Clinical characteristics and mortality prediction in neonatal gastric perforation: Insights from a regional...

To characterize the clinical features, identify prognostic factors, and develop a risk prediction model for poor outcomes in neonates with gastric perforation (NGP).

We retrospectively analyzed the clinical, microbiological, surgical, and pathological data of 83 infants with NGP admitted between 2000 and 2024 to four major hospitals in southern China. Univariate and multivariate logistic regression analyses were used to identify independent risk factors. A nomogram prediction model was constructed and validated using ROC curves, calibration plots, decision curve analysis (DCA), and bootstrap resampling.

The median age at onset was 2 days, with a median birth weight of 2370 g; 62.7% were preterm infants. The predominant clinical manifestations included abdominal distension (94.0%) and diminished bowel sounds (66.3%), while the mortality or treatment abandonment rate was 25.3%. Perforations were most frequently located along the greater curvature of stomach (66.7%). Histopathology revealed muscular layer defects in 73.8% of cases, which were not correlated with short-term outcomes. Multivariate analysis identified distal intestinal obstruction (OR = 6.22) and symptom-to-surgery interval ≥24 h (OR = 4.24) as independent predictors of poor prognosis. The resulting nomogram demonstrated robust discrimination (AUC = 0.845), good calibration, and satisfactory clinical utility.

Neonatal gastric perforation remains a rare but life-threatening surgical emergency. Distal obstruction and symptom-to-surgery interval are key prognostic determinants. The proposed nomogram based on clinically accessible variables enables early identification of high-risk patients and may support timely clinical decision-making.