Neonatal pharyngeal pseudodiverticulum mimicking esophageal atresia

Iatrogenic perinatal pharyngoesophageal injury: a disease of prematurity

OBJECTIVE

Perinatal pharyngoesophageal instrumentation, including endotracheal intubation, oral suctioning, and feeding tube placement, is often necessary but risks tissue damage. Our objective was to estimate the incidence of iatrogenic perinatal pharyngoesophageal injury (IPPI) in preterm versus term infants in a children's hospital neonatal intensive care unit (NICU). A secondary goal was to explore the clinical characteristics and outcomes associated with these complications.

METHODS

All NICU discharge summaries from 2004 to 2008 were searched for IPPI-related keywords. Highlighted records were reviewed and the incidence of complications calculated by gestational age and weight.

RESULTS

Of 5910 total NICU discharges, 6 cases of IPPI were identified, for an overall incidence of 0.10%. All injuries occurred in infants less than 33 weeks gestational age and 1500g, with a trend towards higher incidence with increasing prematurity. The incidence of IPPI rose to 4/1321 (0.30%) at 27-32 weeks and 2/521 (0.38%) at less than 27 weeks gestation. Similarly, IPPI occurred in 3/675 (0.44%) babies born at 1000-1500g and 3/642 (0.47%) babies below 1000g. All affected infants survived with conservative management.

CONCLUSIONS

IPPI is a rare but serious complication of perinatal airway instrumentation and is primarily a disease of prematurity. In this sizeable cohort, no complications occurred in term infants, and the incidence of injury increased with decreasing gestational age and weight. This increased propensity towards injury should prompt special care when performing even routine airway procedures on premature neonates.

Traumatic pharyngeal pseudodiverticulum mimicking esophageal atresia

Obstruction of passage of a catheter through esophagus in a newborn is mostly diagnosed as esophageal atresia (EA) with or without tracheo esophageal fistula (TEF). Rarely a traumatic instrumentation may produce pharyngeal or upper esophageal perforation and attempt at passage of a catheter may produce a false passage submucosally called pseudodiverticulum. Here it is present the case of a extremely premature (28 wk) and low birth weight (950 gms) newborn with traumatic laceration and pharyngeal pseudodiverticulum mimicking EA. The authors discuss the diagnostic characteristics and management of such a situation.

Traumatic retropharyngeal emphysema as a cause for severe respiratory distress in a newborn

Traumatic injury to the pharynx or esophagus in a newborn from intubation or tube suctioning may have various presentations. Difficulty passing a gastric tube or feeding problems may erroneously suggest the diagnosis of esophageal atresia. Associated respiratory distress may be caused by pneumothorax or pleural effusion if the pleural space is entered. We report the case of a full-term newborn presenting with severe respiratory distress caused by a large retropharyngeal air collection resulting from hypopharyngeal perforation from prior intubation and suctioning. Chest abnormality, sufficient to account for the degree of respiratory distress, was not demonstrated.