Iatrogenic Esophageal Perforation in Premature Infants: A Multicenter Retrospective Study from Poland
Aleksandra Mikołajczak1, Katarzyna Kufel2, Joanna Żytyńska-Daniluk3
1Neonatal Department, Collegium Medicum of Cardinal Stefan Wyszynski University, 01-938 Warsaw, Poland.
Insights
Iatrogenic esophageal perforation (EP) in preterm infants is a serious risk. This study found air leaks were the only significant difference in infants with EP, and identified three common nasogastric tube positions associated with perforation.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Radiology
Background:
- Iatrogenic esophageal perforation (EP) is a rare but serious complication in very low birth weight (VLBW) preterm infants.
- Early recognition and understanding of EP are crucial to mitigate long-term morbidities.
Purpose of the Study:
- To investigate iatrogenic EP in VLBW preterm infants.
- To analyze the radiographic consequences of orogastric/nasogastric tube placement.
- To explore the association between histological chorioamnionitis and EP.
Main Methods:
- Retrospective analysis of 1149 VLBW preterm infants (2009-2016).
- Comparison of mortalities and morbidities between infants with and without EP.
- Radiographic assessment of nasogastric tube (NGT) position and analysis of placental histopathology.
Main Results:
- No statistically significant difference in histopathological chorioamnionitis between EP and non-EP groups.
- Air leaks were the only statistically significant difference (p=0.01) between groups.
- Three common NGT X-ray locations identified: high (below carina), intra-abdominal, and right pleural.
Conclusions:
- Air leaks are a key indicator of potential iatrogenic esophageal perforation in preterm infants.
- Specific NGT malpositions on radiography are associated with EP.
- Awareness of these radiographic findings and associated symptoms can aid in early diagnosis and management of EP.
Abstract:
Greater awareness of possible iatrogenic esophageal perforation (EP) is needed. Though rare, EP is a legitimate health risk as it may lead to long-term morbidities. This study presents and discusses iatrogenic EP in a subset of preterm infants. Using radiographic images, we study and describe the consequences of the orogastric/nasogastric tube position (in radiographic images). We analyze the possible influence of histological chorioamnionitis on the development of esophageal perforation. This retrospective study examines the hospital records of 1149 preterm infants, 2009-2016, with very low birth weight (VLBW) and iatrogenic EP, comparing mortalities and morbidities between the two groups of preterm infants who had birth weights (BWs) of less than 750 g and were less than 27 weeks gestation age at birth: one group with iatrogenic esophageal perforation (EP group) and one group without perforation (non-EP group-the control group). Histopathological chorioamnionitis of the placenta showed no statistically significant differences between the groups. The only statistically significant difference was in the air leaks (p = 0.01). Three types of nasogastric tube (NGT) X-ray location were identified, depending on the place of the perforation: (1) high position below the carina mimicking esophageal atresia; (2) low, intra-abdominal; (3) NGT right pleura-directed. We also highlight the particular symptoms that may be indicative of EP due to a displacement of the nasogastric tube.
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