Neonatal gastric perforation. A systematic review and meta-analysis

Background: Neonatal gastric perforation (NGP) is a rare but life-threatening condition with incidence of 1:2900 to 1:5000 live births and mortality rates as high as 62–70%. Despite existing research, standardized diagnostic protocols and management strategies are lacking. This meta-analysis aims to estimate pooled mortality, characterize demographic and anatomical patterns, and evaluate temporal and socioeconomic variation in NGP outcomes. Methods: We searched four databases from December 1950 to September 2024. Observational studies including case reports, case series and cohorts were included. Mean and prevalence ratios for various variables were pooled by random effects model using Stata version 18.5. A mixed generalized linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel plots. The primary outcome was pooled mean mortality, with secondary outcomes including gestational age, sex distribution, age at presentation, and anatomical site of perforation. Subgroup analysis was conducted based on time periods and income status of the country of study. Results: Fifty-four studies including 789 neonates with gastric perforation were analyzed. The pooled mortality rate was 36% (95% CI 29%-43%). Preterm infants comprised 54% (95% CI 44%-65%) of cases, with a male predominance (68%; 95% CI 63%-74%). The greater curvature was the most frequent site of perforation (64%; 95% CI 53%-75%), followed by the lesser curvature (23%; 95% CI 15%-33%) and anterior wall (18%; 95% CI 10%-28%). Most cases were presented within the first week of life (modal age 3.5 days). Mortality declined over time but remained higher in lower-middle-income countries compared with high- and upper-middle-income countries. Conclusion: NGP remains life-threatening despite advances in neonatal care, with prematurity, male sex, and physiological vulnerability as consistent risk factors. Greater curvature predominance reflects anatomical predisposition and potential iatrogenic mechanisms. Significant mortality disparities persist between high-income and low- to middle-income countries. Standardized reporting of injury mechanisms, time to surgical intervention, and sepsis status are critical priorities for future research.