Prognostic factors of preterm neonates with gastrointestinal perforation: a retrospective cohort study from a tertiary neonatal center's 13-year experience in China.

Abstract

This study aimed to describe the clinical features of preterm neonatal gastrointestinal perforation (GIP) and evaluate the prognostic factors. This retrospective study comprised 191 preterm neonates diagnosed with GIP, who were categorized into survival and non-survival groups. Clinical and demographic data, laboratory and imaging features, and outcomes were retrospectively collected. Univariate and multivariate logistic regression analyses were conducted to identify independent prognostic factors. The median gestational age was 34 weeks, and the median birth weight was 2000 g. The overall mortality in the study cohort was 25.1%. The median age of onset of gastric perforation was 3 days (range: 1-11 days), while it was 7.5 days (range: 1-30 days) for intestinal perforation. Abdominal distension was the most common symptom in 184/191 (96.3%) subjects. Ninety-one (47.6%) neonates were diagnosed with a complication of necrotizing enterocolitis. Finally, three independent prognostic factors were identified: severe acidosis (OR: 7.604; 95% CI: 1.424-51.910; P = .025), shock (5.131; 2.419-11.266; P < .001), and coagulopathy (3.269; 1.511-7.431; P = .003). Severe acidosis, shock, and coagulopathy are independent prognostic factors in preterm neonates with GIP. Indexes of systemic status evaluation should be given more attention when treating GIP in premature infants.