Neonatal gastric perforation: a systematic review and meta-analysis of clinical characteristics, risk factors, surgical management and outcomes
In brief
Neonatal stomach perforation carries 29% mortality; sepsis and surgical delay raise risk
A review of 410 newborns found that nearly 3 in 10 died in hospital; sepsis at presentation and surgery delayed beyond 24 hours were the strongest predictors of death. Most affected infants were premature or low birth weight, and most operated infants had primary repair. The findings point to urgent recognition and timely care, but observational data cannot establish that faster surgery improves survival.
- Journal
- Pediatric surgery international (Q2)
- Published
- 20 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Fayaz Ahmad Najar, Mohamad Altaf Ganayee, Ubayer Nabi
- PMID
- 42900289
- DOI
- 10.1007/s00383-026-06692-0
Why clinicians should know about it
- Picked for Pediatric Surgery (top studies of the week, 25 October 2026): Neonatal surgical emergency; management and mortality evidence
Abstract
BACKGROUND: Neonatal gastric perforation (NGP) is a rare but life-threatening surgical emergency of the newborn. We systematically reviewed its clinical characteristics, risk factors, surgical management and outcomes. METHODS: Five databases were searched from inception to 31 December 2025 for observational studies reporting at least five neonates (≤ 28 days) with confirmed gastric perforation. Two reviewers independently screened records, extracted data and appraised quality. Proportions were pooled using random-effects models; predictors of mortality were summarised as odds ratios (OR). The review followed PRISMA 2020 and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS: Twenty studies (410 neonates) were included. Pooled prevalences were prematurity 58.3%, low birth weight 63.5% and male sex 59.0%; abdominal distension (90.5%) and pneumoperitoneum (80.9%) were the commonest features. Primary repair was performed in 78.4% of operated neonates. Pooled in-hospital mortality was 28.6% (95% CI 22.0-36.3%). Sepsis at presentation (OR 4.10) and delay to surgery beyond 24 h (OR 3.55) were the strongest predictors of death. CONCLUSIONS: NGP mainly affects premature, low-birth-weight neonates, and still carries approximately 28% mortality. Early recognition, prompt treatment of sepsis and timely surgery offer the clearest route to improved survival. PROSPERO ID: CRD420261436438.
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.