Nonoperative management of esophageal perforations in the newborn

Esophageal perforation in neonates occurs most often in cases of extreme prematurity and is commonly due to iatrogenic causes. Treatment over recent decades has become more conservative. The purpose of this study was to review cases of esophageal perforation in neonates and to describe the presentat...

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Bibliographic Details
Published in:The Journal of surgical research 2016-09, Vol.205 (1), p.102-107
Main Authors: Onwuka, Ekene A., Saadai, Payam, Boomer, Laura A., Nwomeh, Benedict C.
Format: Article
Language:English
Subjects:
Disease Management
Enteral Nutrition - adverse effects
Esophageal perforation
Esophageal Perforation - etiology
Esophageal Perforation - therapy
Female
Humans
Iatrogenic
Iatrogenic Disease
Infant, Extremely Premature
Infant, Newborn
Male
Neonatal
Retrospective Studies
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Summary:Esophageal perforation in neonates occurs most often in cases of extreme prematurity and is commonly due to iatrogenic causes. Treatment over recent decades has become more conservative. The purpose of this study was to review cases of esophageal perforation in neonates and to describe the presentation, management, and outcomes. A retrospective chart review was performed for patients with International Classification of Diseases, Ninth Revision code for esophageal perforation treated at our institution between the years 2009 and 2015. Data collected included demographic information, etiology of perforation (specifically focusing on cases secondary to orogastric tube placement), treatment course, time to resumption of enteral feeds, length of antibiotic use, time to subsequent radiographic resolution, and mortality. Twenty-five patients met study criteria. The average post-conceptual age at time of diagnosis was 26.5 ± 2.3 wk. All 25 patients were managed nonoperatively with bowel rest, parenteral nutrition, and broad-spectrum antibiotics. Enteral feeds were resumed after a median of 8 d (interquartile range [IQR]: 7-11), the median antibiotic duration was 7 d (IQR: 7-10), and the median time to follow-up esophagram was 7 d (IQR: 7-10). Overall, 24 of 25 patients (96%) demonstrated radiological resolution of perforation on initial follow-up esophagram. Four patients died during the study period, but no deaths were related to the diagnosis of esophageal perforation. In this largest reported sample of neonates treated for esophageal perforation, nonoperative management with bowel rest, parenteral nutrition, and antibiotics was successful.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2016.06.027