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Eguchi S, Hisaeda Y, Ukawa T, Koto M, Hosokawa M, Tsurisawa C, Takeda T, Amagata S, Nakao A. Clinical Features of iatrogenic Pharyngo-esophageal perforation in very low birth weight infants. Pediatr Neonatol 2024:S1875-9572(24)00072-X. [PMID: 38769031 DOI: 10.1016/j.pedneo.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Iatrogenic pharyngoesophageal perforation (IPEP) is one of the complications of gastric tube insertion and it tends to occur more frequently in premature infants. Although the frequency is significantly low, attention should be paid as it can lead to serious outcomes with high mortality. This study will help raise awareness with respect to early diagnosis, management, and prevention. METHODS We performed a retrospective cohort study of all very low birth weight infants diagnosed with IPEP between 1993 and 2022. RESULTS A total of 6 patients (0.27% of very low birth weight infants) with the diagnosis of IPEP were included. The median gestational age was 27 + 1 weeks (range 23+5-28 + 6 weeks), and the median birth weight was 823 g (range 630-1232 g). Symptoms included difficulty with gastric tube insertion, bloody secretions in the oral cavity, and increased oral secretions. X-rays revealed aberrant running of the gastric tube in all patients. In three cases, contrast studies demonstrated contrasted mediastinum tapering like a bead. Laryngoscope was used to view the perforation sites but this was not useful in the smallest patient. All patients were treated conservatively with antibiotics and survived. CONCLUSIONS When inserting a gastric tube for premature infants, it is critical to remember that these infants are at risk of IPEP. In addition to a frontal X-ray, a lateral X-ray and contrast study may be useful for early diagnosis.
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Affiliation(s)
- Shu Eguchi
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Yoshiya Hisaeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Toshiko Ukawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Mayu Koto
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Miku Hosokawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Chisa Tsurisawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Tomohiro Takeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Shusuke Amagata
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Atsushi Nakao
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
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Bartos HB, Diez S, König A, Görlach J, Besendörfer M, Mahnken AH, Drommelschmidt K, Weiss C, Müller H. Differences in neonatal gastric tubes during insertion into a 3D model in relation to risk of potential perforation. J Pediatr Gastroenterol Nutr 2024; 78:601-607. [PMID: 38305079 DOI: 10.1002/jpn3.12137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Perforation of esophagus or stomach is a potential complication during and after insertion of a gastric tube in neonates. The aim of this study was to analyze different types of gastric tubes in a three-dimensional (3D) model of neonatal esophagus and stomach regarding potential perforations. METHODS A 3D model of esophagus and stomach was created based on computed tomography data of a term neonate. Three types of gastric tubes were inserted into the 3D model, the localization was examined by radioscopy and the behavior, stiffness and manageability of each gastric tube was evaluated. RESULTS Insertion of gastric tubes with higher stiffness was easier. The rates of correct localization differed significantly between the gastric tubes with the highest rate of correct localization in the softest tube (48.5%) and the lowest rate in the tube with the highest stiffness (21.2%). Additionally, the softest tube showed the lowest rate of localization of its tip at the stomach wall. CONCLUSIONS The study illustrates differences between various types of gastric tubes regarding stiffness, behavior and resiliency. Softer gastric tubes may be beneficial. These differences may be relevant in neonatal care of very immature and very sick infants.
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Affiliation(s)
- Hilda-Brigitta Bartos
- Department of Diagnostic & Interventional Radiology, University Hospital Marburg, University of Marburg, Marburg, Germany
| | - Sonja Diez
- Department of Pediatric Surgery, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander König
- Department of Diagnostic & Interventional Radiology, University Hospital Marburg, University of Marburg, Marburg, Germany
| | - Jannis Görlach
- Department of Diagnostic & Interventional Radiology, University Hospital Marburg, University of Marburg, Marburg, Germany
| | - Manuel Besendörfer
- Department of Pediatric Surgery, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas H Mahnken
- Department of Diagnostic & Interventional Radiology, University Hospital Marburg, University of Marburg, Marburg, Germany
| | - Karla Drommelschmidt
- Department of Pediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics, and Information Processing, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Hanna Müller
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital Marburg, University of Marburg, Marburg, Germany
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Sorensen E, Yu C, Chuang SL, Midrio P, Martinez L, Nash M, Jester I, Saxena AK. Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020217. [PMID: 36832348 PMCID: PMC9955351 DOI: 10.3390/children10020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of this multicenter retrospective study and literature review was to review management and outcomes of neonatal esophageal perforation (NEP). METHODS Protocol data were collected from four European Centers on gestational age, factors surrounding feeding tube insertion, management and outcomes. RESULTS The 5-year study period (2014-2018) identified eight neonates with median gestational age of 26 + 4 weeks (23 + 4-39) and median birth weight 636 g (511-3500). All patients had NEP from enterogastric tube insertions, with the perforation occurring at median 1st day of life (range 0-25). Seven/eight patients were ventilated (two/seven-high frequency oscillation). NEP became apparent on first tube placement (n = 1), first change (n = 5), and after multiple changes (n = 2). Site of perforation was known in six (distal n = 3, proximal n = 2 and middle n = 1). Diagnosis was established by respiratory distress (n = 4), respiratory distress and sepsis (n = 2) and post-insertion chest X-ray (n = 2). Management in all patients included antibiotics and parenteral nutrition with two/eight receiving steroids and ranitidine, one/eight steroids only and one/eight ranitidine only. One neonate had a gastrostomy inserted, while in another an enterogastric tube was orally successfully re-inserted. Two neonates developed pleural effusion and/or mediastinal abscess requiring chest tube. Three neonates had significant morbidities (related to prematurity) and there was one death 10 days post-perforation (related to prematurity complications). CONCLUSIONS NEP during NGT insertion is rare even in premature infants after evaluating data from four tertiary centers and reviewing the literature. In this small cohort, conservative management seems to be safe. A larger sample size will be necessary to answer questions on efficacy of antibiotics, antacids and NGT re-insertion time frame in NEP.
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Affiliation(s)
- Eva Sorensen
- Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London SW10 9NH, UK
| | - Connie Yu
- Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London SW10 9NH, UK
| | - Shu-Ling Chuang
- Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London SW10 9NH, UK
| | - Paola Midrio
- Department of Pediatric Surgery, Cà Foncello Regional Hospital, 31100 Treviso, Italy
| | - Leopoldo Martinez
- Department of Pediatric Surgery, University Hospital La Paz, 28046 Madrid, Spain
| | - Mathew Nash
- Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Ingo Jester
- Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Amulya K. Saxena
- Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London SW10 9NH, UK
- Correspondence:
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Manzar S. Survival of the smallest premature infant with gastric perforation. Pediatr Neonatol 2022; 64:221-222. [PMID: 36344412 DOI: 10.1016/j.pedneo.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/04/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Shabih Manzar
- Section of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
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Moser MF, Müller IJ, Schalamon J, Resch B. Neurodevelopmental outcome of very preterm infants with gastrointestinal tract perforations does not differ compared to controls. Wien Klin Wochenschr 2021; 133:680-686. [PMID: 34110498 PMCID: PMC8292234 DOI: 10.1007/s00508-021-01886-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/24/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate gastrointestinal tract (GIT) perforations in very low birth weight infants and the effects on neurodevelopmental outcome. METHODS Between 2000 and 2017 all cases with GIT perforation were analyzed regarding causes, associated morbidities and neurodevelopmental outcome and compared with matched (gestational age, birth weight, gender, year of birth) by 1:2 controls. RESULTS The incidence of GIT perforation was 2.0% (n = 38/1878). Diagnoses associated with GIT were meconium obstruction of prematurity (MOP,n = 19/50%), spontaneous intestinal perforation (SIP, n = 7/18%), necrotizing enterocolitis (NEC, n = 6/16%), iatrogenic perforation (n = 3/8%), volvulus (n = 2/5%) and meconium ileus (n = 1/3%). The NEC-associated perforations occurred later compared to those associated with MOP and SIP (median 8 days and 6 days vs. 17 days, p = 0.001 and 0.023, respectively) and main localization was the terminal ileum (84%). Cases had higher rates of late onset sepsis (55% vs. 24%, p = 0.003), longer duration of mechanical ventilation (median 30 days vs 18 days, p = 0.013) and longer stays at the hospital (median 122 days vs 83 days, p < 0.001); mortality rates did not differ. The 2‑year neurodevelopment follow-up revealed no differences between groups (normal development 49% vs. 40%). CONCLUSION Despite increased morbidities preterm infants with GIT perforation did not have a higher mortality rate and groups did not differ regarding neurodevelopmental outcome at the corrected for prematurity age of 2 years.
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Affiliation(s)
- Michael F Moser
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Irina J Müller
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Johannes Schalamon
- Division of Pediatric Surgery, Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34/1, 8036, Graz, Austria
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria. .,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
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Furthner E, Kowalewski MP, Torgerson P, Reichler IM. Verifying the placement and length of feeding tubes in canine and feline neonates. BMC Vet Res 2021; 17:208. [PMID: 34098946 PMCID: PMC8185947 DOI: 10.1186/s12917-021-02909-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background Tube feeding is a common procedure in neonatology. In humans, tube misplacement reportedly occurs in up to 59% of all cases and may lead to perforation in 1.1% of preterm intubated neonates. While numerous studies on optimal tube placement have been performed in human neonates, current recommendations on tube feeding in canine and feline neonatology are based, at best, on studies performed in adult animals. Herein, we aimed to test ultrasonography as a tool to verify tube placement in puppies and kittens and to compare different anatomical predictive markers used in human, canine and feline neonates. Results The predictive tube length when held bent between the last rib and the mouth may induce trauma compared to when held straight. A strong positive linear correlation was observed between birthweight and gastric cardia localization. Ultrasonography findings were similar to coeliotomy findings. Stomach volume was less than 2 mL per 100 g in the less-than-one-day-old studied puppies (n = 25) and kittens (n = 28). Conclusions A weight-based equation was calculated to help predict appropriate tube placement. Ultrasonography can be used to control gastric tube placement, and neonates less than one-day-old have a smaller stomach capacity. Further studies are required to evaluate whether more-than-one-day-old puppies follow the same linear correlation with their weight. Further in vivo studies are warranted to determine the gold standard procedure for tube feeding in neonatal puppies and kittens.
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Affiliation(s)
- Etienne Furthner
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
| | - Mariusz Paweł Kowalewski
- Institute of Veterinary Anatomy, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Paul Torgerson
- Institute of Veterinary Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Iris Margaret Reichler
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
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Asui R, Mizumoto H, Sato M, Hata D. Edi catheter-related gastric perforation in a 373 g infant. Pediatr Int 2021; 63:734-736. [PMID: 34033199 DOI: 10.1111/ped.14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Risa Asui
- Departments of, Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Hiroshi Mizumoto
- Departments of, Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Masahito Sato
- Department of, Pediatric Surgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Daisuke Hata
- Departments of, Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
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Milassin TG, Ng ZQ, Gera P. Haematemesis as a sign of silent neonatal gastric perforation. J Paediatr Child Health 2020; 56:1830-1832. [PMID: 32364323 DOI: 10.1111/jpc.14906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Tamas G Milassin
- Department of Paediatric Surgery, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Zi Qin Ng
- Department of Paediatric Surgery, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Parshotam Gera
- Department of Paediatric Surgery, Perth Children's Hospital, Perth, Western Australia, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia, Australia
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