title: Prognostic factors and concomitant anomalies in neonatal gastric perforation.
abstract: OBJECTIVE
  Neonatal gastric perforation is a rare and serious issue. This study aimed to highlight the vital clinical features and identify prognostic factors in such cases.
  Medical charts from January 1997 through December 2008 were reviewed retrospectively. Neonates with a diagnosis of gastric perforation were included.
  
  
  RESULTS
  Thirteen patients were identified with a male:female ratio of 9:4. Five (38%) were preterm infants. The mortality rate was 30% (4/13), and the median age of onset was 3 days (range: 1-14 days). The most common presenting sign was abdominal distension, followed by respiratory distress and vomiting. Except for one patient in whom gastric perforation was diagnosed during surgical repair for gastroschisis, all patients had pneumoperitoneum on admission; 70% and 46% of patients had peritonitis and sepsis, respectively. Concomitant gastrointestinal (GI) tract anomalies or disorders included ischemic bowel/necrotizing enterocolitis (5 patients), intestinal malrotation (2), duodenal web (1), hiatal hernia (1), and gastroschisis (1), which necessitated secondary operations during hospitalization in 5 patients. Seven patients had leukopenia on admission, and 9 developed thrombocytopenia in the following 48 h. All patients who died presented with leukopenia on admission and thrombocytopenia in the following 48 h, yielding sensitivity and specificity rates of 100% and 67%, respectively.
  
  
  CONCLUSIONS
  Neonatal gastric perforation is often concomitant with GI anomalies or inflammatory/infectious disease. Patients who were outborn and those with leucopenia, peritonitis, and thrombocytopenia development within 48 h were at risk for poor outcome.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan; USC Division of Neonatal Medicine, Department of Pediatrics, Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Department of Pediatrics, The LAC/USC Medical Center, Keck School of Medicine, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033, USA; Department of Pediatrics, Division of Neonatology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
authors.forename: Chang-Yo
authors.initials: CY
authors.lastname: Yang
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan.
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan.
authors.forename: Ren-Huei
authors.initials: RH
authors.lastname: Fu
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan.
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan.
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan.
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Lai
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
authors.forename: Parviz
authors.initials: P
authors.lastname: Minoo
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305 Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: newborntw@gmail.com.
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chiang
mesh_terms: D004065:Digestive System Abnormalities / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries*; D013272:Stomach Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery
keywords: Gastric perforation; etiology; gastrointestinal anomalies; neonate; outcome; thrombocytopenia