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Neonatal oesophageal perforation: The role for non-operative management.
- Source :
- Journal of Paediatrics & Child Health; Aug2018, Vol. 54 Issue 8, p872-874, 3p, 1 Black and White Photograph, 1 Chart
- Publication Year :
- 2018
-
Abstract
- <bold>Aim: </bold>Isolated oesophageal perforation in neonates is a rare but potentially life-threatening condition. Although management has historically been operative, conservative management (antibiotics, bowel rest, parenteral nutrition) is now more routinely used. The aim of this study was to evaluate the management of this condition in two large neonatal surgical centres.<bold>Methods: </bold>A retrospective cohort study was conducted for neonates admitted to The Hospital for Sick Children (Toronto, Canada) or The Royal Children's Hospital (Melbourne, Australia) with a diagnosis of oesophageal perforation, from 2006 to 2016. Patients with oesophageal atresia or tracheo-oesophageal fistula were excluded. Data were collected from chart review regarding demographics, clinical course, management and outcomes.<bold>Results: </bold>Eleven neonates with oesophageal perforation were identified over a 10-year period at the two centres. Median gestational age at birth was 25.3 weeks (interquartile range 24.2-28.8) and the majority (7/11, 64%) of neonates were extremely low birthweight. Diagnosis was made on day 1 of life for 9 of 11 (81%) neonates and was secondary to nasogastric tube insertion in 10 of 11 (91%) neonates. Only four (36%) neonates had symptomatic complications. All neonates were managed with bowel rest and intravenous antibiotics for a median of 7 days (interquartile range 7-10); two patients required operative intervention. Three neonates (27%) developed chronic lung disease and two (19%) died prior to discharge.<bold>Conclusions: </bold>Oesophageal perforation is severe complication secondary to instrumentation of the upper gastrointestinal tract in neonates. Prompt and accurate diagnosis is crucial. Non-operative management is effective for the majority, though morbidity is common. [ABSTRACT FROM AUTHOR]
- Subjects :
- NEWBORN infants
ESOPHAGEAL abnormalities
CHILDREN
SICK children
GASTROINTESTINAL system
LOW birth weight
CHEST X rays
CHILDREN'S hospitals
COMPARATIVE studies
ESOPHAGOSCOPY
GESTATIONAL age
LONGITUDINAL method
RESEARCH methodology
MEDICAL cooperation
NEONATAL intensive care
RESEARCH
RISK assessment
SURVIVAL
TRACHEA intubation
SYMPTOMS
EVALUATION research
NEONATAL intensive care units
TREATMENT effectiveness
RETROSPECTIVE studies
ESOPHAGEAL perforation
HOSPITAL mortality
Subjects
Details
- Language :
- English
- ISSN :
- 10344810
- Volume :
- 54
- Issue :
- 8
- Database :
- Complementary Index
- Journal :
- Journal of Paediatrics & Child Health
- Publication Type :
- Academic Journal
- Accession number :
- 131205659
- Full Text :
- https://doi.org/10.1111/jpc.13905