Identifying Risk Factors for Neonatal Gastric Perforation: A Scoping Review and Case Series in a Tertiary Center

Abstract

Aim

To identify preventable risk factors for neonatal gastric perforation (NGP) and assess clinical outcomes.

Methods

A scoping review of the existing literature was conducted using PRISMA guidelines from 1992 to 2022. A retrospective analysis of NGP cases at our institution between 1998 and 2022 was conducted and reported as a case series.

Results

A total of 48 case reports and 34 case series were included in our scoping review, consisting of 418 patients. Our review suggested that prematurity, low birth weight (<2.5 kg), singleton pregnancies, male gender, cesarean section delivery, and the presence of gastrointestinal anomalies are risk factors for NGPs. The overall mortality rate was around 40.1% from NGPs. A retrospective analysis of NGP (n = 11) in our institute was also conducted to identify other risk factors and clinical outcomes. Overall, the mortality rate was significantly lower at our institution (9.1%), as sepsis was treated aggressively with early surgical intervention. The mean gestational age was 31 ± 4.3 weeks, and the mean birth weight was 1.68 ± 0.8 kg. The mean age of presentation with gastric perforation was 4.2 ± 1.5 days after birth.

Conclusion

This is the largest scoping review for non-necrotizing enterocolitis-related NGP, supplemented by a case series from our institution. Based on this study, risk factors for NGP are low birth weight, prematurity, male gender, singleton pregnancy, cesarean section delivery, and gastrointestinal anomalies in neonates who require intragastric tube insertion and are on concomitant positive pressure ventilation. These neonates should be ventilated at lower pressures (starting inspiratory pressure at 20 cmH₂O and positive end-expiratory pressure of 5 cmH₂O) and gradually up-titrated. Close monitoring and vigilance would be recommended from day 3 to 5, as this is when most gastric perforations occur.