Summary
This report looks at an incident where a neonate suffered an oesophageal perforation following endotracheal and nasogastric tube insertion.
NHS England: Unintentional perforation of oesophagus in neonates from invasive procedures
https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/how-we-acted-on-patient-safety-issues-you-recorded/unintentional-perforation-of-oesophagus-in-neonates-from-invasive-procedures/
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