# Iatrogenic Esophageal Perforation in Extremely Premature Babies With Low Birth Weight: A Case Series at a Single Tertiary-Care Center

## TL;DR

This study examines non-surgical treatment of esophageal perforation in extremely premature low birth weight babies, showing successful recovery without surgery.

## Contribution

The paper presents a case series demonstrating the safety and efficacy of non-operative management for iatrogenic esophageal perforation in extremely premature infants.

## Key findings

- Seven extremely premature infants with iatrogenic EP were successfully managed without surgery.
- All patients resumed enteral feeding after a mean of 22 days with no complications from the perforation.
- Four infants died from comorbidities of prematurity, not the perforation itself.

## Abstract

Background: Iatrogenic esophageal perforation (EP) is a rare but serious complication of nasogastric tube (NGT) or orogastric tube (OGT) insertion in neonates. Early recognition of this condition is often challenging, as clinical and radiological findings may mimic esophageal atresia. Reported mortality is high, largely owing to the sequelae of extreme prematurity and associated comorbidities. The purpose of this study was to review cases of iatrogenic EP in extremely premature babies with low birth weight and to describe the presentation, management, and outcomes.

Methods: Retrospective chart review of seven patients with iatrogenic EP treated non-operatively at King Abdulaziz Medical City in Riyadh, Saudi Arabia, from 2004 to 2024.

Result: Seven extremely premature infants with iatrogenic EP were managed conservatively without primary surgical repair. All resumed enteral feeding successfully after a mean of 22 days, with no complications directly attributed to the perforation. However, four infants died from comorbidities of extreme prematurity rather than the perforation itself.

Conclusion: Iatrogenic EP diagnosis can be difficult in extremely premature babies with low birth weight. Non-operative management of such cases can be considered a safe and efficient option with no need for subjecting the patient to operative options.