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

Abstract

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.

Gastric perforation resulting into pneumoperitoneum in a neonate: a case report

“…Others causes include meconium gastritis, Meckel’s diverticulum and intestinal malrotation [ 1 , 2 ]. Idiopathic cause includes preterm neonates due to the lack of gastric maturity and protective factors, such as lack of C-KIT mast cells and intestinal pacemaker cells [ 6 ]. This can be augmented with other factors, such as stress, asphyxia and small for gestational age [ 1 , 4 , 9 ].…”

“…Nevertheless it is said that irrespective of the etiology, most neonatal gastric perforation occurs between 2 and 7 days of life [ 4 , 8 ]. The overall survival rate has improved overtime due to the advancement in the intensive care units although mortality rates have been reported ~70% [ 6 ].…”

“…Surgery remains the mainstay as the definitive management [ 9 ]. Gastrorrhaphy is the procedure of choice and rarely is gastrectomy to be performed [ 6 , 9 ]. In addition, underlying anatomical cause should be identified and corrected [ 2 , 6 ].…”

Neonatal gastric perforation: is prematurity the only cause?

“…Therefore, in a neonate with suspected NGP, signs of hypovolemic or septic shock must be actively checked, as timely treatment of this complication appeared to be the single most important factor influencing survival. 13 In very sick ,VLBW babies, bedside peritoneal drainage might be only intervention required followed by surgical exploration once the baby's condition stabilized. Persistence of pneumo-peritoneum on X-ray, deranged ABG analysis and features of peritonitis should mandate surgical exploration.…”

Gastrointestinal perforations in newborns with high mortality: A series of 18 cases

“…[1,2,4,9] Peritoneal drainage is a temporary measure to stabilize hemodynamically unstable newborns, especially premature and low birth weight babies. [10][11][12][13] In our series, peritoneal drainage was given in cases with significant abdominal distension and respiratory compromise. This surgical technique allowed us to stabilize 3 cases of perforated necrotizing enterocolitis; but it was temporary because due to the lack of adequate neonatal resuscitation, these children did not survive until their condition was completely cured.…”