Gastric Ischemia: The Primary Factor in Neonatal Perforation

Abstract

The incidence of perinatal asphyxia and evidence for gastric ischemia were investigated in six patients from the Yale-New Haven Hospital and 87 previously reported cases having neonatal gastric perforation. All our patients and 69 per cent of the collected series were found to have significant perinatal complications predisposing to asphyxia; five of our patients and 41 per cent of those reviewed had evidence of gastric ischemia as manifested by mucosal hemorrhage, ulceration, or necrosis. Gastric ischemia is the primary factor in neonatal perforation although pneumatic distention with separation of the gastric musculature, the effects of the acid pepsin response on the gastric mucosa, and direct trauma to the stomach wall are important contributing factors which make gastric perforation unique.