Abstract
Neonatal gastric perforation (NGP) is a rare entity. Our aim was to report our experience and review the recent literature to characterize NGP, describe associated factors, and define prognostic factors. Retrospective review of all consecutive patients with NGP treated between June 2009 and December 2017 in a third level pediatric hospital. In addition, a systematic review of Medline and Scopus database was performed using a defined strategy. All articles referring to NGP published between 2005 and 2017 were retrieved. Variables considered: prematurity (<37 weeks gestation), birth weight (BW), Apgar score, prenatal complications, age at diagnosis, bag ventilation, pathogenetic events, site of perforation, treatment of perforation, sepsis, and outcome. Mann-Whitney or Fisher's test were used as appropriate. Results are median (range) or prevalence. Between 2009 and 2016 we treated 8 consecutive patients for NGP and 199 further cases were retrieved from the systematic review (total of 207 patients). Overall survival was 73%. Most frequently reported pathogenesis: iatrogenic (20 patients), hypoxic/ischemic or infection stress (13 patients), duodenal/jejunal obstruction (11 patients), drugs (11 patients), esophageal atresia (10 patients). 60% patients had only primary repair of the perforation as gastric surgery. Sepsis developed in 56 patients (34%). Although the pathogenesis of NGP is pleomorphic, prematurity and low BWs are frequent in these patients. Reviewing our experience and the available literature, none of the variables considered, but sepsis was associated with mortality.
Highlights
Neonatal gastric perforation (NGP) is an uncommon life-threatening entity in newborns, potentially challenging for the treating physicians
The number of neonatal gastrointestinal perforation is in progressive rise, may be due to the increasing number of very-low birth weight and premature infants, while the mortality related to NGP has dropped by about tenfold, Neonatal Gastric Perforation probably due to the improvement of the quality of the neonatal intensive care [3]
The mothers of all preterm patients received steroids, weeks before delivery in two, and shortly before delivery in the third
Summary
Neonatal gastric perforation (NGP) is an uncommon life-threatening entity in newborns, potentially challenging for the treating physicians. The reported incidence is 1:5,000 live births and NGP represents 7% of all gastrointestinal perforations in the newborn [1]. The first reported case of spontaneous NGP was in 1825 by Siebold [2]. The number of neonatal gastrointestinal perforation (including NGP) is in progressive rise, may be due to the increasing number of very-low birth weight and premature infants, while the mortality related to NGP has dropped by about tenfold, Neonatal Gastric Perforation probably due to the improvement of the quality of the neonatal intensive care [3]. Despite the increase in prevalence, NGP remains a relatively rare condition, with mainly case reports or small series reported. Several aspects of NGP are still unclear, ranging from the etiology to its best treatment
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