Objective: Neonatal Gastric perforation (NGP) is a rare disease among neonates with poor outcome, high mortality rate and uncertain etiology. The aim of this study is to demonstrate the risk factors and evaluate the possible prognosis.
Case: We describe 5 cases of neonates who were diagnosed with gastric perforation in Newborn Intensive Care Unit (NICU) at Army Central Hospital Jakarta during January to May 2019. There were 3 boys and 2 girls, four of them were preterm infants and 1 full-term. Two babies had low birth weight (1700 g and 2265 g) and 1 baby had extremely low birth weight (775 g). The initial clinical manifestations were abdominal distension and vomiting which occurred during day 1 to 5. Four babies had gastrointestinal malformation due to duodenal atresia, anal atresia, Hirschsprung’s disease, and duodenal stenosis. One baby was in intrauterine hypoxia condition due to severe pre-eclampsia with absent end-diastolic flow condition. Other comorbidities were congenital heart disease (Patent Ductus Arteriosus and Atrium Septal Defect) and respiratory distress syndrome on Continuous Positive Airway Pressure (CPAP). Abdominal X-ray showed free air sub-diaphragm, extra-lumen free air, gastric distension and gasless abdomen. The surgeries were performed at 2-13 days after the first clinical symptom. Intra-operative findings showed perforation on gastric fundus (3 cases), gastric antrum and pylorus (1 case), and gastric greater curvature.  One baby survived and all premature babies passed away.
Conclusion: In our cases, 4 neonates had gastrointestinal malformation lead to distal obstruction, one was in chronic hypoxia condition, extremely preterm, and extremely low birth weight. Recognizing all those risk factors as one of our comprehensive approach is very important to ease the incident of NGP and reduce the mortality rate.