Neonatal gastric perforation: a systematic review and meta-analysis of clinical characteristics, risk factors, surgical management and outcomes

Neonatal gastric perforation (NGP) is a rare but life-threatening surgical emergency of the newborn. We systematically reviewed its clinical characteristics, risk factors, surgical management and outcomes.

Five databases were searched from inception to 31 December 2025 for observational studies reporting at least five neonates (≤ 28 days) with confirmed gastric perforation. Two reviewers independently screened records, extracted data and appraised quality. Proportions were pooled using random-effects models; predictors of mortality were summarised as odds ratios (OR). The review followed PRISMA 2020 and was registered in the International Prospective Register of Systematic Reviews (PROSPERO).

Twenty studies (410 neonates) were included. Pooled prevalences were prematurity 58.3%, low birth weight 63.5% and male sex 59.0%; abdominal distension (90.5%) and pneumoperitoneum (80.9%) were the commonest features. Primary repair was performed in 78.4% of operated neonates. Pooled in-hospital mortality was 28.6% (95% CI 22.0-36.3%). Sepsis at presentation (OR 4.10) and delay to surgery beyond 24 h (OR 3.55) were the strongest predictors of death.