Iatrogenic esophageal perforation occurs rarely in neonates and was first reported in the literature by Eklof and colleagues.1 In the past two decades, perforation of the esophagus in extremely premature neonates has become increasingly recognized and reported. Spontaneous perforation of the esophagus (neonatal Boerhaave’s syndrome) is extremely rare, and Fryfogle2 performed the first successful repair. Despite the favorable results of nonoperative management in cases of neonatal esophageal perforation, this condition may be fatal without early diagnosis and treatment, and aggressive surgical therapy is occasionally warranted.3 7 Surgeons must continue to play a central role in the individualization of care in these patients.