Conservative treatment of iatrogenic perforations caused by gastric tubes in extremely low birth weight infants

Background: Iatrogenic gastrointestinal perforations are rare, but life-threatening events in preterm infants. Aim: Aim of the study was to report on incidence, management, morbidity, and mortality. Study design: This was a retrospective analysis performed at a tertiary neonatal intensive care unit in Vienna, Austria. Subjects: Extremely low birth weight infants (ELBW, birth weight < 1000 g) with perforations of the upper gastrointestinal tract (GIT) caused by gastric tubes were included. Outcome measures: All ELBW infants born within the 6-year study period were identified and their discharge summaries or notes were screened for esophageal and gastric perforations. Data on incidence, management of GIT perforations, morbidity, and mortality were obtained. Results: During a 6-year study period 646 ELBW infants were analyzed. Incidence of perforations was 1.1% (n = 7/646). Median gestational age was 23 + 3 (range: 23 + 0-24 + 5). Perforations occurred on the third day of life (= median, range: day 2-14) and were primarily managed conservatively. Enteral feeding was stopped for 6 days (range: 4-13 days), antibiotic therapy administered for 16 days (range: 8-22 days). In one infant, gastrorrhaphy was performed. Conclusions: Conservative treatment of upper GIT perforations led to spontaneous recovery without major complications in 85.7%.