Neonatal gastric perforation in 26 full-term infants: a retrospective cohort study

Abstract:

Objective To analyze the clinical features of neonatal gastric perforation（NGP）in full-term infants，to reduce the occurrence of clinical adverse outcomes.Methods Full-term infants diagnosed with gastric perforation in Children’s Hospital of Chongqing Medical University from January 2009 to October 2020 were included in the study. The data of the infants including clinical manifestations，treatment options and short-term outcomes during three months after discharge from hospital were collected，and the clinical characteristics were retrospectively investigated.Results A total of 26 full-term infants diagnosed with gastric perforation were included in the study. The rate of male was significantly higher than that of female among these cases（88.5% vs. 11. 5%）. The median age at admission and onset were 94.5（48.0，135.0） h and 38.0（0.0，96.0）h. Among the accompanying clinical manifestations，abdominal distension（69.2%），vomiting（46.2%）and poor response（30.8%） were the main manifestations. The main positive pathogen in blood culture was in Enterococcus faecium（15.0%） and Staphylococcus haemolyticus（30.8%） was the first positive pathogen in peritoneal puncture fluid culture，while the negative rates of both the cultures were high（55.0% and 23.1%）. There were 25 cases（96.2%） who underwent abdominal plain film examination and 21 cases（84.0%） showed signs of pneumoperitoneum. Abdominal ultrasonography was performed in 9 cases（34.6%），and no one was found pneumoperitoneum signs but with mainly ascites signs（88.9%）. The most favorite site of gastric perforation was the fundus of the stomach（61.6%），with single site perforation（92.3%） as the main site. Eighteen cases（69.2%） underwent pathological examination，and the majority（66.7%） was hyperemia and hemorrhage associated with necrosis of gastric wall. All cases were treated by emergency surgery，mainly taking gastric perforation repair and abdominal drainage（53.9%）. Follow-up within 3 months after discharge showed that a total of 24 cases（92.3%） recovered well after surgery，and only 1 case（3.9%） died after discharge due to refusal of reoperation and abandonment of treatment.Conclusion NGP usually occurs in males and within 4 days after birth. Infants with performance for abdominal distention，vomiting and poor response should be timely examined by abdominal plain film to discover whether there are signs of pneumoperitoneum. If timely operation can be performed，short-term prognosis of NGP is good.