Risk Factors for Mortality in Neonatal Gastric Perforation: A Retrospective Cohort Study

Frontiers in Pediatrics

article

Yao Huang¹  Qi Lu¹  Nan Peng¹  Li Wang¹  Yan Song¹  Qin Zhong¹  Peng Yuan² 

[1] Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics;Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University

关键词: gastric perforation;    mortality;    cohort study;    thrombocytopenia;    hyperlactatemia;    shock;    neonate;   

DOI  :  10.3389/fped.2021.652139

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Neonatal gastric perforation is a rare but life-threatening issue. The aim of this study was to describe the clinical characteristics and prognosis of patients with neonatal gastric perforation and identify predictive factors for poor prognosis. Methods: This was a retrospective cohort study of patients with neonatal gastric perforation treated in a tertiary pediatric public hospital between April 2009 and October 2020. The enrolled patients were divided into survival and non-survival groups. Demographic information, clinical characteristics, laboratory and imaging features, and outcomes were collected from the electronic medical record. Univariate and multivariate logistic regression analyses were performed to obtain the independent factors associated with death risk. Additionally, we separated this population into two groups (pre-term and term groups) and explored the mortality predictors of these two groups, respectively. Results: A total of 101 patients with neonatal gastric perforation were included in this study. The overall survival rate was 70.3%. Seventy-one (70.3%) were pre-term neonates, and sixty-two (61.4%) were low-birth-weight neonates. The median age of onset was 3 days (range: 1–11 days). Abdominal distension [98 (97.0%) patients] was the most common symptom, followed by lethargy [78 (77.2%) patients], shortness of breath [60 (59.4%) patients] and vomiting [34 (33.7%) patients]. Three independent mortality risk factors were identified: shock (OR, 3.749; 95% CI, 1.247–11.269; p = 0.019), serum lactic acid > 2.5 mmol/L (5.346; 1.727–16.547; p = 0.004) and platelet count 2.5 mmol/L and platelet count 2.5 mmol/L, and hyponatremia were statistically different between non-survival and survival groups. Conclusion: Shock, hyperlactatemia, and thrombocytopenia are independently associated with an increased risk of death in patients with neonatal gastric perforation. Identification of modifiable risk factors during the critical periods of life will contribute to the development of effective prevention and intervention strategies of neonatal gastric perforation.

【 授权许可】

CC BY