The paper describes a case of a baby of 26 weeks of gestation. At birth she was intubated in delivery room for respiratory insufficiency, but she needed repeated attempts at endotracheal intubation. She was extubated on the 3rd day of life and non invasive ventilation was started. At the end of the first week of life she presented with respiratory distress and abdominal distension with gastric residual. She had a chest X-Ray, which showed the presence of right-sided pneumothorax with the nasogastric tube deviated from its normal course and with the distal end at the level of the diaphragm. Esophageal perforation is commonly iatrogenic condition, but is life threatening. Perforation allows bacteria and digestive enzymes to spread into the mediastinum or subphrenic space leading to mediastinitis, empyema, abscesses or sepsis. Clinical signs can vary from respiratory distress, cough, to hypersalivation. Diagnosis can be made with X-Ray. Treatment is usually conservative.