The clinical characteristics and prognostic factors of neonatal gastric perforation and rupture: a multicenter retrospective study in Japan.

PURPOSE: Neonatal gastric perforation is a life-threatening surgical emergency with high mortality rates. The confounding effect of tracheoesophageal fistula (TEF) on prognostic analyses remains inadequately addressed. This study aimed to identify the prognostic factors for in-hospital mortality using a multicenter analysis. METHODS: We conducted a retrospective study at six tertiary pediatric surgery centers in Japan, including all neonates who underwent surgical treatment for either gastric perforation or rupture between 1994 and 2025. Logistic regression and sensitivity analyses, excluding TEF cases, were performed. RESULTS: Thirty-seven patients were identified, with a median birth weight of 1202 g, of whom 56.8% had a very low birth weight. The overall mortality rate was 37.8% (14/37). On a multivariate analysis, TEF was the strongest independent prognostic factor (OR 51.85, 95% CI 3.26-824.6; p = 0.005). In the sensitivity analysis excluding TEF cases (n = 28), the age at surgery (OR 1.23, 95% CI 1.01-1.51; p = 0.041) and the perforation length (OR 1.09, 95% CI 1.00-1.18; p = 0.043) were significant predictors of mortality. CONCLUSION: TEF is the strongest prognostic factor for neonatal gastric perforation. Excluding TEF confounding factors revealed the prognostic importance of the age at surgery and the perforation size, highlighting the value of early diagnosis and management.