Making the diagnosis of appendicitis in an infant is extremely difficult, and it is unusual for the diagnosis to be made before there is perforation. Because the diagnosis is often delayed, the mortality rate is high. Given the need to make this diagnosis as soon as possible, it is a little surprising that few studies have looked at factors that are associated with infant appendicitis.
Dr. Yakun Liu and colleagues from 7 institutions from China conducted a retrospective case-control study that compared infants who were diagnosed with appendicitis, either during surgery or autopsy, with those who did not have appendicitis. Their article, entitled “Preterm Birth and Infantile Appendicitis,” is being early released in Pediatrics this week (10.1542/peds.2023-063815).
Three-quarters of the infants diagnosed with appendicitis experienced perforation of the appendix. The authors did not report on the mortality rate in this study.
The highest risk for appendicitis during infancy came with being born preterm—the risk being more than 3 times the risk for infants born at term. Other risk factors were male sex, formula feeding, and low birth weight. These risk factors were significant for both appendicitis diagnosed in the first 28 days of life and appendicitis diagnosed between 28 and 365 days of life.
While this study was not designed to look at possible explanations for these risks, the authors speculate that infantile appendicitis may be associated with bacterial infection, and this is certainly plausible, particularly given the increased susceptibility to infections in infants born preterm and the protection that human milk can provide against infection.
I hope that we will see further studies from this group and others that may provide more clues that are helpful in diagnosing—and maybe even preventing—this life-threatening condition.
