Evans, M., & Fleming, P. J. (2006). Major epidemiological changes in sudden infant death syndrome: A 20-year population-based study in the UK. Lancet, 367, 314–319.CrossRefPubMedGoogle Scholar
  21. 21.
    Alm, B., Norvenius, S. G., Wennergren, G., Skjarven, R., Oyen, N., Milerad, J., et al. (2001). Changes in the epidemiology of sudden infant death syndrome in Sweden 1973–1996. Archives of Disease in Childhood, 84, 24–30.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Platt, M. J., & Pharoah, P. O. (2003). The epidemiology of sudden infant death syndrome. Archives of Disease in Childhood, 88, 27–29.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Rusen, I. D., Liu, S., Sauve, R., Joseph, K. S., & Kramer, M. S. (2004). Sudden infant death syndrome in Canada: Trends in rates and risk factors, 1985–1998. Chronic Dis Can, 25, 1–6.PubMedGoogle Scholar
  24. 24.
    Malloy, M. H. (2004). SIDS—A syndrome in search of a cause. New England Journal of Medicine, 351, 957–959.CrossRefPubMedGoogle Scholar
  25. 25.
    Lisonkova, S., Hutcheon, J. A., & Joseph, K. S. (2012). Sudden infant death syndrome: A re-examination of temporal trends. BMC Pregnancy and Childbirth, 12, 59.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Kinney, H. C., & Thach, B. T. (2009). The sudden infant death syndrome. New England Journal of Medicine, 361, 795–805.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Kinney, H. C., Filiano, J. J., & Harper, R. M. (1992). The neuropathology of the sudden infant death syndrome. Journal of Neuropathology & Experimental Neurology, 51, 115–126.CrossRefGoogle Scholar
  28. 28.
    Everett, K. V., Chioza, B. A., Georgoula, C., Reece, A., Gardiner, R. M., & Chung, E. M. K. (2009). Infantile hypertrophic pyloric stenosis: Evaluation of three positional candidate genes, TRPC1, TRPC5 and TRCP6, by association analysis and re-sequencing. Human Genetics, 126, 819–831.CrossRefPubMedGoogle Scholar
  29. 29.
    Moon, R. Y., Horne, R. S., & Hauck, F. R. (2007). Sudden infant death syndrome. Lancet, 370, 1578–1587.CrossRefPubMedGoogle Scholar
  30. 30.
    Hunt, C. E., & Hauck, F. R. (2006). Sudden infant death syndrome. Canadian Medical Association Journal, 174, 1861–1869.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Hunt, C. E. (2005). Gene-environment interactions: Implications for sudden unexpected death in infancy. Archives of Disease in Childhood, 90, 48–53.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Getahun, D., Amre, D., Rhoas, G. G., & Demissie, K. (2004). Maternal and obstetric risk factors for sudden infant death syndrome in the United States. Obstetrics and Gynecology, 103, 646–652.CrossRefPubMedGoogle Scholar
  33. 33.
    Pantelli, C. (2009). New insights into the pathogenesis of infantile pyloric stenosis. Pediatric Surgery International, 25, 1043–1052.CrossRefGoogle Scholar
  34. 34.
    Saps, M., & Di Lorenzo, C. (2008). Gastric motility. In R. Kleinman, O. G. Goulet, G. Mieli-Vergani, & I. Sanderson (Eds.), Walker’s pediatric gastrointestinal disease (Vol. 1, pp. 187–193). New York: McGraw-Hill.Google Scholar
  35. 35.
    Kobayashi, H., Miyahara, K., Yamataka, A., Lane, G. J., Sueyoshi, N., & Miyano, T. (2001). Pyloric stenosis: New histopathologic perspective using confocal laser scanning. Journal of Pediatric Surgery, 36, 1277–1279.CrossRefPubMedGoogle Scholar
  36. 36.
    Vanderwinden, J. M., Mailleux, P., et al. (1992). Nitric oxide synthase activity in infantile hypertrophic pyloric stenosis. New England Journal of Medicine, 327, 511–515.CrossRefPubMedGoogle Scholar
  37. 37.
    Jacoby, N. M. (1962). Pyloric stenosis: Selective medical and surgical treatment: A survey of sixteen years’ experience. Lancet, i, 119–121.CrossRefGoogle Scholar
  38. 38.
    Singh, U. K., & Kumar, E. (2002). Congenital hypertrophic pyloric stenosis. The Indian Journal of Pediatrics, 69, 713–715.CrossRefGoogle Scholar
  39. 39.
    Kawahara, H., Imura, K., Nishikawa, M., Yagi, M., & Kubota, A. (2002). Intravenous atropine treatment in infantile hypertrophic pyloric stenosis. Archives of Disease in Childhood, 87, 71–74.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Kahawara, H., Takama, Y., Yoshida, H., Nakai, H., Okuyama, H., Kubota, A., et al. (2005). Medical treatment of infantile hypertrophic pyloric stenosis: Should we always slice the ‘olive’? Journal of Pediatric Surgery, 40, 1848–1851.CrossRefGoogle Scholar
  41. 41.
    Yamataka, A., Tsukada, K., Yokoyama-Laws, Y., et al. (2000). Pyloromyotomy versus atropine sulfate for infantile hypertrophic pyloric stenosis. Journal of Pediatric Surgery, 35, 338–342.CrossRefPubMedGoogle Scholar
  42. 42.
    Pyloric stenosis. The American Pediatric Surgical Association. Accessed Oct 18, 2012.
  43. 43.
    Gotley, L. M., Blanch, A., Kimble, R., Frawley, K., & Acworth, J. P. (2009). Pyloric stenosis: A retrospective study of Australian population. Emergency Medicine Australasia, 21, 407–413.CrossRefPubMedGoogle Scholar
  44. 44.
    Anderson, R. N., Minino, A. M., Hoyert, D., & Rosenberg, H. (2001). Comparability of causes of death between ICD-9 and ICD-10: Preliminary estimates. National Vital Statistics Reports, 49, 1–32.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyUniversity of British Columbia and the Children’s and Women’s Hospital and Health Centre of British ColumbiaVancouverCanada
  2. 2.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada

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