Pyloric Stenosis in Sick Premature Infants-Reply

In Reply.—The objective of our report was to highlight what, in our experience, is not a simple pediatric condition to diagnose clinically in the sick premature infant. None of the infants described in our report had clinical evidence of a pyloric tumor or "conspicuous gastric peristalsis." This is not surprising, since atony of the stomach with prominent gastric dilatation is the most frequent finding in our experience when an upper-gastrointestinal-tract study is performed in a sick premature infant suspected of having a gastric outlet obstruction. Despite our "high-tech" environment, we also take pride in our clinical skills. However, we caution against an infallible belief that in the critically ill premature infant, the presence of a pyloric tumor or visible peristalsis waves can always be found. Our point in presenting the cases was to emphasize the importance of considering this diagnosis even in an unlikely patient population.