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

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

Nomogram for assessment of risk factors for early mortality after laparotomy in neonatal gastric perforation from a tertiary care unit

“…Huang Y et.al additionally found (PH < 7.30) was measurably unique between non-survival and survival groups [10]. The comparable outcome was likewise found by Sakaria RP, in which 64% of the NGP had metabolic acidosis [11]. In our data we found the median PH of patients with gastric perforation was 7.2984, it was lower in the non-survival group (7.2161) than in the survival group (7.3236).…”

Differences in neonatal gastric tubes during insertion into a 3D model in relation to risk of potential perforation

“…Esophageal and gastric perforations are primarily diagnosed after respiratory failure with pneumothorax, septicemia and pleural effusion (nutrition) in the case of esophageal perforations or after acute abdominal deterioration with pneumoperitoneum and ascites (nutrition) in the case of gastric perforations. 12,13 Gastric perforations lead to increased mortality. 14 A rapid diagnosis and adequate therapy prevent further deterioration and reduce mortality in affected infants.…”

The Use of Broad-Spectrum Antibiotics Plus Metronidazole in Newborns with Gastric Perforation: Impact on Short-term Outcomes

“…[1,2] It accounts for 7 to 12% of all gastrointestinal perforations in the neonatal period. [3,4] Despite a signi cant reduction in mortality rates, from 100% in the 1980s to 16.7% in the 2010s, [1] mortality remains high in extremely low birth weight infants (ELBWIs, birth weight < 1,000 g). [3] Several adverse factors contribute to mortality, including leucopenia, peritonitis, and thrombocytopenia development within 48 hours of birth, hyponatremia (serum sodium < 130 mmol/L), metabolic acidosis (pH < 7.3), and sepsis.…”

“…[9] Treatment of NGP involves antibiotics therapy and surgical repair, including exploratory laparotomy and gastrorrhaphy. [4,10] Antibiotics have demonstrated effectiveness in both prophylaxis of gastrointestinal surgery and the treatment of abdominal infections. [11] For instance, ertapenem, with lower complication rates, is a safe and effective therapeutic option for treating diffuse peritonitis in pediatric patients, as are gentamicin plus metronidazole.…”

“…[1,4−6] In rare cases, NGP may also result from the use of medications such as nonsteroidal anti-in ammatory drugs (NSAIDs) and corticosteroids, or nasogastric tube insertion. [4] Clinical presentation usually occurs within the rst week of life and includes distension of the abdomen, vomiting and lethargy/sepsis. Radiological features such as pneumoperitoneum are also indicative of NGP.…”