Contents lists available at ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev Conservative treatment of iatrogenic perforations caused by gastric tubes in extremely low birth weight infants ☆ Margarita Thanhaeuser a , Claudia Lindtner-Kreindler a , Angelika Berger a , Nadja Haiden b, ⁎ a Medical University of Vienna, Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care & Neuropediatrics, Waehringer Guertel 18-20, 1090 Vienna, Austria b Medical University of Vienna, Department of Clinical Pharmacology, Waehringer Guertel 18-20, 1090 Vienna, Austria ARTICLE INFO Keywords: Preterm infant Iatrogenic perforation Gastric tube Conservative management ABSTRACT 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 eso- phageal 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, gas- trorrhaphy was performed. Conclusions: Conservative treatment of upper GIT perforations led to spontaneous recovery without major complications in 85.7%. 1. Introduction ELBW infants depend on gastric tubes for enteral feeding, applica- tion of medications or gastric decompression while receiving nasal continuous positive airway pressure (CPAP). Perforations of the upper GIT – i.e. gastric or esophageal perforation – by misplacement of gastric tubes are rare but life-threatening events [1–3]. While the incidence in preterm infants is low with 0.4–0.5%, mortality remains high with 21–30% [1,4]. Therefore, the safe use of nasogastric tubes is of high importance. The correct placement of a nasogastric tube is part of daily routine at neonatal intensive care units and usually performed by highly trained nursing staff. Nevertheless, tube misplacement – possibly leading to a perforation – occurs in up to 55.6% [5]. Perforations of the upper GIT can be managed by either surgical or conservative care. Conservative management options of esophageal perforations consist of removal of the gastric tube, withholding of enteral feeds, antibiotic therapy, and if required drainage of pneumothorax or pneumoper- itoneum. These measures eventually lead to spontaneous closure of the lesion [1,2,4,6]. Data on the conservative management of gastric per- forations in preterm infants are scarce and in most patients gastro- rrhaphy is performed [7,8]. There are no randomized controlled trials comparing surgical and conservative treatment of upper GIT perfora- tions. The aim of this study is to report on incidence, management, morbidity, and mortality of upper GIT perforations due to polyurethane https://doi.org/10.1016/j.earlhumdev.2019.104836 Received 2 July 2019; Received in revised form 8 August 2019; Accepted 13 August 2019 Abbreviations: BPD, bronchopulmonary dysplasia; CPAP, continuous positive airway pressure; ELBW, extremely low birth weight; GIT, gastrointestinal tract; IVH, intraventricular hemorrhage; LISA, less invasive surfactant application; NEC, necrotizing enterocolitis; NEMU, nose to ear to mid-umbilicus distance; NEX, nose to ear to xiphoid distance; PDA, persistent ductus arteriosus; PVC, polyvinylchloride; PEEP, positive end-expiratory pressure; ROP, retinopathy of prematurity; SGA, small for gestational age ☆ The research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit-sectors. ⁎ Corresponding author. E-mail addresses: margarita.thanhaeuser@meduniwien.ac.at (M. Thanhaeuser), claudia.lindtner-kreindler@meduniwien.ac.at (C. Lindtner-Kreindler), angelika.berger@meduniwien.ac.at (A. Berger), nadja.haiden@meduniwien.ac.at (N. Haiden). Early Human Development 137 (2019) 104836 0378-3782/ © 2019 Elsevier B.V. All rights reserved. T