Neonatal Gastric Perforation: Report of 15 Cases and Review of the Literature

Background

Gastric perforation among neonates is a rare but frequently fatal condition of uncertain etiology. The aim of this study was to review the clinical course of neonatal gastric perforation and to evaluate possible prognostic factors.

Methods

We retrospectively analyzed the medical records of 15 patients with neonatal gastric perforation over a 19-year period. Another 97 patients described in the medical literature, for whom the gestational ages and birth weights were clearly stated, were also reviewed.

Results

In our series, there were three girls and 12 boys, nine of whom were fullterm infants and six preterm infants. The most common initial manifestations were poor activity, abdominal distension, and respiratory distress. The overall mortality was 47% (7/15). Prematurity was the only statistically significant risk factor; 83% (5/6) of premature infants died compared with 22% (2/9) of term babies (p < 0.05). Combining our series with the patients reported in the literature, there were a total of 50 premature infants and 62 term infants. Gastric perforation occurred on postnatal days 2–7 and presented with nonspecific manifestations. The mortality was significantly higher in premature than in term infants (31/50, 62% vs. 16/62, 26%; p < 0.001). A trend towards higher mortality in infants with lower birth weights was observed (> 2500 g, 28%; 1501–2500 g, 52%; 1000–1500 g, 60%; < 1000 g, 100%). Infants with birth weights < 2500 g had a significantly higher mortality than infants with birth weights > 2500 g (32/58, 55% vs. 15/54, 28%; p < 0.05).

Conclusion

Neonatal gastric perforation is associated with high mortality, particularly in premature infants. There is also a trend towards higher mortality in lowerbirth-weight infants.

Key Words:  gastric perforation , low-birth-weight , neonate

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