Nonoperative management of esophageal perforations in the newborn

Ekene A. Onwuka, Payam Saadai, Laura A. Boomer, Benedict C. Nwomeh

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Esophageal perforation in neonates occurs most often in cases of extreme prematurity and is commonly due to iatrogenic causes. Treatment over recent decades has become more conservative. The purpose of this study was to review cases of esophageal perforation in neonates and to describe the presentation, management, and outcomes. Materials and methods A retrospective chart review was performed for patients with International Classification of Diseases, Ninth Revision code for esophageal perforation treated at our institution between the years 2009 and 2015. Data collected included demographic information, etiology of perforation (specifically focusing on cases secondary to orogastric tube placement), treatment course, time to resumption of enteral feeds, length of antibiotic use, time to subsequent radiographic resolution, and mortality. Results Twenty-five patients met study criteria. The average post-conceptual age at time of diagnosis was 26.5 ± 2.3 wk. All 25 patients were managed nonoperatively with bowel rest, parenteral nutrition, and broad-spectrum antibiotics. Enteral feeds were resumed after a median of 8 d (interquartile range [IQR]: 7-11), the median antibiotic duration was 7 d (IQR: 7-10), and the median time to follow-up esophagram was 7 d (IQR: 7-10). Overall, 24 of 25 patients (96%) demonstrated radiological resolution of perforation on initial follow-up esophagram. Four patients died during the study period, but no deaths were related to the diagnosis of esophageal perforation. Conclusions In this largest reported sample of neonates treated for esophageal perforation, nonoperative management with bowel rest, parenteral nutrition, and antibiotics was successful.

Original languageEnglish (US)
Pages (from-to)102-107
Number of pages6
JournalJournal of Surgical Research
Volume205
Issue number1
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Esophageal Perforation
Newborn Infant
Anti-Bacterial Agents
Parenteral Nutrition
Small Intestine
International Classification of Diseases
Demography
Mortality
Therapeutics

Keywords

  • Esophageal perforation
  • Iatrogenic
  • Neonatal

ASJC Scopus subject areas

  • Surgery

Cite this

Nonoperative management of esophageal perforations in the newborn. / Onwuka, Ekene A.; Saadai, Payam; Boomer, Laura A.; Nwomeh, Benedict C.

In: Journal of Surgical Research, Vol. 205, No. 1, 01.09.2016, p. 102-107.

Research output: Contribution to journalArticle

Onwuka, Ekene A. ; Saadai, Payam ; Boomer, Laura A. ; Nwomeh, Benedict C. / Nonoperative management of esophageal perforations in the newborn. In: Journal of Surgical Research. 2016 ; Vol. 205, No. 1. pp. 102-107.
@article{58931453a85c4189b428353af63ec2ed,
title = "Nonoperative management of esophageal perforations in the newborn",
abstract = "Background Esophageal perforation in neonates occurs most often in cases of extreme prematurity and is commonly due to iatrogenic causes. Treatment over recent decades has become more conservative. The purpose of this study was to review cases of esophageal perforation in neonates and to describe the presentation, management, and outcomes. Materials and methods A retrospective chart review was performed for patients with International Classification of Diseases, Ninth Revision code for esophageal perforation treated at our institution between the years 2009 and 2015. Data collected included demographic information, etiology of perforation (specifically focusing on cases secondary to orogastric tube placement), treatment course, time to resumption of enteral feeds, length of antibiotic use, time to subsequent radiographic resolution, and mortality. Results Twenty-five patients met study criteria. The average post-conceptual age at time of diagnosis was 26.5 ± 2.3 wk. All 25 patients were managed nonoperatively with bowel rest, parenteral nutrition, and broad-spectrum antibiotics. Enteral feeds were resumed after a median of 8 d (interquartile range [IQR]: 7-11), the median antibiotic duration was 7 d (IQR: 7-10), and the median time to follow-up esophagram was 7 d (IQR: 7-10). Overall, 24 of 25 patients (96{\%}) demonstrated radiological resolution of perforation on initial follow-up esophagram. Four patients died during the study period, but no deaths were related to the diagnosis of esophageal perforation. Conclusions In this largest reported sample of neonates treated for esophageal perforation, nonoperative management with bowel rest, parenteral nutrition, and antibiotics was successful.",
keywords = "Esophageal perforation, Iatrogenic, Neonatal",
author = "Onwuka, {Ekene A.} and Payam Saadai and Boomer, {Laura A.} and Nwomeh, {Benedict C.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.jss.2016.06.027",
language = "English (US)",
volume = "205",
pages = "102--107",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "1",

}

TY - JOUR

T1 - Nonoperative management of esophageal perforations in the newborn

AU - Onwuka, Ekene A.

AU - Saadai, Payam

AU - Boomer, Laura A.

AU - Nwomeh, Benedict C.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background Esophageal perforation in neonates occurs most often in cases of extreme prematurity and is commonly due to iatrogenic causes. Treatment over recent decades has become more conservative. The purpose of this study was to review cases of esophageal perforation in neonates and to describe the presentation, management, and outcomes. Materials and methods A retrospective chart review was performed for patients with International Classification of Diseases, Ninth Revision code for esophageal perforation treated at our institution between the years 2009 and 2015. Data collected included demographic information, etiology of perforation (specifically focusing on cases secondary to orogastric tube placement), treatment course, time to resumption of enteral feeds, length of antibiotic use, time to subsequent radiographic resolution, and mortality. Results Twenty-five patients met study criteria. The average post-conceptual age at time of diagnosis was 26.5 ± 2.3 wk. All 25 patients were managed nonoperatively with bowel rest, parenteral nutrition, and broad-spectrum antibiotics. Enteral feeds were resumed after a median of 8 d (interquartile range [IQR]: 7-11), the median antibiotic duration was 7 d (IQR: 7-10), and the median time to follow-up esophagram was 7 d (IQR: 7-10). Overall, 24 of 25 patients (96%) demonstrated radiological resolution of perforation on initial follow-up esophagram. Four patients died during the study period, but no deaths were related to the diagnosis of esophageal perforation. Conclusions In this largest reported sample of neonates treated for esophageal perforation, nonoperative management with bowel rest, parenteral nutrition, and antibiotics was successful.

AB - Background Esophageal perforation in neonates occurs most often in cases of extreme prematurity and is commonly due to iatrogenic causes. Treatment over recent decades has become more conservative. The purpose of this study was to review cases of esophageal perforation in neonates and to describe the presentation, management, and outcomes. Materials and methods A retrospective chart review was performed for patients with International Classification of Diseases, Ninth Revision code for esophageal perforation treated at our institution between the years 2009 and 2015. Data collected included demographic information, etiology of perforation (specifically focusing on cases secondary to orogastric tube placement), treatment course, time to resumption of enteral feeds, length of antibiotic use, time to subsequent radiographic resolution, and mortality. Results Twenty-five patients met study criteria. The average post-conceptual age at time of diagnosis was 26.5 ± 2.3 wk. All 25 patients were managed nonoperatively with bowel rest, parenteral nutrition, and broad-spectrum antibiotics. Enteral feeds were resumed after a median of 8 d (interquartile range [IQR]: 7-11), the median antibiotic duration was 7 d (IQR: 7-10), and the median time to follow-up esophagram was 7 d (IQR: 7-10). Overall, 24 of 25 patients (96%) demonstrated radiological resolution of perforation on initial follow-up esophagram. Four patients died during the study period, but no deaths were related to the diagnosis of esophageal perforation. Conclusions In this largest reported sample of neonates treated for esophageal perforation, nonoperative management with bowel rest, parenteral nutrition, and antibiotics was successful.

KW - Esophageal perforation

KW - Iatrogenic

KW - Neonatal

UR - http://www.scopus.com/inward/record.url?scp=84977160703&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84977160703&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2016.06.027

DO - 10.1016/j.jss.2016.06.027

M3 - Article

C2 - 27621005

AN - SCOPUS:84977160703

VL - 205

SP - 102

EP - 107

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 1

ER -