S1874 Neonatal Gastric Perforations: an Updated Review of the English-Language Literature from 2008 Through 2022

Introduction: Neonatal gastric perforation (NGP) is rare and the current body of knowledge on NGP is based on case series reports and reviews of these case reports, both of which are limited by small sample sizes. Further, the reviews contain very old case series, the outcomes of which may not reflect the advances in neonatal care in the last 2 decades. The objective of this review was to characterize the epidemiology, hospital course, and outcomes of NGP in a contemporary cohort over the past 15 years from 2008 through 2022. Methods: We retrospectively reviewed all published articles with ≥3 neonates with gastric perforations. We searched PubMed and Google Scholar using the keywords ‘’neonates’’ and ‘’gastric perforation’’. We extracted data from individual articles onto an Excel spreadsheet for additional analysis. The outcomes of interest were the perinatal characteristics, the timing of the perforation, co-morbidities, surgical interventions, and mortality. Due to the heterogeneous nature and differences in reporting, for each outcome of interest, the analysis was limited to the case series’ that had complete information on that particular outcome of interest. Descriptive statistics were used to summarize the data. Results: A total of 531 patients from 28 case series were included in the analysis. The majority were male (279/413, 67.8%) and preterm (289/471, 61.4%). The mean gestational age and birthweight were 33.7 ± 2.4 weeks and 2149.0 ± 445.3 g, respectively (Figure 1). Perforations occurred at a median age of 3.8 days. Prior to the perforation, 32.7% (73/223) had feeding tubes inserted and respiratory support occurred in 23.9% (64/268). Congenital gastrointestinal (GI) anomalies were present in 16.5% (67/407), of which malrotation was the commonest (28/67; 41.8%). Where the site of the perforation was specified, the majority occurred on the greater curvature (197/531; 37.1%). Primary repair was the most common (328/413, 79.4%) procedure performed. While the overall mortality was 32.1% (169/527), the mortality rate in industrialized countries was significantly lower than in non-industrialized countries (13.3 vs 35.7%, P = 0.001). The leading cause of death was sepsis (46/169; 27.2%) (Table 1). Conclusion: NGPs occur largely in preterm newborns, some of whom have other GI anomalies. The mortality rate is high, and sepsis is the leading cause of death. Thus, the occurrence of NGP should prompt the evaluation for other GI anomalies and increased attention to antisepsis can potentially reduce mortality.Figure 1.: Mean gestational age and birthweight. Table 1. - Characteristics of gastric perforations, surgical procedures, and outcomes of 531 neonates with neonatal gastric perforations from 28 case series reports in the English-Language literature from 2008 through 2022 n/N (%)β Site of perforationΩ Greater curvature 197/531 (37.1) Lesser curvature 197/531 (9.8) Anterior wall 48/531 (9.0) Posterior wall 32/531 (6.0) Unspecified/others 212/531 (39.9) Surgical procedures Unspecified 118/531 (22.2) Specified procedures 413/531 (78.8) Primary repair 328/431 (79.4) Primary repair with gastrostomy 40/413 (9.7) Partial gastrectomy 32/413 (7.7) Peritoneal drain only 4/413 (1.0) Others 9/413 (2.1) Mortality 169/527 (32.1) Industrialized countries 13/90 (13.3) Non-industrialized countries 156/437 (35.7) Cause of death Sepsis 46/169 (27.2) Multi-organ failure 10/169 (5.9) Pneumonia 2/169 (1.2) Others 16/169 (9.5) Unspecified 95/169 (56.2) βn (numerator) is the number with the specified characteristic; N (denominator) is the total number of infants with NGPs for which the specified characteristic was reported; Numbers in parentheses represent proportions.ΩSum of proportions exceed 100% because some had multiple perforations involving different sites or some of the perforations involved multiple regions