ArticleFrontiers in pediatrics2026
Iatrogenic esophageal perforation in extremely preterm newborn with multiple comorbidities: case report and ethical considerations.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Neonatal esophageal perforation (EP) is a rare but potentially life-threatening complication, particularly in extremely low birth weight (ELBW) infants exposed to repeated invasive procedures. Although conservative management has progressively improved survival rates, mortality remains significant among the most vulnerable neonates. Literature studies predominantly describe favorable outcomes, possibly underrepresenting early lethal cases and overlooking the ethical implications of iatrogenic injury in infants at the threshold of viability. We report a fatal case of iatrogenic EP in an ELBW preterm infant and discuss diagnostic challenges, management strategies, and ethical considerations. A male infant was born at 27 weeks' gestation with severe intrauterine growth restriction and birth weight of 480 g. His clinical course was complicated by respiratory distress syndrome requiring prolonged mechanical ventilation, sepsis, patent ductus arteriosus, evolving bronchopulmonary dysplasia, pulmonary hypertension, hypertrophic cardiomyopathy, and periventricular leukomalacia. On day 24 of life, acute abdominal distension and clinical deterioration prompted radiographic and ultrasonographic evaluation. Imaging demonstrated malposition of the orogastric tube and right-sided pneumothorax, and subsequent mediastinal emphysema, confirming esophageal perforation. Conservative management was initiated, consisting of tube removal,
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