Neonatal Gastric Perforation

Inouye, William Y.; Evans, G. A.

doi:10.1001/archsurg.1964.01310210145024

Cited by 33 publications

(10 citation statements)

References 38 publications

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“…Incoordination of gastroesophageal motility, typical of pre-mature neonates, is considered as a possible mechanism causing increased intragastric pressure, leading to gastric rupture ( 8 ). When gastric rupture occurs solely from excessive expansion, the rupture is usually along the curvature minor ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

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

Huang

Peng

et al. 2021

Front. Pediatr.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Huang

Peng

et al. 2021

Front. Pediatr.

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“…Incoordination and immaturity of esophagogastric motility, typical of premature neonates, are suggested as a possible mechanism causing increased intragastric pressure, thereby predisposing to gastric rupture ( 59 ). However, when gastric rupture occurs solely from overdistension, the rupture is usually along the lesser curvature ( 60 ). In present series, and collected patients from the systematic review of the literature, the perforation was most commonly in the greater curvature, suggesting that also other factors may play a role in gastric rupture in these patients.…”

Section: Discussionmentioning

confidence: 99%

Pathogenetic and Prognostic Factors for Neonatal Gastric Perforation: Personal Experience and Systematic Review of the Literature

et al. 2018

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IntroductionNeonatal 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.Materials and methodsRetrospective 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.ResultsBetween 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%).ConclusionAlthough 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.

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“…In 1964, an article explained lesser curvature perforation was more common, if inciting factor was solely overdistension. 6 In contrast, use of orogastric tube and related trauma due to it might cause perforation on lesser curvature. 7 Traumatic gastric perforation might develop during the course of positive pressure ventilation following rigorous resuscitation attempt.…”

Section: Discussionmentioning

confidence: 99%

Neonatal gastric perforation: is prematurity the only cause?

et al. 2020

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Background: Neonatal Gastric Perforation (NGP) is a serious and life-threatening emergency and challenging in terms of diagnosis and management. The precise aetiology remains obscure in most cases. Published literatures provide theories of gastric ischemia, aerophagia & trauma with or without definite inciting pathology. Owing to its high mortality rate, it requires early detection & urgent intervention to bring out the newborn from this catastrophe.Methods: We report five cases of neonatal gastric perforation over period of 2013-2019 admitted to a tertiary paediatric surgical care hospital managed by early detection, prompt resuscitation along with exploration and primary repair of the defect in gastric wall.Results: The common feature in these five cases were preterm age, low birth weight, hypoxic event and marked abdominal distension causing respiratory distress. Features of imminent or complete septic shock were present in all cases. Perforation was found on anterior wall along greater curvature of stomach in all babies. Four babies out of five survived except in one case of jejunoileal Artesia that developed gastric perforation in post operative period.Conclusions: Neonatal gastric perforation should be suspected in cases of rapidly deteriorating premature newborn with gross abdominal distension and pneumoperitoneum. In our opinion, etiology of NGP is multifactorial. Prematurity, low APGAR score with vigorous resuscitation could be a clue for early diagnosis. Good outcome in our series was due to early diagnosis and prompt pre and postoperative measures. Additionally, sterile gastric content in peritoneum might lead to survival from this catastrophic event.

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Neonatal Gastric Perforation

Cited by 33 publications

References 38 publications

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

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

Pathogenetic and Prognostic Factors for Neonatal Gastric Perforation: Personal Experience and Systematic Review of the Literature

Neonatal gastric perforation: is prematurity the only cause?

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