Clinical Review of Spontaneous Neonatal Gastric Perforation

Hyunhee Kwon, Ju Yeon Lee, Jung-Man Namgung, D. Kim, S. Kim
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Abstract

Purpose: Spontaneous neonatal gastric perforation is a rare but fatal disease with unclear etiology. In this study, we reviewed its clinical manifestations, outcomes, and discussed the etiology and prognostic factors. Methods: There were 12 neonates with gastric perforation in our hospital from 1989 to 2015. Their medical records were reviewed retro-spectively including birth record, associated disease, site and size of perforation, type of surgical management, clinical outcome. Also, the prognostic factors were analyzed. Results: The median gestational age and birth weight was 32 weeks (range, 26-43 weeks; preterm birth rate, 66.7%) and 1,883 g (range, 470-4,400 g), respectively. Five patients had associated gastrointestinal anomalies including esophageal atresia and tracheoesophageal fistula (two patients), midgut volvulus, non-rotation and microcolon, and meconium plug syndrome. The median age at surgery was six days after birth (range, 2-13 days), and the median weight at surgery was 1,620 g (range, 510-3,240 g). Upper third part of stomach was the most frequently involved location of perforation. The size of perforation varied from pin point to involving the whole greater curvature. Primary repairs were done in seven cases, and in five cases, resections of necrotic portion were needed. Mortality rate was 33.3% (n=4), morbidity (re-operation) rate was 16.7% (n=2). The causes of death were sepsis (n=3), and heart failure from Ebstein anomaly (n=1). The median hospital stay was 92.5 days (range, 1-176 days). The factors mentioned as prognostic factors in previous studies showed no significant relations to the mortality and morbidity in our study. Conclusion: There were improvements of outcomes in patients with large size perforation. As previous studies, we assume these improvements were possible due to the improvements of critical care medicine. Given that rare incidence, a multi-center study can help us get a better understanding of this disease, and a better outcome.
新生儿自发性胃穿孔的临床回顾
目的:新生儿自发性胃穿孔是一种罕见但致命的疾病,病因不明。在本研究中,我们回顾了其临床表现,结果,并讨论了病因和预后因素。方法:1989 - 2015年我院收治12例胃穿孔新生儿。回顾性回顾患者的医疗记录,包括出生记录、相关疾病、穿孔部位和大小、手术方式、临床结果。并对影响预后的因素进行了分析。结果:中位胎龄和出生体重为32周(范围26-43周;早产率,66.7%)和1883克(范围,470- 4400克)。5例患者伴有食管闭锁、气管食管瘘(2例)、中肠扭转、不旋转、微结肠、胎便塞综合征等胃肠道异常。手术时的中位年龄为出生后6天(范围2-13天),手术时的中位体重为1,620 g(范围510-3,240 g)。胃的上三分之一是最常发生穿孔的部位。穿孔的大小从针尖到整个大曲率不等。7例进行了初步修复,5例需要切除坏死部分。死亡率为33.3% (n=4),发病率(再手术)为16.7% (n=2)。死亡原因为败血症(n=3)和Ebstein异常心力衰竭(n=1)。住院时间中位数为92.5天(范围1-176天)。以往研究中作为预后因素提及的因素在本研究中与死亡率和发病率无显著关系。结论:大口径穿孔患者的预后有明显改善。正如以前的研究,我们假设这些改进是可能的,由于危重病护理医学的改进。鉴于这种罕见的发病率,多中心研究可以帮助我们更好地了解这种疾病,并获得更好的结果。
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