Article Text

REEVALUATION OF NEONATAL GASTRIC PERFORATION: FROM A NEONATOLOGIST’S POINT OF VIEW
  1. MC Chiang1,
  2. R Lien1,
  3. RH Fu1,
  4. PH Yang1
  1. 1Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine Chang Gung University, Taoyuan, Taiwan-R.O.C

Abstract

Objective Neonatal gastric perforation is a rare and serious problem. The aim of this study is to highlight the vital clinical features and to identify the prognostic factors of such cases.

Methods Medical charts were reviewed retrospectively from January 1997 through December 2007. Neonates with the diagnosis of gastric perforation were enrolled.

Results Twelve patients were identified. Male to female ratio was 9:3. Four of them (33%) were preterm infants. The mortality rate was 33% (4/12). Median age of onset was 3 days old (range 1–14 days). The most common presenting S/S was abdominal distension, followed by respiratory distress and vomiting. Except for one patient whose gastric perforation was diagnosed during surgical repair for gastroschisis, all others were found to have pneumoperitoneum at admission. 75% and 50% of patients had peritonitis and sepsis, respectively. The concomitant GI anomaly or disorders included NEC with/without bowel perforation (5), intestinal malrotation (2), duodenal web (1), hiatal hernia (1), and gastroschisis (1), which led to the need for a second operation during hospitalization in 5 patients. Six patients had leucopenia at admission and seven patients developed thrombocytopenia in the following 48 hours. All the mortality patients had leucopenia at admission and thrombocytopenia in the following 48 hours.

Conclusions Neonatal gastric perforation concomitant with GI anomaly or infectious disease is not uncommon. It is mandatory to inspect the small intestine carefully whenever repairing a gastric perforation. Patients with leucopenia and developing thrombocytopenia within 48 hours are at risk for poor outcome.

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