Efficacy and safety of upper gastrointestinal endoscopy in the neonatal intensive care unit.

BACKGROUND: Upper gastrointestinal (GI) disorders frequently lead to neonatal intensive care unit (NICU) admissions; however, conventional imaging often fails to detect atypical presentations. The development of miniaturized endoscopes has progressively expanded the feasibility of upper GI endoscopy in neonates. Evidence regarding the diagnostic utility and safety of upper GI endoscopy in neonates remains limited, and neonatal-specific guidelines are currently absent in China. This study aimed to evaluate the diagnostic value and safety of upper GI endoscopy in NICU infants. METHODS: We retrospectively analyzed data from 41 NICU infants who underwent upper GI endoscopy. Indications, endoscopic findings, clinical correlations, and safety were assessed. Statistical analyses were performed using IBM SPSS version 24.0 and data were presented as medians (interquartile ranges) or frequencies (percentages). RESULTS: All infants presented with persistent, severe, and unexplained GI symptoms and remained undiagnosed following initial evaluation and conventional investigations. The smallest infant weighed 1,810 g at a corrected gestational age of 33 weeks at the time of endoscopy. Among 41 infants, recurrent vomiting (78.0%), hematemesis (53.7%), hematochezia (24.4%), and dysphagia (19.5%) were the primary indications for endoscopy. Endoscopic clinically significant abnormalities included gastric ulcer (n = 16), esophageal hiatal hernia (n = 11), gastric volvulus (n = 6), esophageal stricture (n = 4) and duodenal ulcer (n = 4). Therapeutic interventions included local hemostasis (n = 15), duodenal-jejunal tube placement (n = 11), and balloon dilation for esophageal stricture (n = 2). Clinically significant findings constituted the majority of detected abnormalities and frequently prompted endoscopic therapy. All infants recovered without major complications, and no perforations, infections, or deaths occurred. CONCLUSIONS: In this highly selected cohort of 41 NICU infants with persistent unexplained GI symptoms refractory to conventional evaluation, upper GI endoscopy identified clinically significant findings in 90.2% (37/41) of cases, with no major procedural complications. These results support the diagnostic utility and safety of upper GI endoscopy when performed in carefully selected neonates by an experienced multidisciplinary team.