Perforation of the gastrointestinal tract in neonatal period has been associated with a grim prognosis. Recently there has been some improvement in survival. To evaluate the remaining pitfalls in management, 19 neonatal gastrointestinal perforation cases from May 1989 to July 1996 were analysed retrospectively. Seven patients were premature and low birth weight infants. Perforation was most common in the ileum{56.3%). Mechanical or functional obstruction distal to the perforation site was identified in 7 cases; Hirschsprung's disease 3, small bowel atresia 3, and anorectal malformation 1. These lesions were often not diagnosed until operation. Five cases of necrotizing enterocolitis and 1 of muscular defect were the other causes of perforation. In six cases, the cause of the perforation was not identified. Perinatal ischemic episodes were associated in five cases. Overall mortality was 15.1 %. Because a considerable number of gastrointestinal perforations resulted from distal obstruction, pediatric surgeon should be alert for early identification and intervention of gastrointestinal obstruction, particularly in patients that are premature and have a history of ischemia..