Esophageal perforation in neonates: a report of seven cases from Kuwait

Preterm neonates exposed to invasive procedures are at risk of esophageal perforation [EP]. We are reporting a series of seven cases of EP, which have occurred in the neonatal intensive care unit [NICU] of Farwaniya Hospital, Kuwait, over a period of nine years [1994-2002]. This gives an incidence of one in 8,118 live births and one in 278 NICU admissions. All patients were premature [below 32 weeks] and were exposed to various invasive procedures. Two cases had a tentative diagnosis of esophageal atresia at the time of presentation. Other five cases presented with a feeding tube in an ectopic position and air leak syndrome. All cases were managed conservatively. The perforations healed without any complication. The overall outcome was good as none of the mortality and morbidity was attributed to EP. Our objective in this report is to highlight the existence of this problem and emphasize the importance of its early diagnosis, management and prevention. Misdiagnosis might lead to unnecessary investigation and / or surgical intervention

Oesophageal atresia: NICH experience

Nineteen patients of oesophageal atresia with and without tracheo-oesophageal fistula were managed at the National Institute of Child Health [NICH] between 1st January, 1995 and 31st October, 1995. Only four patients were referred within 24 hours of birth. Eight [42.11%] patients had associated anomalies. None of the patients belonged to the Waterston's risk category A. Three patients died before operation. Seven [36.84%] patients survived following operation, of which three had associated anomalies. Frothing at the mouth, which is a tell-tale sign of oesophageal atresia, went unrecognized in a large number of cases. A simple known diagnostic technique of demonstrating oesophageal atresia is highlighted to ensure early referral in the future - the key to survival