Abstract
Objective Neonatal gastric perforations (NGPs) are rare and account for 7 to 12% of all gastrointestinal
perforations in the neonatal period. The etiology and prognostic factors associated
with NGP remain unclear. The aim of this study is to review the cases of NGP in our
neonatal intensive care unit (NICU) in the past 14 years and describe the risk factors,
clinical presentation, and outcomes associated with it.
Study Design A retrospective chart review of neonates with gastric perforation admitted to the
NICU between June 2006 and December 2020 was performed. Data regarding their antenatal
and neonatal characteristics, laboratory and radiological results, intra-operative
findings, hospital course, and outcomes were recorded.
Results We identified 350 patients with gastrointestinal perforation at our center during
the study period of which 14 (4%; nine males and five females) patients were diagnosed
with NGP during surgery. A total of 71% neonates were born preterm (range: 24–39 weeks,
median: 34 weeks). Two neonates (14%) were SGA. Only one neonate received cardiopulmonary
resuscitation at birth. In all neonates, except two, perforation occurred within the
first 10 days of life (median: 4 days, range: 1–22 days). In total, 79% infants received
feeds prior to perforation. Ten neonates had a feeding tube, and one neonate had a
gastrostomy tube placed prior to perforation. Abdominal distension and pneumoperitoneum
were present in all neonates. Majority of the babies had metabolic acidosis (64%)
and elevated C-reactive protein (79%). Most (86%) neonates received surgical intervention
within 12 hours. Overall survival in our study was 93%.
Conclusion NGP is a rare entity seen mostly in preterm infants within the first 10 days of life.
Clinical presentation is similar to perforation anywhere along the gastrointestinal
tract and definite diagnosis requires exploratory laparotomy. With prompt recognition
and surgical intervention, the overall mortality related to neonatal gastric perforation
is low.
Key Points
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Neonatal gastric perforation is a rare but life threatening entity with unclear etiology.
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Prematurity is associated with an increased incidence of gastric perforations in the
neonate.
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Laparotomy is required for definitive diagnosis and treatment.
Keywords
neonate - pneumoperitoneum - lactobezoar - gastric perforation
