Is continue positive airway pressure causing neonatal gastric perforation?

Abstract

Objectives: Neonatal gastric perforation (NGP) is a rare surgical emergency that causes significant morbidity and mortality and costs thousands of health dollars. We aim to assess risk factors, outcomes, and preventive measures for NGP. Material and Methods: We retrospectively reviewed clinical notes, charts and operative findings for all NGPs from 2000 to 2022 in the Neonatal Intensive Care Unit. The demography, gestational age at birth, age of perforation, potential risk factors, intraoperative findings, incision site and outcome were analysed. Study ethically approved. Results: A total of 8 NGPs were sampled. The gestational age ranged from 24–35 (mean of 28.4) weeks. The birth weight was 700–3030 g (1402 g). Seven had respiratory distress and received respiratory support. Six were on continuous positive airway pressure (CPAP), and one was intubated. One baby was on room air and had a <1 cm perforation in the posterior gastric wall by nasogastric tube (NGT). The intubated baby had perforation due to necrotising enterocolitis (NEC) involving the posterior gastric wall (size – 1.5 cm). The remaining six babies had CPAP-related NGP (Estimated P < 0.05) found at the greater curvature (Size >2 cm). Six had left upper quadrant surgical incisions, and two had right-sided incisions requiring an extension. The NGP mortality rate is 1 out of 8 (12.5%). Conclusion: CPAP is the leading cause of NGP in low body weight and premature babies. NGT and NEC also cause perforation. Clinical assessment is key to appropriate surgical incisions and minimize the mortality rate.