Three cases of iatrogenic esophageal perforation seen in premature inf
ants over the last three years are reported. The cause was a gastric c
atheter inserted through the mouth. Although only very few similar cas
es have been reported in the literature, the frequency of this complic
ation is probably underestimated. Ventilatory assistance usually precl
udes clinical diagnosis. On plain roentgenograms, a right pneumothorax
and an abnormal position of the catheter are suggestive. Management r
elies on broad spectrum parenteral antimicrobials, total parenteral nu
trition, and, if needed, drainage of the air and fluid effusion. After
about 14 days, an esogastroduodenal radiologic study is performed and
a gastric catheter is inserted under fluoroscopic guidance. Enteral n
utrition can then be resumed. Iatrogenic esophageal perforation is usu
ally not responsible for local sequelae or death but occurs in infants
with a high risk of death due to prematurity and growth retardation.