فهرست نشریات علمی دسترسی آزاد ایران

Introduction: Neonatal gastric perforation(NGP) is a rare but life threatening condition affecting the neonates. The exact mechanism of NGP is poorly understood but its often associated with preterm birth, hypoxia and sepsis. But spontaneous cases of NGP are unpredictable resulting in complicated diagnosis and management. In the present study we elucidate the risk factors, clinical findings,management strategies and the outcomes in patients restrospectively over a period of 10 years Materials and methods: A retrospective study of all the patients presenting with NGP was conducted over a period 10 years from march 2013 to march 2023 at our institution and a complete data of 87 of these patients were accrued and analysed. A compete demographic data, preoperative chateristics, clinical presentation,intraoperative characteristics, clinical outcomes and postoperative complications were recorded and analysed. Besides comparison was made between the surviving and non-surviving neonates to elucidate the risk factors in morality. Results : A total of 87 cases  of neonatal gastric perforation were included in our study. The majority of NGP patients were male (73.56%, M:F = 2.78:1), preterm (59.77%), and of low birth weight (51.72%). Common clinical presentations included abdominal distension (88.5%), vomiting (71.26%), and respiratory distress (57.47%). Key laboratory findings included mean hemoglobin of 15.84 ± 1.2 g/dl, leucocyte count of 18.71 ± 4.12 × 10³/µl, and serum pH of 7.26 ± 0.14. Radiological findings prominently showed the "football sign" (93.1%) and gas under the diaphragm (74.71%). Gastric perforations predominantly involved the greater curvature (36.78%) and were mostly single (82.75%) and small (<5 cm, 65%). Spontaneous perforation was the most common cause (65%), followed by trauma (21%) and necrotizing enterocolitis (NEC, 10%). Surgical management included gastric repair with peritoneal lavage and venting gastrostomy. Postoperative complications included respiratory issues (74 cases), sepsis (54 cases), and wound infections (25 cases). Neonatal mortality was 42.53%, with significant predictors including male sex(p value=0.004), prematurity(p value=0.002, low birth weight(p<0.001), thrombocytopenia(p value<0.001), high CRP levels(p value<0.001) acidosis(p value<0.001), and elevated lactate levels(p<0.001).   Conclusion:   Neonatal gastric perforation presents a substantial risk of mortality, particularly among male, preterm, and low birth weight infants. Early recognition of clinical signs, prompt surgical intervention, and vigilant postoperative care are crucial to improving survival rates. Monitoring laboratory indicators such as platelet counts, CRP levels, pH, and lactate levels can aid in assessing prognosis and guiding treatment strategies.