Prognostic Factors in Preterm Infants with Neonatal Gastrointestinal Perforation: A Retrospective Cohort Study

Background: Gastrointestinal perforation (GIP) among neonates is a major clinical emergency associated with high mortality, which is severe and life-threatening, especially in preterm infants. This study aimed to describe the clinical features of preterm neonatal gastrointestinal perforation and evaluate the potential prognostic factors. Methods A total of 191 preterm neonates with gastrointestinal perforation were included in this retrospective cohort study and assigned to survival and non-survival groups. Information containing clinical and demographic data, laboratory and imaging features, and outcomes were collected and recorded by retrospective medical records review. The independent factors associated with death risk were determined by univariate and multivariate logistic regression analyses. Results The overall mortality in the study cohort was 25.1%. The median age of onset of gastric perforation was 3 days (range: 1–11 days), while the median age of onset of intestinal perforation was 7.5 days (range: 1–30 days). Abdominal distension (184 [96.3%] patients) was the most common symptom, followed by absent bowel sounds (157 [82.2%] patients), lethargy (148 [77.5%] patients), and shortness of breath (60 [59.4%] patients). Finally, three independent mortality risk factors were identified: severe acidosis (OR,7.604; 95% CI, 1.424‒51.910; p  = 0.025), shock (5.131; 2.419‒11.266; p  < 0.001) and coagulopathy (3.269; 1.511–7.431; p  = 0.003). Conclusions Severe acidosis, shock, and coagulopathy are independently and significantly associated with an increased risk of death in preterm infants with neonatal gastrointestinal perforation. The identification of novel risk factors will facilitate the development of therapeutic strategies for preterm neonates with gastrointestinal perforation.