Outcomes in omphalocele correlate with size of defect
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Read the article on jpedsurg.org ↗Article · Aug 2019 · 1 min read
In brief
In brief
Multicenter study of 274 neonates with omphalocele demonstrates that defect size independently predicts morbidity and mortality, with 81% overall survival. Large defects correlate with prolonged hospitalization, ventilator dependence, and delayed enteral feeding compared to small defects.
Written by the GCMD Library team from the article.
Background
Omphaloceles can be some of the more challenging cases managed by pediatric surgeons. Single center studies have not been meaningful in delineating outcomes due to the length of time required to accumulate a large enough series with historical changes in management negating the results. The purpose of this study was to evaluate factors impacting the morbidity and mortality of neonates with omphaloceles.
Methods
A multicenter, retrospective observational study was performed for live born neonates with omphalocele between 2005 and 2013 at nine centers in the United States. Maternal and neonatal data were collected for each case. In-hospital management and outcomes were also reported and compared between neonates with small and large omphaloceles.
Results
Two hundred seventy-four neonates with omphalocele were identified. The majority were delivered by cesarean section with a median gestational age of 37 weeks. Overall survival to hospital discharge was 81%. The presence of an associated anomaly was common, with cardiac abnormalities being the most frequent. Large omphaloceles had a significantly longer hospital and ICU length of stay, time on ventilator, number of tracheostomies, time on total parenteral nutrition, and time to full feeds, compared to small omphaloceles. Birth weight and defect size were independent predictors of survival.
Conclusion
This is the largest contemporary study of neonates with omphalocele. Increased defect size is an independent predictor of neonatal morbidity and mortality.
Level of Evidence
Level II.