Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature

Babayiğit, Arzu; Özaydın, Seyithan; Çetınkaya, Merih; Sander, Serdar

doi:10.1007/s00383-017-4205-1

Cited by 19 publications

(30 citation statements)

References 15 publications

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“…The systematic review of the literature allowed to identify 51 articles (Figure 1 ) describing 200 further cases of NGP ( 1 – 3 , 5 – 26 , 30 – 52 , 55 – 57 ). One patient was excluded from this study because managed conservatively and the perforation could not be confirmed, leaving 199 patients for the analysis (Table 1 ).…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…[ 1 2 ] Gastric perforations are also unique as they are less frequent, more life-threatening with higher mortality rates in preterms, especially in very low birth weight (LBW) infants. [ 3 4 ] Multiple causes have been described previously in literature, of which prematurity-related predispositions worsened by multiple contributing factors (such as hypoxia, sepsis, external trauma, and hypotension) seem to be the most pertinent. [ 1 2 3 4 5 6 ] Increased intragastric pressure due to various causes is the most important variable.…”

Section: Introductionmentioning

confidence: 99%

“…[ 3 4 ] Multiple causes have been described previously in literature, of which prematurity-related predispositions worsened by multiple contributing factors (such as hypoxia, sepsis, external trauma, and hypotension) seem to be the most pertinent. [ 1 2 3 4 5 6 ] Increased intragastric pressure due to various causes is the most important variable. [ 1 2 3 4 5 6 ] Usual site of perforation is at the greater curvature.…”

Section: Introductionmentioning

confidence: 99%

Neonatal gastric perforation: Our experience and important preoperative and intraoperative caveats to prognosticate and improve survival

Garge

Paliwal

2020

J Indian Assoc Pediatr Surg

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Aim: Neonatal gastric perforation (NGP) is a rare, perplexing, life-threatening entity affecting neonates. We share our experience of operating upon cases of NGP s and highlight important points observed which may aid in further improving care of neonates, diagnosed with this entity. Materials and Methods: A retrospective analysis of all consecutive patients with NGP operated by the author, at various centers between January 2015 and December 2018, was carried out. We analyzed different variables for these and reached logical conclusions. Results: Between January 2015 and December 2018, we treated ten patients with gastric perforation. All the neonates were preterm, except one. Mean birth weight in our series was 1745 g (range 1300–2400 g). Deterioration in activity, worsening of sepsis, metabolic acidosis, increased ventilator requirements, and abdominal distension were prominent clinical features identified in all patients. All patients subsequently had massive pneumoperitoneum before surgery. Six patients had perforation along the greater curvature, two had perforation at the posterior wall, and two had near total gastric necrosis. We had four mortalities out of ten patients operated. Conclusion: NGP is associated with high mortality, especially in premature and low birth weight neonates. Severity of contributing factors in a premature predisposed neonate determines the severity of gastric necrosis, which in turn is an important prognostic factor. Certain preoperative signs can be useful and can aid in initiating preventive measures to curtail severity of the pathology.

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“…Rates of mortality following gastric perforation vary widely with reported rates as low as 20%,7 to as high as 83% 8. Prolonged operative time, blood loss with the need for transfusion, as well as renal dysfunction increases the risk for failure of gastrointestinal anastomosis 9.…”

Section: Discussionmentioning

confidence: 99%

Gastric necrosis in a term infant treated with near-total gastrectomy and delayed reconstruction with a Hunt-Lawrence pouch

et al. 2019

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The creation of an intestinal pouch following total gastrectomy is exceedingly rare in infants. We present the case of a term infant who underwent a near-total gastrectomy on day 2 of life for diffuse gastric necrosis with perforation due to severe hypoxemia from an intrapartum nuchal cord. Gastrointestinal continuity was restored at 5 months of age with a Hunt-Lawrence pouch. The child is now 3 years old and has achieved a weight in the 47th percentile despite challenges with micronutrient deficiencies, reduced caloric intake and renal insufficiency requiring 8 months of intermittent haemodialysis.

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Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature

Abstract: Male gender, chorioamnionitis, early sepsis, asphyxia, hemodynamic PDA, persistent hypotension, ibuprofen and paracetamol usage, and orogastric catheter administration were the main risk factors for gastric perforations in VLBW infants.

Cited by 19 publications

References 15 publications

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

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

Neonatal gastric perforation: Our experience and important preoperative and intraoperative caveats to prognosticate and improve survival

Gastric necrosis in a term infant treated with near-total gastrectomy and delayed reconstruction with a Hunt-Lawrence pouch

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