Multivariate prognostic analyses of neonatal gastric perforation
Objective To explore the prognostic factors of neonatal gastric perforation(GP).Methods From January 2010 to January 2022,the relevant clinical data were retrospectively reviewed for 115 hospitalized GP neonates.There were 76 boys and 39 girls.And they were full-term(n=41)and premature(n=74).Average weight was 2.37(1.15-3.85)kg and average age of onset was 3.25(1.23-7.55)day.And 88 cases were aged 1-3 days.There were gastric wall muscle layer defect(n=109)and gastric wall inflammation,necrosis and perforation(n=6).They were assigned into two groups of survival(n=85)and death(n=30).The clinical,surgical and pathological factors potentially affecting the prognosis of neonatal GP were compared.Survival group was followed up to understand their survival status.Results No statistically significant differences(P＞0.05)existed between survival and death groups in terms of gender,whether or not premature birth occurred,other gastrointestinal abnormalities were present,there was a defect in gastric wall muscle layer,coagulation dysfunction,electrolyte disorder,preoperative calcitonin value,preoperative serum albumin value,preoperative erythrocyte and serum albumin values,maximal perforation diameter,operative duration or intraoperative volume of blood loss.Preoperative lactate value,statistically significant differences(P＜0.05)in whether or not there was a low birth weight and time from an onset of clinical symptoms to medical consultation;The independent factor affecting the prognosis of neonatal GP was identified as time from an onset of clinical symptoms to presentation(P＜0.05)by incorporating preoperative lactate value,low birth weight and an onset of clinical symptoms to presentation into multivariate Logistic regression analysis.The follow-up results indicated that 2 cases in survival group developed postoperative adhesive intestinal obstruction.One child underwent intestinal adhesiolysis surgery while another was relieved after conservative measures.Mortality rate was 26.1％(30/115)in death group.All children attained normal growth and development.Nutritional status was decent.Conclusion Time from onset to treatment is the most important prognostic factor affecting neonatal GP.Thus timely treatment remains a key for patient survival.
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