P1.041. Feeding Tube–Related Oesophageal Perforation in Preterm Infants and a Rare Complication of a Routine Procedure

Abstract

Abstract Topic Benign Disease: Iatrogenic Esophageal Disease, Perforation and Postsurgical Complications Background Iatrogenic oesophageal perforation is an uncommon but potentially serious complication in neonatal practice, particularly among preterm and very-low-birth-weight infants. Orogastric and nasogastric tube placement is a routine procedure in neonatal intensive care, yet repeated or difficult insertion can cause pharyngo-oesophageal injury in this vulnerable group. Diagnosis may be delayed because clinical signs are often non-specific, including respiratory deterioration, sepsis-like features, feeding intolerance, or abnormal tube position on chest radiography. Methods A focused narrative review of published literature was undertaken using selected studies, case series and retrospective reviews examining neonatal and paediatric iatrogenic oesophageal perforation. Particular attention was given to studies reporting patient characteristics, mechanism of injury, imaging findings, management strategies and clinical outcomes following suspected or confirmed feeding tube–related perforation. Results The available literature suggests that iatrogenic oesophageal perforation occurs most frequently in extremely preterm or very-low-birth-weight infants, often following nasogastric or orogastric tube insertion. Reported cases commonly involve respiratory distress, difficulty aspirating gastric contents, bloody secretions, pleural effusion, air leak, or abnormal tube position on radiography. Recent multicentre data from premature infant cohorts demonstrate that although the condition is rare, it is associated with significant morbidity, including delayed enteral feeding, prolonged parenteral nutrition, respiratory complications and sepsis. However, several studies also suggest that, in the absence of uncontrolled sepsis or persistent leak, non-operative management with tube removal or repositioning, antibiotics, bowel rest, and nutritional support can be effective. Surgical or interventional drainage appears to be reserved for selected cases complicated by abscess, pleural collection, or clinical deterioration. Conclusion Feeding tube–related iatrogenic oesophageal perforation is a rare but important neonatal complication that can easily be missed. In preterm infants with sudden respiratory deterioration, feeding intolerance, bloody aspirates or unusual tube positioning, careful review of chest radiographs should prompt early consideration of oesophageal injury. The literature supports a shift towards conservative management in stable neonates, although management remains variable and evidence is limited by small retrospective cohorts. Greater awareness, careful tube-placement technique and clearer neonatal unit pathways may reduce diagnostic delay and improve outcomes.