A “Wandering” Orogastric Tube in a Preterm Neonate

Azrunorudin Alias, Wan Nurulhuda Wan Md Zin, Faizah Mohd Zaki, Fook-Choe Cheah

Abstract

Endotracheal intubation is an essential procedure to secure the airway of neonates who have pulmonary conditions that require invasive mechanical respiratory support. This may be more challenging and potentially traumatic in neonates born at extremely low gestation or low birth weight. Complications include laryngeal injury, commonly, and tracheal or esophageal perforation, which is quite rare. The latter needs a high index of suspicion with appropriate diagnostic methods for early recognition and prompt intervention.

We report a case of a preterm neonate (born at 33 weeks of gestation) who had minimal respiratory effort at birth, which required endotracheal intubation for positive pressure ventilation. Intubation led to esophageal perforation, which was promptly diagnosed using chest radiograph followed by bedside ultrasound and an upper gastrointestinal fluoroscopic study.

The neonate was treated with intravenous amoxicillin and clavulanic acid. He was kept nil per oral and was supported with total parenteral nutrition while awaiting the perforation to heal. A repeat upper gastrointestinal study on day 12 of life showed that the esophageal perforation had healed. Enteral feeding was commenced and progressed well until hospital discharge at day 40 of life.