The Use of Broad-Spectrum Antibiotics Plus Metronidazole in Newborns with Gastric Perforation: Impact on Short-term Outcomes

Abstract Objective The objective of this retrospective study was to investigate whether the use of broad-spectrum antibiotics plus metronidazole improves short-term outcomes in neonates with gastric perforation. Methods Medical records of neonatal gastric perforation were reviewed from January 2016 to December 2021 at Children’s Hospital of Chongqing Medical University. A total of 86 neonates were identified, of which 23 were excluded (12 abandoned before surgery, 11 abandoned after surgery within 1 week). Of the remaining 63 neonates, 15 were treated with metronidazole (group M), while 48 were not (group N). Group M was further matched with group N1 (n = 15, without metronidazole) based on birth weight (< 250 g), gestational age (< 1 week), and age at onset (< 1 day). The data from groups M, N, and N1 were compared and analyzed. Results There were no significant differences in baseline characteristics, clinical manifestations, treatments, postoperative outcome indicators, hospital stay, comorbidities, and laboratory results between group M and group N (or N1). However, the age at admission was significantly higher in group M than in group N ( P = 0.006) and group N1 ( P = 0.005). Group M had significantly higher rate of feeding after birth (P = 0.04) and lower rate of prenatal hormone exposure ( P = 0.004) compared to group N. Procalcitonin and blood sodium levels were significantly higher in group M than in group N ( P = 0.014 and P = 0.004) and group N1 ( P = 0.005 and P = 0.036). Elevated C-reactive protein was significantly different in group M and group N1 ( P = 0.020). The incidence rate of surgical site infection (SSI) in group M was higher than in group N ( P = 0.046), while there was no significant difference in the incidence rate between group M and group N1 ( P > 0.05). Conclusions Our study suggests that the use of broad-spectrum antibiotics plus metronidazole may not improve short-term outcomes after surgery in newborns with gastric perforation. Future prospective randomized controlled studies with larger sample sizes are warranted to further investigate the optimal antibiotic regimen for the treatment of neonatal gastric perforation.