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[Esophageal perforation in premature newborn infants. Presentation of 8 cases]
G Flores-Nava1, H Joachín-Roy, G Rodríguez-Cueto
1Unidad de Cuidados Intensivos Neonatales, Hospital de Ginecobstetricia, Dr. Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, México D.F.
Insights
Esophageal perforation in newborns is often linked to mechanical ventilation and pneumothorax. Conservative management, including antibiotics and nutritional support, is currently favored over immediate surgery for these infants.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Critical Care
Context:
- Esophageal perforation is a rare but serious complication in neonates.
- Preterm infants requiring mechanical ventilation for respiratory distress are at increased risk.
- Associated conditions include pneumothorax and complications from feeding tubes.
Purpose:
- To describe the clinical presentation and management of esophageal perforation in a cohort of newborn infants.
- To evaluate the outcomes of conservative management strategies.
- To highlight the association between mechanical ventilation, pneumothorax, and esophageal injury.
Summary:
- Eight neonates with esophageal perforation were identified, all preterm and requiring mechanical ventilation.
- Six cases were associated with pneumothorax; three involved orogastric tube malposition, and three showed milk in pleural drains.
- Management involved a ten-day fasting period, parenteral nutrition, broad-spectrum antibiotics, and complication prevention, with surgery not being the primary recommendation.
Impact:
- This study suggests that conservative management is a viable initial approach for neonatal esophageal perforation.
- It underscores the importance of vigilant monitoring for esophageal injury in ventilated preterm infants, especially those with pneumothorax.
- Findings may influence clinical guidelines regarding the surgical versus non-surgical management of this condition.
Abstract:
We report eight newborn with esophageal perforation. They were preterm infants and received mechanical ventilation for respiratory problem. Six were associated with pneumothorax, three of they show aberrant way of an orogastric tube, and another three show milk fluid in the pleural tube installed for pneumothorax. The management was fasting during ten days, parenteral nutrition, wide spectrum antibiotics, and prevention of complications; surgery treatment is not the first of all recommended at present.