BREAKING! Pediatricians Warn That COVID-19 Can Cause Gastric Perforations In New Borns!

COVID-19 News: In an alarming revelation, pediatricians have found that COVID-19 can cause gastric perforations in newborns. This development underscores the need for heightened awareness and prompt medical intervention to save lives. This COVID-19 News report highlights the clinical features indicating gastric perforation in neonates, emphasizing the importance of timely surgery for positive outcomes.


COVID-19 Can Cause Gastric Perforations In New Borns. An X-ray of the abdomen in case 5 revealed a “football sign.” Arrows outline the “football” silhouette.

Data Collection and Analysis
Data was collected retrospectively from all neonates who presented to the Himalayan Institute of Medical Sciences with a diagnosis of gastric perforation from January 2020 to December 2023. Simple statistical analysis involving sums, means, averages, and percentages was utilized. Over three years, five neonates were operated on with a diagnosis of gastric perforation. Among these, two cases were spontaneous, while the remaining three were associated with malrotation, prematurity, and COVID-19. All five cases were diagnosed through the finding of free gas in the peritoneum on abdominal radiographs. The overall mortality rate was 60% (three out of five neonates).
 
Clinical Presentation and Diagnosis
Neonatal gastric perforation typically occurs within the first week of life, particularly between the second and seventh days. The onset of symptoms is usually sudden, with abdominal distension as the initial sign. Acidic contents can cause severe peritonitis, leading to rapid progression to sepsis and shock. Early diagnosis, followed by timely resuscitation and surgical repair, is crucial for favorable outcomes. Massive pneumoperitoneum on abdominal radiographs with typical signs in a neonate should raise suspicion of gastric perforation, especially within the first week of life.
 
Case Studies
Case 1: A Four-Day-Old Baby Boy
A four-day-old baby boy was brought to the pediatric emergency with excessive crying and abdominal distention. Delivered at full term via normal vaginal delivery at home, the baby had a birth weight of 2.7 kg and initially tolerated feeds well. However, an abdominal X-ray revealed free gas under both hemidiaphragms. After resuscitation, the baby underwent urgent abdominal exploration, which revealed a small perforation on the posterior gastric wall. Despite post-operative challenges, including a prolonged ventilator requirement, the baby recovered and was discharged on the 20th postoperative day.
 
Case 2: A Preterm Baby Boy
A 1.4 kg preterm baby boy, delivered at 30 weeks gestation, developed abdominal distension and septic shock on the seventh day of life. Abdominal radiography confirmed pneumoperitoneum. After stabilization, abdominal exploration revealed a large perforation on the posterior wall of the stomach. Despite initial post-operative recovery, the baby developed severe sepsis and ultimately succumbed to the condition by the 30th postoperative day.
 
Case 3: A Full-Term Baby Girl
A full-term baby girl, delivered via cesarean section, developed significant abdominal distension and sepsis on the third day of life. Abdominal radiography confirmed pneumoperitoneum, and an abdominal drain was inserted. Exploratory laparotomy revealed a gastric perforation along the lesser curve of the stomach. The baby's COVID IgG-positive status, despite a negative RT-PCR test, indicated a possible association with the perforation. Despite extensive medical care and multiple surgeries, the baby eventually recovered and was discharged.
 
Case 4: An Eleven-Day-Old Full-Term Baby Boy
An eleven-day-old full-term baby boy presented with abdominal distension and shortness of breath. An abdominal X-ray confirmed massive pneumoperitoneum. Following initial resuscitation and stabilization, exploratory laparotomy revealed a large gastric perforation. Unfortunately, the baby developed severe sepsis and multi-organ dysfunction postoperatively, leading to his demise by the fourth postoperative day.
 
Case 5: A Full-Term Baby Boy
A full-term baby boy presented with abdominal distension and vomiting on the sixth day of life. Abdominal radiography confirmed pneumoperitoneum. Exploratory laparotomy revealed a gastric perforation near the gastroesophageal junction and malrotation, which was corrected during surgery. Despite initial improvement, the baby's condition deteriorated due to sepsis, resulting in his death on the tenth postoperative day.

Etiology of Gastric Perforation
Three primary mechanisms have been proposed for gastric perforation in neonates: traumatic, ischemic, and spontaneous. Traumatic perforations are often due to iatrogenic causes, such as aggressive nasogastric tube manipulation. Ischemic perforations are commonly seen in preterm neonates, linked to conditions of profound physiological stress like severe prematurity, sepsis, and neonatal asphyxia. Spontaneous perforations, although rare, occur in otherwise healthy full-term neonates, typically within the first week of life.
 
COVID-19 and Gastric Perforation
COVID-19 has introduced new complexities to neonatal gastric perforation. While gastrointestinal complications are rare in COVID-19, mesenteric ischemia and intestinal perforation have been reported. Case 3 in our series suggests a possible link between COVID-19 and gastric perforation, with the baby's COVID IgG-positive status indicating past exposure. The hypercoagulable state associated with COVID-19 may contribute to extensive disease and complications.
 
Diagnosis and Management
Early diagnosis of gastric perforation is critical. Symptoms include sudden onset of abdominal distension and respiratory compromise. Radiographic signs, such as massive pneumoperitoneum, the "continuous diaphragm sign," and the "football sign," are key indicators. Aggressive resuscitation, prompt antibiotic coverage, and intensive monitoring are essential. Surgical repair is the definitive treatment, with intraoperative examination necessary to identify secondary causes and other perforations.
 
Conclusion
Gastric perforation in neonates, although rare, is a life-threatening condition that requires immediate attention. The COVID-19 pandemic has added a new dimension to this already complex condition, highlighting the need for vigilance and prompt intervention. Early diagnosis and timely surgical repair are crucial for improving outcomes. This study emphasizes the importance of recognizing the clinical signs of gastric perforation, particularly in the context of COVID-19, to save lives and reduce mortality rates.
 
By understanding the clinical features and implementing early intervention strategies, healthcare professionals can significantly improve the prognosis for neonates with gastric perforation. This awareness is vital, especially in the wake of the COVID-19 pandemic, to ensure the best possible outcomes for our youngest and most vulnerable patients.
 
The study findings were published in the peer reviewed journal: Cureus.
https://www.cureus.com/articles/242484-tiny-tummies-big-challenges-a-case-series-of-neonatal-gastric-perforations#!/
 
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https://www.thailandmedical.news/news/breaking-covid-19-news-case-study-shows-that-even-asymptomatic-sars-cov-2-infections-can-lead-to-spontaneous-bowel-perforations
 
https://www.thailandmedical.news/news/covid-19-news-study-finds-that-all-exposed-to-the-sars-cov-2-virus-are-at-risk-of-various-digestive-diseases