Neonatal Gastric Perforation Research Articles

Neonatal Gastric Perforation: A Report of Two Cases

Abstract Gastric perforation in neonates is a rare and serious issue. The condition usually occurs within the first week of life. Due to the high fatality rate, early diagnosis and prompt surgical intervention are required. Here, we describe two newborns who underwent emergency laparotomies for gastric perforation at the ages of 5 and 10 days, respectively. The first case did have sepsis during the recovery time, but it was successfully managed. The second neonate had stature disruption and biliary peritonitis. She eventually developed multi-organ failure syndrome and succumbed on the fourth day after the second laparotomy.

Gastric perforation in neonates: Our experience

Background: Neonatal gastric perforation (NGP) is a life-threatening condition with a high mortality rate. It accounts for 7% of all gastrointestinal tract (GIT) perforations. The number of NGP cases has been increasing due to the rise in premature and low birth weight neonates. In this study, we present our experience with gastric perforation in neonates. Methods: This retrospective study analyzed all cases of gastric perforation in neonates that were treated at Loma Linda University Medical Center's Neonatal Intensive Care Unit (NICU) between the years 2000 and 2023. The study looked at several variables including patient demographics, birth weight, age at admission and surgery, comorbidities, use of non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, and mortality rate. Results: We treated 15 patients with neonatal gastric perforation (NGP) during the study tenure. The median age at admission was 2 days, with 67% admitted within that timeframe. Surgery occurred at a median age of 5.5 days, and the median birth weight was 2.075 kg, with 26.67% below 1 kg. Males comprised 67%, and 60% had patent ductus arteriosus. Steroids were given to 46.66%, and 30-day mortality was 26.67%, with higher rates among males. Idiopathic cases were common, with notable etiologies including ischemia, necrosis, and congenital anomalies. Primary surgical repair was the main modality, and perforations occurred at various locations. Two cases had necrotizing enterocolitis. Six patients had favorable outcomes, while others experienced mild to moderate complications. Conclusion: Our research supports the idea that males have a worse outcome in terms of both prevalence and survival rates in neonatal gastric perforation (NGP) patients. However, our findings did not confirm the notion that NGP mortality risk is higher in neonates with low birth weight. We also discovered that the median time between admission and surgery in our study group was 1.5 days, emphasizing the importance of early detection of NGP in neonates. Early diagnosis can lead to better decision-making regarding treatment options and surgical intervention.

Neonatal gastric perforation in Twins: Two distinct cases

Background: Neonatal gastric perforation (NGP) is an uncommon but fatal condition. The exact cause of NGP remains unclear, although some cases have been linked to medical interventions. NGP is rarely reported in twins. Case Presentation: Herein we report two cases of gastric perforation in twins. The first baby was one of the 34-week preterm twins that developed abdominal distension and respiratory distress on the third day of life. While the other baby was one of the 32-week preterm twins that too developed abdominal distension and respiratory distress. Both had gastric perforations that needed surgical repair. One baby died of sepsis while the other neonate had a stormy postoperative course, which was managed with meticulous monitoring and multidisciplinary management, and discharged in good clinical condition. Conclusion: Clinical cases demonstrate that successful management of NGP requires a multidisciplinary approach, including timely surgical intervention, meticulous postoperative care, and close monitoring of complications.

Successful management of neonatal gastric perforation in Tripura medical college and Dr. BRAM teaching hospital-a rare case report

Gastric perforation in the newborn is a rare surgical emergency in our practice area; nevertheless, since the earlier it is diagnosed, the better the prognosis, it is a possibility that we must be aware of. Perforation would be suspected in an infant with severe abdominal distension and diagnosis is confirmed with simple abdominal X-rays, including anteroposterior and lateral projections with horizontal ray, on which pneumoperitoneum will be shown. We report the case of a neonate diagnosed with gastric perforation at 72 hours of age who underwent a successful surgical intervention and was able to go home clinically healthy 14 days later.

Effect of early postoperative enteral nutrition on the short‐term prognosis in neonatal gastric perforation

AbstractThe aim of this retrospective study was to investigate the impact of early postoperative enteral nutrition on the short‐term prognosis of neonatal gastric perforation. The 63 neonates were divided into two groups based on enteral nutrition timing: the early enteral nutrition (EEN) group (≤15 days) and the late enteral nutrition (LEN) group (>15 days). The EEN group was additionally matched with the LEN1 group based on closely aligned gestational age (difference ≤6 days), birth weight (difference <250 g), and age of onset (<1 day). Data from the EEN, LEN, and LEN1 groups were compared and analyzed. No significant differences were observed among the groups in baseline characteristics such as gestational age, birth weight, age at hospital admission, cesarean section rate, and so on (p > 0.05). Furthermore, preoperative comorbidities, clinical symptoms, and examination results were not significantly different between the three groups (p > 0.05). However, the time required to achieve total enteral nutrition, the length of hospital stay, and fistula retention time were significantly less in the EEN group compared to the LEN groups (p < 0.05). The EEN group also exhibited a shorter gastrointestinal decompression time than the LEN1 group, but other major postoperative outcome measures were not significantly different. In conclusion, our study suggests that early postoperative enteral nutrition (≤15 days) could reduce the time to total enteral nutrition, length of hospital stay, and fistula retention time, without increasing adverse prognosis rates.

Neonatal gastric perforation in a premature newborn: a case report

Gastric perforation is a rare but highly lethal surgical problem in neonates, especially in preterm and low birth weight infants. The mechanisms of occurrence are still not fully understood. We present a case of successful surgical treatment of a two-day-old premature girl with a burdened history, born and operated on in a perinatal center. A child with a preliminary diagnosis of perforation of a hollow organ, established according to X-ray data, underwent preliminary peritoneal drainage at the first stages. The final diagnosis of gastric perforation was established intraoperatively. After the detection of extensive necrosis of the anterior wall of the stomach with perforation at the border with the pyloric region and a rupture along the greater curvature, suturing of the pinpoint perforation and rupture with plastic surgery of the anterior wall of the stomach with local tissues, gastro- and gastroenterostomy, and drainage of the abdominal cavity was performed. Given the concomitant prematurity, at the age of 1 month 19 days of life, the child was able to return home clinically healthy.

S1874 Neonatal Gastric Perforations: An Updated Review of the English-Language Literature from 2008 Through 2022

S1874 Neonatal Gastric Perforations: An Updated Review of the English-Language Literature from 2008 Through 2022

Visualization of Risk Factors and Predictive Models for Early Death of Neonatal Gastric Perforation.

A retrospective analysis was performed from May 2003 to October 2021 at our hospital. One hundred and eleven neonates diagnosed with gastric perforation were categorized into non-survivor and survivor groups based on prognosis. The mortality rate was 23.42%. Logistic regression was used to analyze the factors influencing the early neonatal death. The non-survivor groups showed more abdominal distension, vomiting, hypoxia, acidosis, hyperkalemia, and coagulation abnormalities. Serum potassium concentration (odds ratio [OR] 2.148, P = .043) was an independent risk factor; however, arterial partial pressure of oxygen (OR 0.977, P = .024), bicarbonate (OR 0.779, P = .023), and platelet count (OR 0.986, P = .014) had protective effects on neonatal death. Based on this, a visualized nomogram prediction model was constructed, patients who had a nomogram score of more than 163.787 was considered to have high risks of mortality, the area under the curve of this was up to 0.828 (95% confidence interval [0.733, 0.923]), the sensitivity was 80.0%, and the specificity was 76.9%.

Wound healing of gaster perforation with Human Dried Amniotic Membrane (H-DAM) as biomaterial patch viewing from the fibroblasts counts and collagen density

Link of Video Abstract: https://youtu.be/UldBMnzIelE Background: Gastric perforation in neonates is an emergency in neonatology with a mortality rate of up to 75%. Many studies have been carried out to improve tissue healing, including using various surgical techniques and materials, one of which is using H-DAM technology. Therefore, this study aims to evaluate the differences in the number of fibroblasts and collagen density in gastric perforation repair with H-DAM as a biomaterial patch compared to using an omental patch in New Zealand white rabbits. Methods: A true-experimental study was conducted among 30 samples of rabbits and none of them dropped out. The inclusion criteria for this study are New Zealand White Rabbit male sex, age 6-9 months with a weight of 2-3 kg, healthy and active. The Exclusion criteria for this study are rabbits not fasted for 12 hours. During the 12-hour fasting period, it behaved aggressively, attacked other rabbits, and found surgical site infection. Data were analyzed using SPSS version 25.0 for Windows. Results: From the examination results, there was a significant difference in gastric healing in terms of examining the number of fibroblasts with the Kruskal-Wallis test (p=0.000. The One-way ANOVA analysis found that the three data groups had no significant difference (p=0.234). Conclusion: There is an increase in the number of fibroblasts and collagen density in gastric perforation repair with H-DAM as a biological dressing compared to primary repair of gastric perforation using an omental patch in rabbit models so that H-DAM can be the repair technique of choice in gastric perforation in the rabbit.

Is continue positive airway pressure causing neonatal gastric perforation?

Objectives: Neonatal gastric perforation (NGP) is a rare surgical emergency that causes significant morbidity and mortality and costs thousands of health dollars. We aim to assess risk factors, outcomes, and preventive measures for NGP. Material and Methods: We retrospectively reviewed clinical notes, charts and operative findings for all NGPs from 2000 to 2022 in the Neonatal Intensive Care Unit. The demography, gestational age at birth, age of perforation, potential risk factors, intraoperative findings, incision site and outcome were analysed. Study ethically approved. Results: A total of 8 NGPs were sampled. The gestational age ranged from 24–35 (mean of 28.4) weeks. The birth weight was 700–3030 g (1402 g). Seven had respiratory distress and received respiratory support. Six were on continuous positive airway pressure (CPAP), and one was intubated. One baby was on room air and had a <1 cm perforation in the posterior gastric wall by nasogastric tube (NGT). The intubated baby had perforation due to necrotising enterocolitis (NEC) involving the posterior gastric wall (size – 1.5 cm). The remaining six babies had CPAP-related NGP (Estimated P < 0.05) found at the greater curvature (Size >2 cm). Six had left upper quadrant surgical incisions, and two had right-sided incisions requiring an extension. The NGP mortality rate is 1 out of 8 (12.5%). Conclusion: CPAP is the leading cause of NGP in low body weight and premature babies. NGT and NEC also cause perforation. Clinical assessment is key to appropriate surgical incisions and minimize the mortality rate.

Neonatal Gastric Perforation due to Barotrauma

Neonatal Gastric Perforation due to Barotrauma

Neonatal gastric perforation: Case report

Neonatal gastric perforation (NGP) is a life-threatening condition associated with high morbidity and mortality rates. Despite several proposed etiological theories, the causative principle is still unclear and controversial. A male neonate was born at 26 weeks 3 days gestation. The patient showed symptoms of acute respiratory failure and hypoxia and was admitted to the neonatal intensive care unit. On day of life (DOL) 2, a chest and abdominal radiography showed a large amount of free intraperitoneal air, for which exploratory laparotomy was performed. A small antimesenteric perforation in the distal ileum was found and repaired primarily. On DOL 7, a chest and abdominal radiography demonstrated recurrent pneumoperitoneum for which a repeat exploratory laparotomy was performed. The patient had global intestinal ischemia and a perforation in the anterior wall of the stomach, which was repaired. On DOL 12, a planned upper gastrointestinal water-soluble contrast study showed spillage of contrast into the anterior abdomen, for which the patient underwent a repeat exploratory laparotomy. We found a dehiscence of the prior gastric repair and closed it primarily. The remainder of the hospital course was uneventful and the patient reached full feedings on DOL 41. Premature neonates are at risk for gastric perforation. Gastric perforation should be in the differential diagnosis of a premature neonate who presents abdominal distension and pneumoperitoneum. Due to the fragility of the premature neonatal tissues, confirming the integrity of the gastric closure with a contrast study is recommended prior to initiating enteral feedings.

Perforación gástrica neonatal recurrente: Reporte de un caso inusual

Neonatal gastric perforation is a rare but potentially fatal pathology; its recurrence is even more infrequent, and there are few reports in the international literature. We present the case of a premature newborn (32 weeks) and low birth weight (1725g) who, on the first day of life, presented a surgically corrected gastric perforation and on the fourth postoperative day was re-operated with a presumed diagnosis of gastric raffia dehiscence, finding a new gastric perforation, which was surgically repaired. On both occasions, the surgical intervention was early. The subsequent evolution and outcome were favorable.

Transillumination in neonatal gastric perforation

Transillumination in neonatal gastric perforation

Diagnosis and management of neonatal gastric perforation: a narrative review

Diagnosis and management of neonatal gastric perforation: a narrative review

First case report of spontaneous perinatal gastric perforation in premature neonate with potter sequence and syndrome.

Introduction and importanceThe Potter sequence is defined as a series of congenital defects related to severe oligohydramnios, associated with polycystic kidney disease, bilateral renal agenesis, pulmonary hypoplasia, obstructive uropathy and premature rupture of membrane, which compromises the life of the neonate sometime after birth. Within the evidence published so far, which is very little, no perforation of the gastrointestinal tract has been reported as a complication of this condition.Case presentationMale neonate born preterm with prenatal diagnosis of pulmonary hypoplasia, polycystic renal dysplasia and severe oligohydramnios (Potter sequence), presented acute respiratory distress syndrome 10 min after birth, requiring mechanical ventilation and admission to the intensive care unit. During her stay in intensive care, he developed abdominal distension and presence of biliary content in the nasogastric tube. An abdominal X-ray was performed and showed signs of pneumoperitoneum, evidencing gastric perforation on exploratory laparotomy.Clinical discussionGastric perforation in neonates is a condition that causes high health costs, morbidity, high risk of mortality and disability, regardless of the cause. The management of gastric perforation in Potter syndrome, as well as any other complication, represents a challenge due to the prognosis of these patients. Renal failure and acute respiratory distress syndrome are disorders that compromise the function of various structures and organs such as the heart and brain.ConclusionGastric perforation is a possible complication of the Potter sequence or syndrome. In addition, there is no literature describing the benefits or disadvantages of specific surgical techniques in the resolution of perforation.

Neonatal Gastric Perforation: 14-Year Experience from a Tertiary Neonatal Intensive Care Unit.

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. 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. 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%. 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. · Neonatal gastric perforation is a rare but life threatening entity with unclear etiology.. · Prematurity is associated with an increased incidence of gastric perforations in the neonate.. · Laparotomy is required for definitive diagnosis and treatment..

Risk Factors for Mortality in Neonatal Gastric Perforation: A Retrospective Cohort Study.

Background: Neonatal gastric perforation is a rare but life-threatening issue. The aim of this study was to describe the clinical characteristics and prognosis of patients with neonatal gastric perforation and identify predictive factors for poor prognosis.Methods: This was a retrospective cohort study of patients with neonatal gastric perforation treated in a tertiary pediatric public hospital between April 2009 and October 2020. The enrolled patients were divided into survival and non-survival groups. Demographic information, clinical characteristics, laboratory and imaging features, and outcomes were collected from the electronic medical record. Univariate and multivariate logistic regression analyses were performed to obtain the independent factors associated with death risk. Additionally, we separated this population into two groups (pre-term and term groups) and explored the mortality predictors of these two groups, respectively.Results: A total of 101 patients with neonatal gastric perforation were included in this study. The overall survival rate was 70.3%. Seventy-one (70.3%) were pre-term neonates, and sixty-two (61.4%) were low-birth-weight neonates. The median age of onset was 3 days (range: 1–11 days). Abdominal distension [98 (97.0%) patients] was the most common symptom, followed by lethargy [78 (77.2%) patients], shortness of breath [60 (59.4%) patients] and vomiting [34 (33.7%) patients]. Three independent mortality risk factors were identified: shock (OR, 3.749; 95% CI, 1.247–11.269; p = 0.019), serum lactic acid > 2.5 mmol/L (5.346; 1.727–16.547; p = 0.004) and platelet count <150 × 109/L (3.510; 1.115–11.053; p = 0.032). There was a borderline significant association between sclerema neonatorum and total mortality (4.827; 0.889–26.220; p = 0.068). In pre-term infants, serum lactic acid > 2.5 mmol/L and platelet count <150 × 109/L remained independent risk factors for death. In term infants, the incidence of shock, coagulopathy, pH < 7.3, serum lactic acid > 2.5 mmol/L, and hyponatremia were statistically different between non-survival and survival groups.Conclusion: Shock, hyperlactatemia, and thrombocytopenia are independently associated with an increased risk of death in patients with neonatal gastric perforation. Identification of modifiable risk factors during the critical periods of life will contribute to the development of effective prevention and intervention strategies of neonatal gastric perforation.

Transillumination in neonatal gastric perforation.

Journal of Paediatrics and Child HealthVolume 57, Issue 5 p. 760-760 Images of the Month Transillumination in neonatal gastric perforation First published: 07 May 2021 https://doi.org/10.1111/jpc.2_15242Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume57, Issue5May 2021Pages 760-760 RelatedInformation

Transillumination in neonatal gastric perforation.

Transillumination in neonatal gastric perforation.