'Spontaneous' neonatal gastric perforation: Is it really spontaneous?

Background/Purpose: Most historical reports have described gastric perforat ion in the neonatal population as "spontaneous." More recently, several var iables, including prematurity and nasal ventilation, have been implicated a s contributing factors. The authors sought to analyze the etiology, course, and outcome of newborns with spontaneous gastric perforation from one inst itution over a 16-year period. Methods: The authors reviewed retrospectively the charts of all infants who underwent operation or had perforation of the stomach diagnosed in the new born period. Results: Among more than 84,000 live births, 7 newborns were identified wit h perforation of the stomach. Four had coexisting gastrointestinal lesions (2 necrotizing enterocolitis, 1 undiagnosed tracheoesphageal fistula, 1 mec onium plug), and 1 received nasal continuous positive airway pressure (CPAP ). In only 2 cases were no other gastrointestinal lesions or other presumed contributing factors (nasal CPAP) present, and thus, only 2 cases could be classified as "sponta neous." Mortality rate was 57%. Three of the patient s were premature, all of whom died. Conclusions: Whereas in the older literature, most cases of gastric perfora tion were considered spontaneous, and were full term, the authors' review o f 7 cases over a 16-year period leads us to question the cause as spontaneo us. The authors found that prematurity and concomitant gastrointestinal les ions were associated with gastric perforation in the neonate and that few c ases truly are spontaneous. The authors suggest that when gastric pelf orat ion occurs in neonates, a contributing cause should be sought. Copyright (C ) 2000 by W.B. Saunders Company.