The clinical characteristics and prognostic factors of neonatal gastric perforation and rupture: a multicenter retrospective study in Japan
In brief
Tracheoesophageal fistula raises death risk about 50-fold in neonatal gastric perforation
In a Japanese multicenter review of 37 newborns with gastric perforation, overall mortality was 38%, and the presence of tracheoesophageal fistula increased the odds of death roughly 50 times. Among infants without fistula, older age at surgery and larger perforation size were linked to higher mortality, underscoring the need for rapid diagnosis and early repair.
- Journal
- Pediatric surgery international (Q2)
- Published
- 6 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Toshio Harumatsu, Koshiro Sugita, Ayano Hidaka, Tsubasa Goshima, Shohei Yoshimura, Daisuke Masui, et al.
- PMID
- 42701961
- DOI
- 10.1007/s00383-026-06616-y
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 7 September 2026): Multicenter retrospective study of neonatal gastric perforation outcomes
Abstract
PURPOSE: Neonatal gastric perforation is a life-threatening surgical emergency with high mortality rates. The confounding effect of tracheoesophageal fistula (TEF) on prognostic analyses remains inadequately addressed. This study aimed to identify the prognostic factors for in-hospital mortality using a multicenter analysis. METHODS: We conducted a retrospective study at six tertiary pediatric surgery centers in Japan, including all neonates who underwent surgical treatment for either gastric perforation or rupture between 1994 and 2025. Logistic regression and sensitivity analyses, excluding TEF cases, were performed. RESULTS: Thirty-seven patients were identified, with a median birth weight of 1202 g, of whom 56.8% had a very low birth weight. The overall mortality rate was 37.8% (14/37). On a multivariate analysis, TEF was the strongest independent prognostic factor (OR 51.85, 95% CI 3.26-824.6; p = 0.005). In the sensitivity analysis excluding TEF cases (n = 28), the age at surgery (OR 1.23, 95% CI 1.01-1.51; p = 0.041) and the perforation length (OR 1.09, 95% CI 1.00-1.18; p = 0.043) were significant predictors of mortality. CONCLUSION: TEF is the strongest prognostic factor for neonatal gastric perforation. Excluding TEF confounding factors revealed the prognostic importance of the age at surgery and the perforation size, highlighting the value of early diagnosis and management.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.