Neonatal gastric perforation: a systematic review and meta-analysis of clinical characteristics, risk factors, surgical management and outcomes.
Fayaz Ahmad Najar, Mohamad Altaf Ganayee, Ubayer Nabi
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In 30 seconds
This systematic review and meta-analysis examined clinical features, risk factors, surgical management and outcomes of neonatal gastric perforation using observational studies of neonates aged 28 days or younger. Twenty studies comprising 410 neonates were included. Prematurity and low birth weight were common, and abdominal distension was the most frequent presenting feature. Primary repair was used in 78.4% of operated neonates. Pooled in-hospital mortality was 28.6% (95% CI 22.0-36.3%); sepsis at presentation and surgery delayed beyond 24 h were the strongest reported predictors of death.
Key findings
- Across 20 studies and 410 neonates, pooled in-hospital mortality was 28.6% (95% CI 22.0-36.3%).
- Prematurity occurred in 58.3% and low birth weight in 63.5% of cases.
- Abdominal distension (90.5%) and pneumoperitoneum (80.9%) were the commonest reported features.
- Sepsis at presentation (OR 4.10) and surgery delayed beyond 24 h (OR 3.55) were the strongest predictors of death.
Why it matters
The review describes a substantial mortality burden in neonatal gastric perforation and identifies clinical features and potentially time-sensitive factors associated with death. These pooled findings can help frame recognition and risk assessment, while the observational evidence does not establish that any particular intervention will improve survival.
What to keep in mind
The evidence came from observational studies, so reported predictors are associations and cannot establish causation.