{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:49:19Z","timestamp":1790891359049,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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\u20132018) identified eight neonates with median gestational age of 26 + 4 weeks (23 + 4\u201339) and median birth weight 636 g (511\u20133500). All patients had NEP from enterogastric tube insertions, with the perforation occurring at median 1st day of life (range 0\u201325). 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.<\/jats:p>","DOI":"10.3390\/children10020217","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T01:27:58Z","timestamp":1674782878000},"page":"217","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes"],"prefix":"10.3390","volume":"10","author":[{"given":"Eva","family":"Sorensen","sequence":"first","affiliation":[{"name":"Chelsea Children\u2019s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London SW10 9NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Yu","sequence":"additional","affiliation":[{"name":"Chelsea Children\u2019s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London SW10 9NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Ling","family":"Chuang","sequence":"additional","affiliation":[{"name":"Chelsea Children\u2019s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London SW10 9NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4543-9298","authenticated-orcid":false,"given":"Paola","family":"Midrio","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, C\u00e0 Foncello Regional Hospital, 31100 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leopoldo","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Hospital La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew","family":"Nash","sequence":"additional","affiliation":[{"name":"Birmingham Children\u2019s Hospital, Birmingham Women\u2019s and Children\u2019s NHS Foundation Trust, Birmingham B15 2TG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Jester","sequence":"additional","affiliation":[{"name":"Birmingham Children\u2019s Hospital, Birmingham Women\u2019s and Children\u2019s NHS Foundation Trust, Birmingham B15 2TG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7635-7490","authenticated-orcid":false,"given":"Amulya K.","family":"Saxena","sequence":"additional","affiliation":[{"name":"Chelsea Children\u2019s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London SW10 9NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jss.2016.06.027","article-title":"Nonoperative management of esophageal perforations in the newborn","volume":"205","author":"Onwuka","year":"2016","journal-title":"J. Surg. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1111\/j.1651-2227.2005.tb01860.x","article-title":"Use of polyvinyl feeding tubes and iatrogenic pharyngo-oesophageal perforation in very-low-birthweight infants","volume":"94","author":"Filippi","year":"2005","journal-title":"Acta Paediatr."},{"key":"ref_3","first-page":"A340","article-title":"Outcomes of babies with birth weight under 500 grams in a neonatal intensive care unit","volume":"104","author":"Singh","year":"2019","journal-title":"Arch. Dis. Child."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"104836","DOI":"10.1016\/j.earlhumdev.2019.104836","article-title":"Conservative treatment of iatrogenic perforations caused by gastric tubes in extremely low birth weight infants","volume":"137","author":"Thanhaeuser","year":"2019","journal-title":"Early Hum. Dev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1136\/bcr-2018-227286","article-title":"Where is the orogastric tube going in this preterm neonate?","volume":"11","author":"Marques","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1111\/jpc.13905","article-title":"Neonatal oesophageal perforation: The role for non-operative management","volume":"54","author":"Hodgson","year":"2018","journal-title":"J. Paediatr. Child Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1002\/ccr3.2321","article-title":"Esophageal perforation with orogastric tube malposition in low-birth-weight infant","volume":"7","author":"Maeda","year":"2019","journal-title":"Clin. Case Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1177\/2150135112443268","article-title":"Conservative Management of Iatrogenic Esophageal Perforation During Neonatal Cardiac Surgery","volume":"3","author":"Sasaki","year":"2012","journal-title":"World J. Pediatr. Congenit. Hear. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.epsc.2014.05.008","article-title":"Management of esophageal perforation in infants resulting from transesophageal echocardiogram probes","volume":"2","author":"Derderian","year":"2014","journal-title":"J. Pediatr. Surg. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1046\/j.1440-1754.2003.00271.x","article-title":"Oesophageal perforation in preterm neonates: Not an innocent bystander","volume":"39","author":"Shah","year":"2003","journal-title":"J. Paediatr. Child Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jss.2015.05.018","article-title":"Neonatal esophageal perforation: Nonoperative management","volume":"198","author":"Hesketh","year":"2015","journal-title":"J. Surg. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/014556130808700115","article-title":"Management of hypopharyngeal and esophageal perforations in children: Three case reports and a review of the literature","volume":"87","author":"Baum","year":"2008","journal-title":"Ear. Nose Throat J."},{"key":"ref_13","first-page":"235","article-title":"Management of Esophageal Perforation in Adults","volume":"3","author":"Kaman","year":"2011","journal-title":"Gastroenterol. Res."},{"key":"ref_14","first-page":"678","article-title":"Management of cervical esophageal and hypopharyngeal perforations","volume":"36","author":"Zenga","year":"2015","journal-title":"Am. J. Otolaryngol.-Head Neck Med. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1542\/peds.70.4.592","article-title":"Management of esophageal and pharyngeal perforation in the newborn infant","volume":"70","author":"Johnson","year":"1982","journal-title":"Pediatrics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1001\/archpedi.1976.02120040103020","article-title":"Esophageal Perforation in the Neonate: A Review of the Literature","volume":"130","author":"Lee","year":"1976","journal-title":"Am. J. Dis. Child"},{"key":"ref_17","first-page":"bcr1120115261","article-title":"Oesophageal perforation in extreme prematurity","volume":"2012","author":"Jones","year":"2012","journal-title":"BMJ Case Rep."},{"key":"ref_18","first-page":"8","article-title":"A rare case of accidental esophageal perforation in an extremely low birth weight neonate","volume":"8","author":"Suryawanshi","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1891\/0730-0832.32.2.89","article-title":"Radiographic confirmation of feeding tube placement: A diagnostic tool identifying gastrointestinal anomalies","volume":"32","author":"Soylu","year":"2014","journal-title":"Neonatal Netw."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.jpeds.2008.10.015","article-title":"Esophageal Perforation: A Complication of Nasogastric Tube Placement in Premature Infants","volume":"154","author":"Su","year":"2009","journal-title":"J. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"382","DOI":"10.17659\/01.2016.0092","article-title":"Key words","volume":"6","author":"Janaillac","year":"2016","journal-title":"J. Case Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"bcr2013201397","DOI":"10.1136\/bcr-2013-201397","article-title":"Easily missed, potentially fatal complication in an extremely preterm infant","volume":"2014","author":"Geoghegan","year":"2014","journal-title":"BMJ Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.epsc.2013.12.005","article-title":"Iatrogenic esophageal perforation in a premature neonate: A current nonoperative approach to management","volume":"2","author":"Sticco","year":"2014","journal-title":"J. Pediatr. Surg. Case Rep."},{"key":"ref_24","first-page":"4103734","article-title":"Esophageal Perforation with Unilateral Fluidothorax Caused by Nasogastric Tube","volume":"2016","author":"Mileder","year":"2016","journal-title":"Case Rep. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1007\/s00247-006-0258-3","article-title":"Pericardial sac perforation: A rare complication of neonatal nasogastric tube feeding","volume":"36","author":"Hanafy","year":"2006","journal-title":"Pediatr. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/S0022-3476(78)80622-2","article-title":"Perforation of feeding tube into right renal pelvis","volume":"93","author":"Fogle","year":"1978","journal-title":"J. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1007\/s002470050255","article-title":"Urinary bladder perforation: An unusual complication of neonatal nasogastric tube feeding","volume":"27","author":"Mattar","year":"1997","journal-title":"Pediatr. Radiol."},{"key":"ref_28","first-page":"396","article-title":"Conservative Treatment with Octreotide to Provide Early Recovery of Children with Esophageal Perforation","volume":"66","author":"Karabulut","year":"2017","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1016\/j.jpedsurg.2012.05.001","article-title":"Treatment of persistent esophageal leaks in children with removable, covered stents","volume":"47","author":"Rollins","year":"2012","journal-title":"J. Pediatr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.pedneo.2013.10.011","article-title":"Nasogastric Tube Placement and Esophageal Perforation in Extremely Low Birth Weight Infants","volume":"57","author":"Yong","year":"2016","journal-title":"Pediatr. Neonatol"},{"key":"ref_31","first-page":"72","article-title":"Iatrogenic esophageal perforation in the neonate","volume":"90","author":"Gasmi","year":"2012","journal-title":"Tunis. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S1726-4901(09)70352-1","article-title":"Endoscopic diagnosis and management of latrogenic cervical esophageal perforation in extremely premature infants","volume":"70","author":"Soong","year":"2007","journal-title":"J. Chin. Med. Assoc."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/217\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:16:08Z","timestamp":1760120168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,26]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["children10020217"],"URL":"https:\/\/doi.org\/10.3390\/children10020217","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,26]]}}}