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The Subdiaphragmatic Angle Of The Gastric Tube In Neonates - A Potential Predictor For Perforations?
Sonja Diez1, Hilda Bartos2, Anna Siemes3
1Pediatric Surgery, Erlangen University Hospital, Erlangen, Germany.
Klinische Padiatrie
|December 14, 2023
Summary
Neonatal gastric tube placement can cause rare but serious perforations. A gastric tube angle less than 20 degrees on radiographs may indicate subdiaphragmatic perforation, prompting further investigation.
Area of Science:
- Neonatal medicine
- Pediatric radiology
- Gastroenterology
Background:
- Traumatic subdiaphragmatic perforation of the esophagus or stomach in neonates is a rare complication of gastric tube insertion.
- This condition is associated with significant morbidity and mortality in newborns.
- Early detection is crucial for improving patient outcomes.
Purpose of the Study:
- To determine if the angle of a gastric tube on plain radiographs can predict subdiaphragmatic traumatic perforation in neonates.
- To establish a radiographic marker for identifying iatrogenic esophageal or gastric perforations.
Main Methods:
- Retrospective analysis of thoraco-abdominal radiographs from 128 neonates without perforation and 15 neonates with confirmed perforation.
- Evaluation of the gastric tube angle in relation to postnatal age and perforation status.
Main Results:
- The gastric tube angle increases with postnatal age.
- Neonates with subdiaphragmatic perforation showed a median gastric tube angle of 11°, compared to 31° in the control group.
- An angle less than 20° demonstrated high sensitivity (93.3%) and specificity (91.4%) for predicting perforation.
- Unusual tip localization beyond the gastric bubble is also highly indicative of perforation.
Conclusions:
- The angle of a gastric tube on plain radiographs is a valuable diagnostic tool for predicting subdiaphragmatic perforation in neonates.
- An angle <20° warrants further investigation, including physical examination and imaging like ultrasound or contrast studies.
- Verification of correct gastric tube placement is essential in neonatal care to prevent iatrogenic injuries.
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