Steven L Raymond1, Cynthia D Downard2, Shawn D St Peter3, Joanne Baerg4, Faisal G Qureshi5, Steven W Bruch6, Paul D Danielson7, Elizabeth Renaud8, Saleem Islam9. 1. Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA. 2. Division of Pediatric Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA. 3. The Children's Mercy Hospital, Kansas City, MO, USA. 4. Loma Linda University Children's Hospital, Loma Linda, CA, USA. 5. Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA. 6. Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. 7. Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. 8. Division of Pediatric Surgery, Department of Surgery, Albany Medical College, Albany, NY, USA. 9. Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA. Electronic address: Saleem.Islam@surgery.ufl.edu.
Abstract
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.
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.
Authors: Wendy N Nembhard; Jorieke E H Bergman; Maria D Politis; Jazmín Arteaga-Vázquez; Eva Bermejo-Sánchez; Mark A Canfield; Janet D Cragan; Saeed Dastgiri; Hermien E K de Walle; Marcia L Feldkamp; Amy Nance; Miriam Gatt; Boris Groisman; Paula Hurtado-Villa; Kärin Kallén; Danielle Landau; Nathalie Lelong; Jorge Lopez-Camelo; Laura Martinez; Margery Morgan; Anna Pierini; Anke Rissmann; Antonin Šípek; Elena Szabova; Giovanna Tagliabue; Wladimir Wertelecki; Ignacio Zarante; Marian K Bakker; Vijaya Kancherla; Pierpaolo Mastroiacovo Journal: Birth Defects Res Date: 2020-10-17 Impact factor: 2.661
Authors: Andrea Schmedding; Boris Wittekind; Emilia Salzmann-Manrique; Rolf Schloesser; Udo Rolle Journal: Pediatr Surg Int Date: 2020-03-26 Impact factor: 1.827