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Management of esophageal and pharyngeal perforation in the newborn infant
Insights
Esophageal and pharyngeal perforations in newborns, often from tube placement, can be effectively managed with medical treatment, including antibiotics and drainage. Surgery is typically reserved for severe complications like mediastinitis.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Gastroenterology
Background:
- Esophageal or pharyngeal perforation is a potential complication during endotracheal or nasogastric tube placement in neonates.
- Current management strategies for these perforations remain a subject of debate, with varying approaches between medical and surgical interventions.
Purpose of the Study:
- To evaluate the efficacy of non-operative medical management for esophageal and pharyngeal perforations in newborn infants.
- To determine if surgical intervention is routinely necessary for neonatal esophageal and pharyngeal perforations.
Main Methods:
- Retrospective review of nine neonatal patients treated medically for esophageal or pharyngeal perforation.
- Medical management included antibiotics, nutritional support, and closed chest-tube drainage for pneumothoraces.
- Literature review of 73 previously reported cases of neonatal esophageal and pharyngeal perforations.
Main Results:
- All nine medically treated patients experienced complete healing of their perforations without surgical repair.
- No mortality or significant morbidity was associated with the perforations in the medically managed group.
- Analysis of combined data suggests medical management is a viable option for most cases.
Conclusions:
- Neonatal esophageal and pharyngeal perforations can be successfully managed non-operatively with antibiotics, nutritional support, and chest-tube drainage.
- Routine early surgical exploration is not indicated; surgery should be reserved for specific complications like mediastinitis or mediastinal mass formation.
- Close observation for signs of sepsis and mediastinal changes is crucial to identify infants requiring surgical intervention.
Abstract:
Perforation of the esophagus or pharynx may occur during placement of endotracheal or nasogastric tubes in the newborn infant. Controversy exists, however, whether medical or surgical therapy is better in the management of these perforations. Nine patients who had esophageal or pharyngeal perforation in the neonatal period and were treated medically with antibiotics, nutritional support, and closed chest-tube drainage of pneumothoraces are described. All perforations healed without surgical repair. No mortality or morbidity occurred secondary to these perforations. This study, together with a review of the 73 patients described in the literature, indicate that perforations of the pharynx and esophagus can be satisfactorily managed medically. There is no apparent advantage to routine early surgical exploration. Only complications such as mediastinitis and mediastinal mass formation seem to require surgical treatment. Medical therapy with close observation for signs of sepsis and/or mediastinal changes will enable most newborn infants to avoid an operation and will identify those infants for whom surgery is definitely indicated.