A Rare Case of Accidental Esophageal Perforation in an Extremely Low Birth Weight Neonate

Suryawanshi, Pradeep; Dahat, Amit; Nagpal, Rema; Malshe, Nandini; Kalrao, Vijay

doi:10.7860/jcdr/2014/8554.4460

Cited by 9 publications

(7 citation statements)

References 12 publications

(10 reference statements)

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“…In our cohort, radiological findings alongside respiratory deterioration indicated the diagnosis of NEP. This echoes the literature where routine post-tube insertion Xray [5,7], and acute deterioration in respiratory status [6,10,17,18] led to the diagnosis of NEP. X-ray may show an abnormal path of the enterogastric tube [7,19], or pneumothorax/pneumomediastinum with or without pleural effusion [1,5,6,10].…”

Section: Discussionsupporting

confidence: 75%

Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes

Sorensen

Chuang

et al. 2023

Children

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Background: The aim of this multicenter retrospective study and literature review was to review management and outcomes of neonatal esophageal perforation (NEP). Methods: Protocol data were collected from four European Centers on gestational age, factors surrounding feeding tube insertion, management and outcomes. Results: The 5-year study period (2014–2018) identified eight neonates with median gestational age of 26 + 4 weeks (23 + 4–39) and median birth weight 636 g (511–3500). All patients had NEP from enterogastric tube insertions, with the perforation occurring at median 1st day of life (range 0–25). Seven/eight patients were ventilated (two/seven-high frequency oscillation). NEP became apparent on first tube placement (n = 1), first change (n = 5), and after multiple changes (n = 2). Site of perforation was known in six (distal n = 3, proximal n = 2 and middle n = 1). Diagnosis was established by respiratory distress (n = 4), respiratory distress and sepsis (n = 2) and post-insertion chest X-ray (n = 2). Management in all patients included antibiotics and parenteral nutrition with two/eight receiving steroids and ranitidine, one/eight steroids only and one/eight ranitidine only. One neonate had a gastrostomy inserted, while in another an enterogastric tube was orally successfully re-inserted. Two neonates developed pleural effusion and/or mediastinal abscess requiring chest tube. Three neonates had significant morbidities (related to prematurity) and there was one death 10 days post-perforation (related to prematurity complications). Conclusions: NEP during NGT insertion is rare even in premature infants after evaluating data from four tertiary centers and reviewing the literature. In this small cohort, conservative management seems to be safe. A larger sample size will be necessary to answer questions on efficacy of antibiotics, antacids and NGT re-insertion time frame in NEP.

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Section: Discussionsupporting

confidence: 75%

Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes

Sorensen

Chuang

et al. 2023

Children

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“…Incorrect enteral gastric tube placement in newborns is associated with serious harms, including risk of death ( 1 - 2 ) . To confirm the placement of the tube immediately after its introduction and before each use is central to ensure the safe use of this device, so commonly used in neonatal inpatient units ( 3 - 6 ) .…”

Section: Introductionmentioning

confidence: 99%

Use of pH reagent strips to verify gastric tube placement in newborns

Dias¹,

Almeida

Álvares

et al. 2019

Rev. Latino-Am. Enfermagem

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Objective:to confirm the accuracy of the pH test in identifying the placement of the gastric tube in newborns.Method:double-blind, diagnostic test study conducted with 162 newborns admitted to a neonatal intensive care unit and an intermediate care unit. The subjects were submitted to enteral intubation, followed by pH test with reagent strip, which was analyzed by a nurse, and radiological examination, analyzed by radiologist. Blinding was kept among professionals regarding test results. Diagnostic accuracy analysis of the pH test in relation to the radiological exam was performed.Results:the sample consisted of 56.17% boys, with average birth weight of 1,886.79g (SD 743,41), 32.92 (SD 2.99) weeks of gestational age and the mean pH was 3.36 (SD 1.27). Considering the cutoff point of pH≤5.5, the sensitivity was 96.25%, specificity 50%, positive predictive value 99.35% and negative predictive value 14.29%.Conclusion:The pH test performed with reagent strips is sensitive to identify the correct placement of the gastric tube, so it can be used as an adjuvant technique in the evaluation of the gastric tube placement. In interpreting the results, pH ≤5.5 points to correct placement and values > 5.5 require radiological confirmation.

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“…This case report is about the rare occurrence of oesophageal perforation with a milk pleural effusion in an ELBW infant diagnosed on chest radiography. Pleural effusion with milk has been described in the literature in the context of oesophageal obstruction, in pharyngeal or oesophageal pseudo-diverticulum [2], in the context of a contained cervical perforation and in pneumothoraxes resulting from puncture into the thoracic cavity [2][3][4]. This is the first report of milk effusion and lactobacillus sepsis secondary to oesophageal perforation.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Oesophageal Perforation in an Extremely Low Birth Weight Newborn

Janaillac¹,

El-Jalbout²,

Lapointe³

et al. 2016

JCR

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We report a rare case of an extremely low birth weight (ELBW) baby with oesophageal perforation secondary to an oro-gastric tube insertion and concomitant milk pleural effusion diagnosed on chest radiography. Area of perforation was determined with lateral chest radiography. This is the first case described in the literature of a milk pleural effusion in the context of perforation of the inferior third of the oesophagus in an ELBW infant.

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A Rare Case of Accidental Esophageal Perforation in an Extremely Low Birth Weight Neonate

Cited by 9 publications

References 12 publications

Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes

Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes

Use of pH reagent strips to verify gastric tube placement in newborns

Iatrogenic Oesophageal Perforation in an Extremely Low Birth Weight Newborn

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