Neonatal Gastric Perforation

Abstract

Background: Gastric perforation in neonates is a catastrophe associated with high morbidity. Most are due to underlying primary pathology. Objectives: To review the management of gastric perforation in neonates in Kwa Zulu -Natal, South Africa. Design: Retrospective study of consecutive complete data sets of neonates presenting with gastric perforation. Setting: Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa. Subjects: Eight neonates treated for gastric perforation between January 1998 and April 2003. Main outcome measures: Morbidity and mortality. Results: There was an equal number of males and females. Median birth weight was 2.0 kg with a range of 1.4 to 3.2 kg. Five of the eight neonates were premature. Primary pathologies were associated with perforation in seven of the eight neonates. Prematurity, low birth weight and pneumonia were contributing factors to the poor outcome. Sepsis was a complication in seven of the eight neonates leading to their death (88% mortality). Conclusion: Active perinatal management, early treatment of primary pathologies, and protection of the stomach against distension in neonates at risk are essential in the management of neonatal gastric perforation.