A Review of Five Incidents of Neonatal Gastric Rupture That Occurred in One Year in Our Neonatal Intensive-Care Unit

Abstract

Neonatal gastric rupture has become rare in recent years, but we encountered a total of five incidents in four cases during a single year. In this study, we reviewed each incident and considered the related pathogenetic factors reported in the literature in order to apply them to future neonatal management. All the patients were premature infants born by emergent Caesarean section. They developed gastric rupture at the greater curvature side (n = 3) or at the anterior wall of the gastric body (n = 2) early after birth. The ruptures occurred in anatomically vulnerable areas characteristic of the stomach wall in newborns. In our cases, the etiologies were considered as follows: in addition to an impaired blood flow in the gastric wall due to physiological diving reflex induced by perinatal hypoxia events, an increased intragastric pressure that exceeded the tolerable upper limit of the neonatal stomach due to obstruction of the gastrointestinal passage by a meconium plug; functional hypoperistalsis of the gastrointestinal tract induced by hypothyroidism; and an organo-axial gastric volvulus peculiar to newborns. We reconfirmed the significance of careful monitoring of the abdominal findings over time and maintaining an appropriate decompression of the upper gastrointestinal tract as needed. These managements are quite common in the neonatal intensive care unit, but are important as preventive measures for the onset of neonatal gastric rupture.