Twenty-eight infants with spontaneous neonatal gastric perforation are analyzed along with 10 newborn stomachs experimentally disrupted pneumatically at autopsy. Nineteen infants survived surgical closure of the perforation. Prematurity and delay in diagnosis were significant findings in the nonsurvivors. The location of the perforations and their gross and microscopic appearance led to the assumption that these perforations were mechanical disruptions. Comparison of the clinical material with the experimental material, and proven mechanical disruptions in the literature, along with theoretic considerations, are in support of this hypothesis.