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Yang SS, Huang WC, Wang P, Gong FQ, Liu TX, Tou JF, Lai DM. Echocardiographic measurements of left ventricular dimensions and function in newborns with omphalocele and pulmonary. BMC Pediatr 2023; 23:585. [PMID: 37990192 PMCID: PMC10664469 DOI: 10.1186/s12887-023-04418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE The purpose of this study was to explore echocardiographic parameters of the left ventricle (LV) in relation to the outcomes of omphalocele neonates with pulmonary hypertension (PH). METHODS This retrospective study was conducted among omphalocele patients with PH born from 2019 to 2020. Patients in this study did not have additional severe malformations or chromosomal aberrations. Patients who died under palliative care were excluded. The echocardiographic parameters of LV were obtained within 24 h after birth. Clinical and outcomes data were recorded, echocardiograms evaluated for left ventricular internal dimension in end-diastole (LVIDd), end-diastolic volume (EDV), stroke volume (SV) and cardiac output index (CI), among others. RESULTS There were 18 omphalocele newborns with PH, of whom 14 survived and 4 died. Both groups were comparable in the baseline characteristics. Non-survival was associated with a smaller LV [LVIDd (12.2 mm versus15.7 mm, p < 0.05), EDV (3.5 ml versus 6.8 ml, p < 0.05)] and with worse systolic function [SV (2.3 ml versus 4.2 ml, p < 0.05), and CI (1.7 L/min/m2 versus 2.9 L/min/m2, p < 0.01)]. CONCLUSION In the cohort of omphalocele patients with PH, lower LVIDd, EDV, SV and CI were associated with mortality. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Si-Si Yang
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, Zhejiang, China
| | - Wen-Chang Huang
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, Zhejiang, China
| | - Peng Wang
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, Zhejiang, China
| | - Fang-Qi Gong
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, Zhejiang, China.
| | - Tai-Xiang Liu
- Department of NICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, Zhejiang, China
| | - Jin-Fa Tou
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, Zhejiang, China.
| | - Deng-Ming Lai
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, Zhejiang, China.
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Gallagher LT, Lyttle BD, Meyers ML, Gien J, Zaretsky MV, Galan HL, Behrendt N, Liechty KW, Derderian SC. Fetal lung volumes measured by MRI predict pulmonary morbidity among infants with giant omphaloceles. Prenat Diagn 2023; 43:1514-1519. [PMID: 37807606 DOI: 10.1002/pd.6449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/10/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Giant omphaloceles (GO) have associated pulmonary hypoplasia and respiratory complications. Total lung volumes (TLV) on fetal MRI can prognosticate congenital diaphragmatic hernia outcomes; however, its applicability to GO is unknown. We hypothesize that late gestation TLV and observed-to-expected TLV (O/E TLV) on fetal MRI correlate with postnatal pulmonary morbidity in GO. METHOD A single-institution retrospective review of GO evaluated between 2012 and 2022 was performed. Fetal MRI TLV between 32 and 36 weeks' gestation and O/E TLV throughout gestation were calculated and correlated with postnatal outcomes. RESULTS 86 fetuses with omphaloceles were evaluated; however, only 26 met strict inclusion criteria. MRIs occurred between 18 and 36 weeks' gestation. Those requiring delivery room intubation had significantly lower late gestation TLV and O/E TLV. O/E TLV predicted tracheostomy placement and survival. Neither TLV nor O/E TLV predicted the length of hospitalization or supplemental oxygen after discharge. Three fetuses had a TLV less than 35 mL: one died of respiratory failure, and the other two required tracheostomy. CONCLUSIONS Fetal MRI TLV measured between 32 and 36 weeks' gestation and O/E TLV predict the need for delivery room intubation and tracheostomy. O/E TLV correlated with survival. These data support fetal MRI as a prognostic tool to predict GO associated pulmonary morbidity.
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Affiliation(s)
- Lauren T Gallagher
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bailey D Lyttle
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mariana L Meyers
- Colorado Institute for Maternal and Fetal Health, Aurora, Colorado, USA
- Department of Radiology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Jason Gien
- Colorado Institute for Maternal and Fetal Health, Aurora, Colorado, USA
- Department of Pediatrics, University Colorado Denver, Aurora, Colorado, USA
| | - Michael V Zaretsky
- Colorado Institute for Maternal and Fetal Health, Aurora, Colorado, USA
- Department of Obstetrics and Gynecology, University Colorado Denver, Aurora, Colorado, USA
| | - Henry L Galan
- Colorado Institute for Maternal and Fetal Health, Aurora, Colorado, USA
- Department of Obstetrics and Gynecology, University Colorado Denver, Aurora, Colorado, USA
| | - Nicholas Behrendt
- Colorado Institute for Maternal and Fetal Health, Aurora, Colorado, USA
- Department of Obstetrics and Gynecology, University Colorado Denver, Aurora, Colorado, USA
| | - Kenneth W Liechty
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Colorado Institute for Maternal and Fetal Health, Aurora, Colorado, USA
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatric Surgery, University of Arizona, Tucson, Arizona, USA
| | - Sarkis Christopher Derderian
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Colorado Institute for Maternal and Fetal Health, Aurora, Colorado, USA
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
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3
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Malhotra R, Malhotra B, Ramteke H. Enhancing Omphalocele Care: Navigating Complications and Innovative Treatment Approaches. Cureus 2023; 15:e47638. [PMID: 38021990 PMCID: PMC10667945 DOI: 10.7759/cureus.47638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Congenital abdominal wall abnormalities in infants present an interesting and difficult management problem for surgeons. Congenital malformations of the ventral abdominal wall can be diagnosed by their distinctive anatomical presentations. Among them, omphalocele, gastroschisis and umbilical cord hernias are the most frequently observed clinically detected abdominal wall anomalies. Omphalocele refers to the herniation of abdominal contents through a defect in the abdominal wall at the umbilicus with or without the presence of a sac. This article gives an insight into the embryology, risk factors, treatment, investigations and complications of omphalocele, a common congenital abdominal wall defect. There is minimal proof that environmental factors contribute to the development of omphalocele. However, there is a considerable amount of evidence which points to the importance of genetic or familial risk factors. Newborns and infants with prenatal diagnoses are the most frequently presenting patients with omphalocele to paediatric surgeons. This article describes the problems and the steps of management for handling each circumstance, as well as any further complications. Omphalocele and gastroschisis are frequently described together in many research papers. However, it's crucial to consider that they are two different conditions which vary in anatomy, pathology and associated conditions which account for the difference in their treatments and noticeably varied outcomes. Additionally, there is evidence that each has a different set of factors associated with risk for occurrence. There are no known etiologic causes that cause these abnormalities to develop. The size of the baby, the extent of the lesion, and any other disorders all affect how individuals with these congenital abdominal wall anomalies are treated.
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Affiliation(s)
- Ritika Malhotra
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institue of Higher Education and Research, Wardha, IND
| | | | - Harshal Ramteke
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institue of Higher Education and Research, Wardha, IND
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4
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Yucel Celik O, Keles A, Obut M, Gultekin Calik M, Dagdeviren G, Cayonu Kahraman N, Yücel A, Şahin D. Pregnancy outcomes and prenatal traditional karyotype analysis with fetal omphalocele. Minerva Obstet Gynecol 2023; 75:87-92. [PMID: 37052892 DOI: 10.23736/s2724-606x.21.04917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Omphalocele is associated with many aneuploidies, deletions and congenital anomalies. This study evaluates pregnancies diagnosed with omphalocele and its relevance to concomitant genetic disorders. METHODS The data of patients with the intrauterine diagnosis of omphalocele who had invasive diagnostic testing performed between January 2017 and January 2020 were evaluated retrospectively. The traditional karyotype analysis was performed to prenatal diagnosis for all fetuses. During the study period, all patients were scanned via ultrasonography by an experienced perinatologist, prenatally. RESULTS We evaluated 22 cases of omphalocele whose genetic testing results were available. The mean maternal age was 25 (18-41) years. The median gestational week at diagnosis was 13 (11-22). Invasive genetic testing revealed aneuploidy in 7 patients (31.8%), 2 with trisomy 13 (9.1%), and 5 with trisomy 18 (22.8%). There were 5 fetuses (22.7%) that had extracorporeal liver: 1 had trisomy 18 (20%), 1 had trisomy 13 (20%), and the other 3 fetuses had a normal karyotype (60%). Further, 14 (63.6%) pregnancies were terminated: 4 had trisomy 18 (28.6%), 1 had trisomy 13 (7.1%), and 9 of the terminated pregnancies (64.3%) had additional congenital anomalies. There were 4 infants who died (50%) born from 8 patients who decided to continue with their pregnancy. The omphalocele sac of 1 infant spontaneously regressed in the ensuing weeks of pregnancy who is now 1 year old. CONCLUSIONS The chromosomal abnormalities presented in up to 31.8% of cases diagnosed with omphalocele. Moreover, for cases with normal genetic testing results, the propensity for additional structural defects was high and the prognosis remains poor. Counseling parents to consider their option of terminating the pregnancy is appropriate.
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Affiliation(s)
- Ozge Yucel Celik
- Department of Perinatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey -
| | - Ayse Keles
- Department of Perinatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Mehmet Obut
- Department of Perinatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Mine Gultekin Calik
- Department of Perinatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Gulsah Dagdeviren
- Department of Perinatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Neval Cayonu Kahraman
- Department of Perinatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Aykan Yücel
- Department of Perinatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Dilek Şahin
- Department of Perinatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
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5
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Fetal Omphalocele: Review of Predictive Factors Important for Antenatal Counseling? Obstet Gynecol Surv 2022; 77:683-695. [DOI: 10.1097/ogx.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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6
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Systemic Inflammation Is Associated with Pulmonary Hypertension in Isolated Giant Omphalocele: A Population-Based Study. Healthcare (Basel) 2022; 10:healthcare10101998. [PMID: 36292445 PMCID: PMC9601560 DOI: 10.3390/healthcare10101998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
Our objective is to determine perinatal factors contributing to the development of pulmonary hypertension (PH) in patients with isolated giant omphaloceles (GO). All cases of omphaloceles that underwent prenatal and postnatal care at the University Hospital of Lille between 1996 and 2021 were reviewed. We included all infants with isolated GO, including at least a part of the liver, who were treated by delayed surgical closure. Prenatal and postnatal data were recorded and correlated with postnatal morbidities. We compared outcomes between a group of infants with GO who developed PH and infants with GO with no PH. We identified 120 infants with omphalocele. Fifty isolated GO cases fulfilled the inclusion criteria of our study. The incidence of PH was 30%. We highlighted a prolonged inflammatory state, defined as a CRP superior to 15 mg/L, platelets higher than 500 G/L, and white blood cells higher than 15 G/l for more than 14 days in patients who developed PH. This event occurred in 73% of patients with PH versus 21% of patients without PH (p < 0.05). Late-onset infection was not different between the two groups. We speculate that prolonged inflammatory syndrome promotes PH in infants with GO treated with delayed surgical closure.
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7
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Bohîlțea RE, Bacalbașa N, Mihai BM, Grigoriu C, Gheorghe CM, Georgescu TA, Vlădăreanu IM, Varlas V. Ductus venosus reversed flow in omphalocele: Could it be a prognostic factor for long-term neurological impairment? J Med Life 2022; 14:726-730. [PMID: 35027978 PMCID: PMC8742901 DOI: 10.25122/jml-2021-0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/30/2021] [Indexed: 11/17/2022] Open
Abstract
Omphalocele (exomphalos) represents one of the most frequent congenital abdominal wall defects. It presents as a defect of inconstant size and is located on the midline, at the base of the umbilical cord, the skin, fascia, and abdominal muscles being absent at this level. Omphaloceles are classified as liver-containing or non-liver-containing, the latter containing primarily bowel loops. We present the case of a 37-year-old pregnant woman with an early diagnosis of liver-containing omphalocele associating ductus venosus reversed flow, with the aim to highlight the importance of the first-trimester morphology scan and to develop a pilot study regarding the neurological development of infants after surgical repair of giant omphaloceles. The particularity of this case consists of a fetus with a positive diagnosis of a giant liver-containing omphalocele but with a small abdominal wall defect during the first-trimester morphology scan at 13 weeks and 3 days of gestation which associated ductus venosus reversed flow, presenting a normal karyotype postabortum. With a small defect, we can speculate the risk of strangling besides the mechanical traction exercised on the ductus venosus generating fetal distress, specifically fetal hypoxia at an early gestational age. In conclusion, the main issue, in this case, was if the fetal omphalocele and ductus venosus reversed flow indicated fetal hypoxia, what was the obstruction effect on the oxygenated blood pathway caused by the abdominal defect, and which were the long-term effects on infants with this complex pathology with an unknown outcome.
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Affiliation(s)
- Roxana Elena Bohîlțea
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicolae Bacalbașa
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Bianca Margareta Mihai
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Corina Grigoriu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Consuela-Mădălina Gheorghe
- Department of Marketing and Medical Technology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Irina Maria Vlădăreanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Valentin Varlas
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
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8
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Kawaguchi K, Obayashi J, Koike J, Tanaka K, Seki Y, Nagae H, Ohyama K, Furuta S, Valsenti G, Pringle KC, Kitagawa H. Muscle imbalance as a cause of scoliosis: a study in a fetal lamb abdominal wall defect model. Pediatr Surg Int 2021; 37:1755-1760. [PMID: 34510262 DOI: 10.1007/s00383-021-05000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We created abdominal wall defects (AWD) in fetal lambs to investigate possible causes of scoliosis. METHODS We incised the upper abdominal wall (including Rectus) in 60-day gestation fetal lambs, from the midline to either the right (Group A) or left (Group B) costal margin, in 14 lambs carried by 7 ewes. They were delivered by cesarean section at term (about 145 days). Scoliosis was evaluated by anterio-posterior X-rays, determining the Cobb angle. RESULTS Four fetuses in Group A and 3 in Group B survived. There were 3 successful AWD lambs Group A and 2 in Group B. One lamb in each group survived with the AWD covered with a thick capsule. The convexity of spinal curve was the direction of scoliosis. Right scoliosis was only seen in the 4 Group A lambs. Left scoliosis was only seen in Group B lambs (2/3, 67%). The mean Cobb angle was 41.7 ± 11.5° in Group A and in Group B the Cobb angles were 59.6o and 60.6°. Overall, 4/5 lambs with organ prolapse (80%) and both lambs without organ prolapse had scoliosis. CONCLUSION Muscle imbalance may contribute to the development of scoliosis in a fetal lamb AWD model.
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Affiliation(s)
- Kohei Kawaguchi
- Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand
| | - Juma Obayashi
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Junki Koike
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kunihide Tanaka
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Yasuji Seki
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Hideki Nagae
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Kei Ohyama
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Shigeyuki Furuta
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Gianluca Valsenti
- Department of Radiology, Capital & Coast DHB, Wellington, New Zealand
| | - Kevin C Pringle
- Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand
| | - Hiroaki Kitagawa
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.
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Lelj-Garolla B, Campbell L, Kanungo J, Yoshida N. Use of a neoprene binding to reduce giant omphaloceles followed by delayed closure. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000284. [DOI: 10.1136/wjps-2021-000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/02/2021] [Indexed: 11/03/2022] Open
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10
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Dal Col AK, Bhombal S, Tacy TA, Hintz SR, Feinstein J, Altit G. Comprehensive Echocardiographic Assessment of Ventricular Function and Pulmonary Pressure in the Neonatal Omphalocele Population. Am J Perinatol 2021; 38:e109-e115. [PMID: 32198744 DOI: 10.1055/s-0040-1708048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pulmonary hypertension (PH) has been described in the neonatal omphalocele population. This study was aimed to describe cardiac function and PH severity using echocardiography in newborns with giant omphalocele (GO) and with non-GO and determine if right ventricular (RV) dysfunction is associated with mortality. STUDY DESIGN Retrospective, single-center analysis of first echocardiography among neonatal omphalocele patients born between 2004 and 2017 was conducted. Multivariate logistic and univariate Cox's regression was constructed to measure hazard ratio (HR) for death outcome. RESULTS There were 32 newborns, of whom 18 were GO and 7 died. GO had increased systolic pulmonary arterial to systolic systemic blood pressure ratio (97% [isosystemic] vs. 73% [three-fourths systemic] p = 0.03). RV performance parameters (tricuspid annular plane excursion, HR = 0.40; fractional area change, HR = 0.90; and RV peak global longitudinal strain, HR = 1.39) were associated with mortality. These RV performance parameters remained associated in a multiple logistic regression accounting for gestational age and GO status. The overall population had abnormal eccentricity index and pulmonary artery acceleration time to RV ejection time ratio, two markers of PH. CONCLUSION Patients with omphalocele have increased pulmonary pressure, with GO being worse than non-GO. RV dysfunction at initial echocardiography was significantly associated with mortality.
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Affiliation(s)
- Alexis K Dal Col
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California
| | - Shazia Bhombal
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California
| | - Theresa A Tacy
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California
| | - Jeffrey Feinstein
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California
| | - Gabriel Altit
- Department of Neonatology, McGill University Health Centre, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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11
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Nitzsche K, Fitze G, Rüdiger M, Wimberger P, Birdir C. Prenatal diagnosis of exomphalos and prediction of outcome. Sci Rep 2021; 11:8752. [PMID: 33888820 PMCID: PMC8062495 DOI: 10.1038/s41598-021-88245-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/05/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to detect a parameter for predicting prenatal complications or postnatal surgical options after detecting a fetal exomphalos. This was a retrospective analysis of prenatal diagnosis and outcome of fetuses with 41 cases of exomphalos in between 2007 and 2017, considering the measurement of ratios. The 41 fetuses with exomphalos were examined, 34 cases (82.9%) with karyotyping and 16 cases (39%) with an abnormal karyotype. Outcome of 39 cases showed 6 abortions (15.4%), 15 terminations (38.5%), an intrauterine fetal death (2.5%) and 17 alive babies (43.6%), which were grouped in two: small exomphalos (n = 6, 35.3%) and big exomphalos (n = 11, 64.7%). Maximal diameter of exomphalos/abdomen circumference-ratio (EDmax/AC-ratio) with a cut-off of 0.24 showed a better predictive value of postnatal primary closure. Exomphalos is correlated with abnormal karyotype. EDmax/AC-ratio gives the best prediction for postnatal primary closure of the defect.
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Affiliation(s)
- K Nitzsche
- Department of Obstetrics and Gynecology, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, 01307, Dresden, Germany
| | - G Fitze
- Department of Pediatric Surgery, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, 01307, Dresden, Germany
| | - M Rüdiger
- Department of Pediatrics, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, 01307, Dresden, Germany.,Saxony Center for Feto/Neonatal Health, Technische Universität Dresden, 01307, Dresden, Germany
| | - P Wimberger
- Department of Obstetrics and Gynecology, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, 01307, Dresden, Germany
| | - C Birdir
- Department of Obstetrics and Gynecology, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, 01307, Dresden, Germany. .,Saxony Center for Feto/Neonatal Health, Technische Universität Dresden, 01307, Dresden, Germany.
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12
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Adams AD, Stover S, Rac MW. Omphalocele-What should we tell the prospective parents? Prenat Diagn 2021; 41:486-496. [PMID: 33540475 DOI: 10.1002/pd.5886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
An omphalocele is a congenital defect in the abdominal wall characterized by absent abdominal muscles, fascia, and skin. The characteristic ultrasound appearance includes a midline defect with herniation of abdominal contents into the base of the umbilical cord. Other anatomic abnormalities are seen in approximately 50% of cases, most notably cardiac defects (19%-32%). Approximately, 50% of cases are associated with genetic and multiple malformation syndromes including trisomy 13/18, pentalogy of Cantrell and Beckwith-Wiedemann syndrome. Therefore, a thorough evaluation is recommended, including detailed anatomic survey, fetal echocardiogram, genetic counseling, and prenatal diagnostic testing. Overall prognosis depends on the size of the omphalocele, genetic studies, and associated anomalies. Early prenatal diagnosis remains important in order to provide parental counseling and assist in pregnancy management. Delivery should occur at a tertiary care center. Timing and mode of delivery should be based on standard obstetric indications with cesarean delivery reserved for large omphalocele (>5 cm) or those that involve the fetal liver. Neonatal management involves either primary or staged reduction, both of which can be associated with a prolonged neonatal hospitalization.
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Affiliation(s)
- April D Adams
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Samantha Stover
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Martha W Rac
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA
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Raitio A, Syvänen J, Tauriainen A, Hyvärinen A, Sankilampi U, Gissler M, Helenius I. Long-term hospital admissions and surgical treatment of children with congenital abdominal wall defects: a population-based study. Eur J Pediatr 2021; 180:2193-2198. [PMID: 33666724 PMCID: PMC8195905 DOI: 10.1007/s00431-021-04005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
Congenital abdominal wall defects, namely, gastroschisis and omphalocele, are rare congenital malformations with significant morbidity. The long-term burden of these anomalies to families and health care providers has not previously been assessed. We aimed to determine the need for hospital admissions and the requirement for surgery after initial admission at birth. For our analyses, we identified all infants with either gastroschisis (n=178) or omphalocele (n=150) born between Jan 1, 1998, and Dec 31, 2014, in the Register of Congenital Malformations. The data on all hospital admissions and operations performed were acquired from the Finnish Hospital Discharge Register between Jan 1, 1998, and Dec 31, 2015, and compared to data on the whole Finnish pediatric population (0.9 million) live born 1993-2008. Patients with gastroschisis and particularly those with omphalocele required hospital admissions 1.8 to 5.7 times more than the general pediatric population (p<0.0001). Surgical interventions were more common among omphalocele than gastroschisis patients (p=0.013). At the mean follow-up of 8.9 (range 1.0-18.0) years, 29% (51/178) of gastroschisis and 30% (45/150) of omphalocele patients required further abdominal surgery after discharge from the neonatal admission.Conclusion: Patients with gastroschisis and especially those with omphalocele, are significantly more likely than the general pediatric population to require hospital care. Nevertheless, almost half of the patients can be treated without further surgery, and redo abdominal surgery is only required in a third of these children. What is Known: • Gastroschisis and omphalocele are congenital malformations with significant morbidity • There are no reports on the long-term need for hospital admissions and surgery in these children What is New: • Patients with abdominal wall defects are significantly more likely than the general pediatric population to require hospital care • Almost half of the patients can be treated without further surgery, and abdominal redo operations are only required in a third of these children.
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Affiliation(s)
- Arimatias Raitio
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
| | - Johanna Syvänen
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Asta Tauriainen
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland ,University of Eastern Finland, Kuopio, Finland
| | - Anna Hyvärinen
- Department of Paediatric Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Ulla Sankilampi
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland ,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Nembhard WN, Bergman JEH, Politis MD, Arteaga-Vázquez J, Bermejo-Sánchez E, Canfield MA, Cragan JD, Dastgiri S, de Walle HEK, Feldkamp ML, Nance A, Gatt M, Groisman B, Hurtado-Villa P, Kallén K, Landau D, Lelong N, Lopez-Camelo J, Martinez L, Morgan M, Pierini A, Rissmann A, Šípek A, Szabova E, Tagliabue G, Wertelecki W, Zarante I, Bakker MK, Kancherla V, Mastroiacovo P. A multi-country study of prevalence and early childhood mortality among children with omphalocele. Birth Defects Res 2020; 112:1787-1801. [PMID: 33067932 DOI: 10.1002/bdr2.1822] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Omphalocele is the second most common abdominal birth defect and often occurs with other structural and genetic defects. The objective of this study was to determine omphalocele prevalence, time trends, and mortality during early childhood, by geographical region, and the presence of associated anomalies. METHODS We conducted a retrospective study with 23 birth defect surveillance systems in 18 countries who are members of the International Clearinghouse for Birth Defects Surveillance and Research that submitted data on cases ascertained from 2000 through 2012, approximately 16 million pregnancies were surveyed that resulted in live births, stillbirths, or elective terminations of pregnancy for fetal anomalies (ETOPFA) and cases with omphalocele were included. Overall prevalence and mortality rates for specific ages were calculated (day of birth, neonatal, infant, and early childhood). We used Kaplan-Meier estimates with 95% confidence intervals (CI) to calculate cumulative mortality and joinpoint regression for time trend analyses. RESULTS The prevalence of omphalocele was 2.6 per 10,000 births (95% CI: 2.5, 2.7) and showed no temporal change from 2000-2012 (average annual percent change = -0.19%, p = .52). The overall mortality rate was 32.1% (95% CI: 30.2, 34.0). Most deaths occurred during the neonatal period and among children with multiple anomalies or syndromic omphalocele. Prevalence and mortality varied by registry type (e.g., hospital- vs. population-based) and inclusion or exclusion of ETOPFA. CONCLUSIONS The prevalence of omphalocele showed no temporal change from 2000-2012. Approximately one-third of children with omphalocele did not survive early childhood with most deaths occurring in the neonatal period.
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Affiliation(s)
- Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Little Rock, Arkansas, USA.,Arkansas Reproductive Health Monitoring System, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Jorieke E H Bergman
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria D Politis
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jazmín Arteaga-Vázquez
- RYVEMCE (Mexican Registry and Epidemiological Surveillance of Congenital Malformations), Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations) and ECEMC's Clinical Network, Research Unit on Congenital Anomalies, Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Janet D Cragan
- Metropolitan Atlanta Congenital Defects Program, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saeed Dastgiri
- Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hermien E K de Walle
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy Nance
- Utah Birth Defect Network, Bureau of Children with Special Health Care Needs, Division of Family Health and Preparedness, Utah Department of Health, Salt Lake City, Utah, USA
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Valletta, Malta
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health and Social Development, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Kärin Kallén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- REMAPAR, Paris Registry of Congenital Malformations, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Laura Martinez
- Genetics Department, Hospital Universitario Dr Jose E. Gonzalez, Universidad Autonóma de Nuevo León, Nuevo León, Mexico
| | - Margery Morgan
- The Congenital Anomaly Register and Information Service for Wales, Singleton Hospital, Swansea, Wales, UK
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council/Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Antonin Šípek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovakia
| | - Giovanna Tagliabue
- Lombardy Congenital Anomalies Registry, Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale dei tumori, Milan, Italy
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Marian K Bakker
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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15
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Giant Isolated Omphalocele: Role of Prenatal Diagnosis in Prognostic Asessment and Perinatal Management. Case Rep Med 2020; 2020:4578912. [PMID: 32565822 PMCID: PMC7303742 DOI: 10.1155/2020/4578912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/07/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022] Open
Abstract
Omphalocele is a congenital malformation of the abdominal wall consisting of a protrusion of the abdominal contents at the base of the umbilical cord. It has a high association with genetic and structural defects; however, if the latter is ruled out, its prognosis improves significantly. Prenatal diagnosis has a key role in this condition as omphalocele can be diagnosed by ultrasound in the first trimester scan, enabling a coordinated approach strategy to achieve the best perinatal results. We present a case report of a pregnant patient with a fetus having a giant omphalocele in which prenatal diagnosis played a decisive role, allowing the coordination of a multidisciplinary team, which was crucial in the immediate care of the newborn.
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16
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Hijkoop A, Rietman AB, Wijnen RMH, Tibboel D, Cohen-Overbeek TE, van Rosmalen J, IJsselstijn H. Omphalocele at school age: What do parents report? A call for long-term follow-up of complex omphalocele patients. Early Hum Dev 2019; 137:104830. [PMID: 31374454 DOI: 10.1016/j.earlhumdev.2019.104830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Many children with omphalocele experience morbidity in early life, which could affect long-term outcomes. We determined parent-reported outcomes in school-aged children treated for minor or giant omphalocele. STUDY DESIGN We sent paper questionnaires to the parents of all children treated for omphalocele in 2000-2012. Giant omphalocele was defined as defect diameter ≥ 5 cm with liver protruding. Motor function (MABC-2 Checklist) was compared with Dutch reference data; cognition (PedsPCF), health status (PedsQL), quality of life (DUX-25) and behavior (Strengths and Difficulties Questionnaire; SDQ) were compared with those of controls (two per child) matched for age, gender and maternal education level. Possible predictors of cognition and behavior were evaluated using linear regression analyses. RESULTS Of 54 eligible participants, 31 (57%) returned the questionnaires. MABC-2 Checklist scores were normal for 21/26 (81%) children. Cognition, health status, quality of life and behavior were similar to scores of matched controls. One quarter (26%) of children with omphalocele scored ≤ - 1 standard deviation on the PedsPCF, compared with 9% of matched controls (p = 0.07). Giant omphalocele and presence of multiple congenital anomalies (MCA) were most prominently associated with lower PedsPCF scores (giant omphalocele: β -22.11 (95% CI: -43.65 to -0.57); MCA -23.58 (-40.02 to -7.13)), although not significantly after correction for multiple testing. CONCLUSIONS Parent-reported outcomes of children with omphalocele at school age are reassuring. Children with an isolated, minor omphalocele do not need extensive long-term follow-up of daily functioning. Those with a giant omphalocele or MCA might be at risk for delayed cognitive functioning at school age; we recommend long-term follow-up to offer timely intervention.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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17
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Danzer E, Hoffman C, Miller JS, D'Agostino JA, Schindewolf EM, Gerdes M, Bernbaum J, Adams SE, Rintoul NE, Herkert LM, Taylor L, Schreiber J, Peranteau WH, Flake AW, Adzick NS, Hedrick HL. Autism spectrum disorder and neurodevelopmental delays in children with giant omphalocele. J Pediatr Surg 2019; 54:1771-1777. [PMID: 31196668 DOI: 10.1016/j.jpedsurg.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 05/06/2019] [Accepted: 05/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence and identify risk factors of autism spectrum disorders (ASDs) and neurodevelopmental delays in giant omphalocele (GO) survivors. MATERIALS AND METHODS The study cohort consists of 47 GO survivors enrolled in our follow-up program between 07/2004 and 12/2015. All patients underwent assessments at 2 years of age or older. Outcomes were assessed by either the Bayley Scales of Infant Development II (prior 2006) or III (after 2006), or the Wechsler Preschool and Primary Scale of Intelligence (children older than 4 years). ASD diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders IV (prior to 2014) or 5 criteria. RESULTS The prevalence of ASD in GO children is 16 times higher than the general population (P = 0.0002). ASD patients were more likely to be diagnosed with neurodevelopmental and neurofunctional delays, language disorders, and genetic abnormalities (P < 0.01). While 53.2% of GO children scored within the average range for all developmental domains, 19.1% scored within the mildly delayed and 27.7% in the severe delayed range in at least one domain. Prolonged respiratory support, pulmonary hypertension, gastroesophageal reflux disease, feeding problems, prolonged hospitalization, abnormal BAER hearing screen, presence of delayed motor coordination, and hypotonicity were associated with delayed scores (P < 0.05). CONCLUSIONS There is a significant rate of ASD in GO survivors. Neurodevelopmental delays, language delays, and genetic abnormalities were strongly associated with ASD. Neurological impairments were present in nearly half of GO children. Surrogate markers of disease severity were associated with below average neurodevelopmental scores. Level of evidence Level IV.
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Affiliation(s)
- Enrico Danzer
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia.
| | - Casey Hoffman
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Judith S Miller
- Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jo Ann D'Agostino
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Erica M Schindewolf
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Marsha Gerdes
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Judy Bernbaum
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Samantha E Adams
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Natalie E Rintoul
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Lisa M Herkert
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Lynne Taylor
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jane Schreiber
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - William H Peranteau
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Alan W Flake
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - N Scott Adzick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
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18
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Prenatally diagnosed omphalocele: characteristics associated with adverse neonatal outcomes. J Perinatol 2019; 39:1111-1117. [PMID: 31227786 DOI: 10.1038/s41372-019-0410-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To characterize factors associated with adverse neonatal outcomes in prenatally diagnosed omphalocele cases. STUDY DESIGN Prenatally diagnosed omphalocele cases at a single referral center from 1 January 2009 to 31 December 2017 were retrospectively reviewed. Clinical variables and antenatal imaging measurements were collected. Associations between prenatal and neonatal characteristics and the adverse outcome of death or prolonged length of stay (LOS) were analyzed. RESULTS Out of 63 fetal cases, 33 were live-born, > 50% had other anomalies, and neonatal mortality was 12%. Adverse outcomes were associated with neonatal variables, including lower median 1-min Apgar score, initial mechanical ventilation, and late-onset sepsis, but not approach to omphalocele closure. With multivariate analysis, death or prolonged LOS was associated only with low lung volumes by fetal MRI (OR 34 (3-422), p = 0.006). CONCLUSION Low lung volumes by fetal MRI were associated with death or prolonged LOS in neonates with prenatally diagnosed omphalocele and may guide clinicians with counseling families.
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19
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Raymond SL, Downard CD, St Peter SD, Baerg J, Qureshi FG, Bruch SW, Danielson PD, Renaud E, Islam S. Outcomes in omphalocele correlate with size of defect. J Pediatr Surg 2019; 54:1546-1550. [PMID: 30414688 DOI: 10.1016/j.jpedsurg.2018.10.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/29/2018] [Accepted: 10/04/2018] [Indexed: 11/19/2022]
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.
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MESH Headings
- Birth Weight
- Hernia, Umbilical/epidemiology
- Hernia, Umbilical/mortality
- Hernia, Umbilical/pathology
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/mortality
- Infant, Newborn, Diseases/pathology
- Retrospective Studies
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Affiliation(s)
- Steven L Raymond
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Cynthia D Downard
- Division of Pediatric Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA
| | | | - Joanne Baerg
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steven W Bruch
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Elizabeth Renaud
- Division of Pediatric Surgery, Department of Surgery, Albany Medical College, Albany, NY, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
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20
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Abstract
Management of the very large defect or those in patients with severe comorbidities has evolved to the use of methods that result in escharification and eventual skin coverage over the viscera. This treatment strategy employs principles that were described in the early 20th century. This review will describe the history, principles, methods, and outcomes from the so called 'paint and wait' management of omphalocele.
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Affiliation(s)
- Justin P Wagner
- Department of Pediatric Surgery, Children's Hospital and Medical Center of Omaha, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert A Cusick
- Department of Pediatric Surgery, Children's Hospital and Medical Center of Omaha, University of Nebraska Medical Center, Omaha, NE, USA.
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21
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Abstract
After a diagnosis of omphalocele during pregnancy, questions regarding long-term prognosis are of primary importance for parents. It is imperative that their questions are answered with substantiated data to promote confident decisions for their children. They frequently express concerns regarding long-term survival, quality of life, need for more operations, feeding issues, motor and cognitive development, cosmesis, and the unique difficulties of giant omphaloceles. The available outcome studies that address these questions are discussed.
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Affiliation(s)
- Joanne E Baerg
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, 11175 Campus St., Rm 21111, Loma Linda, CA 92354, United States.
| | - Amanda N Munoz
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, 11175 Campus St., Rm 21111, Loma Linda, CA 92354, United States
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22
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Abstract
The respiratory difficulties experienced by infants with omphalocele are being appreciated with greater frequency. These problems represent self-limited difficulties related to omphalocele closure or are the result of severe pulmonary disease including pulmonary hypoplasia and pulmonary hypertension. Infants with giant omphalocele represent a unique group that may experience increased respiratory morbidity which may lead to chronic respiratory problems extending into childhood and adolescence. Importantly, respiratory insufficiency at birth is an independent predictor of mortality for patients with omphalocele. In this review, we will provide a summary of the respiratory difficulties experienced by patients with omphalocele as well as insight into management and surveillance.
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Affiliation(s)
- Eileen Duggan
- Pediatric Surgery Fellow, Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Pramod S Puligandla
- Pediatric Surgeon and Pediatric Intensivist, Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Room B04.2318, Montreal, QC H4A 3J1, Canada.
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23
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Omphalocele and Gastroschisis. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hutson S, Baerg J, Deming D, St Peter SD, Hopper A, Goff DA. High Prevalence of Pulmonary Hypertension Complicates the Care of Infants with Omphalocele. Neonatology 2017; 112:281-286. [PMID: 28704835 DOI: 10.1159/000477535] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Omphalocele is one of the most common abdominal wall defects. Many newborn infants born with omphalocele present with significant respiratory distress at birth, requiring mechanical ventilatory support, and have clinical evidence of pulmonary hypertension. Little information exists on the prevalence of and risk factors associated with pulmonary hypertension in this cohort of infants. OBJECTIVES To describe the prevalence of and risk factors associated with pulmonary hypertension among infants with omphalocele. METHODS This is a multicenter retrospective chart review of demographic data and clinical characteristics of infants with omphalocele admitted to the neonatal intensive care units of Loma Linda University Children's Hospital and Children's Mercy Hospital between 1994 and 2011. Echocardiogram images were reviewed for pulmonary hypertension, and statistical analyses were performed to identify risk factors associated with the presence of pulmonary hypertension. RESULTS Pulmonary hypertension was diagnosed in 32/56 (57%) infants with omphalocele. Compared to infants without pulmonary hypertension, infants with pulmonary hypertension were more likely to have a liver-containing defect (16/32 [50%] vs. 5/24 [21%], p = 0.03), require intubation at birth (18/32 [56%] vs. 6/24 [17%], p = 0.03), and die during initial hospitalization (12/32 [38%] vs. 2/24 [8%], p = 0.01). CONCLUSION The majority of infants with omphalocele have evidence of pulmonary hypertension which is associated with increased mortality. Echocardiograms to screen for pulmonary hypertension should be obtained at ≥2 days of life in infants with omphalocele, especially in those with liver within the omphalocele sac and/or in those infants who require intubation at birth to screen for pulmonary hypertension.
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Affiliation(s)
- Shandee Hutson
- Department of Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA, USA
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25
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Baerg JE, Thirumoorthi A, Carlton W, Haug S, Hopper AO, Goff D, Ramlogan S, St. Peter SD. Late onset of pulmonary hypertension and sepsis in omphalocele infants. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Baerg JE, Thorpe DL, Sharp NE, Ramlogan SR, Hutson SM, Goff DA, Hopper AO, St Peter SD. Pulmonary hypertension predicts mortality in infants with omphalocele. J Neonatal Perinatal Med 2016; 8:333-8. [PMID: 26836821 DOI: 10.3233/npm-15915011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to identify predictors of mortality in infants with omphalocele. METHODS Medical records of infants with omphalocele born between January 1992 and June 2012, with follow-up toDecember 2012, were retrospectively reviewed. Survivors and non-survivors were compared. Evidence for pulmonary hypertension was sought between the second and seventh day after birth. All included infants had increased right ventricular pressures (RVP >40 mmhg) on echocardiogram on the second day of life with increased oxygen requirements, therefore, the finding of increased pressure was not considered a result of the transitional circulation. Logistic regression was used to evaluate the importance and independence of various factors. RESULTS Of 51 infants whose records were reviewed, 13 died (25%) and 38 survived (75%). The median time to death was 34 days (range: 4 -408 days). The median follow-up time for those who died was 1.5 years (range: 0.01-15 years) and for survivors was 2.6 years (range: 0.08-15 years). Logistic regression revealed that respiratory insufficiency at birth (OR: 14.8; 95% CI: 2.5-85.0) and pulmonary hypertension (OR: 6.4; 95% CI: 1.1-39.0) were independently associated with mortality. CONCLUSION Respiratory insufficiency after birth and pulmonary hypertension are independent predictors of mortality in infants with omphalocele.
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Affiliation(s)
- J E Baerg
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - D L Thorpe
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - N E Sharp
- Children's Mercy Hospital, Kansas City, MO, USA
| | | | - S M Hutson
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - D A Goff
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - A O Hopper
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
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Binet A, Supply E, De Napoli Cocci S, De Cornulier M, Lardy H, Le Touze A. [Tissue expansion in management of giant omphalocele parietal sequelae]. ANN CHIR PLAST ESTH 2016; 62:139-145. [PMID: 27569456 DOI: 10.1016/j.anplas.2016.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE According to major difficulty for the giant omphalocele management in the visceral reintegration and the parietal closure, many teams use currently conservative treatment by topical application. These techniques are suppliers of a covered eventration and a scar sequela requiring a complementary treatment. We report the place of the tissue expansion as complementary treatment. PATIENTS AND METHODS Two patients with a giant omphalocele benefited from a protocol of cutaneous expansion for the correction of their abdominal scar±of their residual eventration. RESULTS An eventration closure was possible thanks to this protocol. The skin expansion allowed the complete excision of the abdominal scar and the defect cover. An additional skin graft was necessary in the first case. CONCLUSION The cutaneous expansion in the parietal sequela management of the giant omphaloceles seems to be an interesting alternative. This technique should be realized remotely and except any septic context.
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Affiliation(s)
- A Binet
- Service de chirurgie pédiatrique viscérale, plastique et brûlés, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours, France.
| | - E Supply
- Service de chirurgie infantile viscérale, néonatale, digestive et thoracique, CHRU de Nantes, 44000 Nantes, France
| | - S De Napoli Cocci
- Service de chirurgie infantile viscérale, néonatale, digestive et thoracique, CHRU de Nantes, 44000 Nantes, France
| | - M De Cornulier
- Établissement de santé pour enfants et adolescents de la région nantaise, 44200 Nantes, France
| | - H Lardy
- Service de chirurgie pédiatrique viscérale, plastique et brûlés, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours, France
| | - A Le Touze
- Service de chirurgie pédiatrique viscérale, plastique et brûlés, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours, France
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Kozlov YA, Novozhilov VA, Koval'kov KA, Rasputin AA, Baradieva PZ, Us GP, Kuznetsova NN. [Congenital defects of abdominal wall]. Khirurgiia (Mosk) 2016:74-81. [PMID: 27447007 DOI: 10.17116/hirurgia2016574-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yu A Kozlov
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk; Irkutsk State Medical Academy of Postgraduate Education
| | - V A Novozhilov
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk; Irkutsk State Medical Academy of Postgraduate Education; Irkutsk State Medical University
| | | | - A A Rasputin
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
| | | | - G P Us
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
| | - N N Kuznetsova
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
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Fawley JA, Peterson EL, Christensen MA, Rein L, Wagner AJ. Can omphalocele ratio predict postnatal outcomes? J Pediatr Surg 2016; 51:62-6. [PMID: 26541312 DOI: 10.1016/j.jpedsurg.2015.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The clinical course of patients with omphalocele is challenging to predict. There is no standard method to characterize omphalocele size. Previous studies suggest that the ratio of abdominal circumference to omphalocele defect in-utero is indicative of postnatal outcomes. We hypothesize that omphalocele ratio correlates with outcomes of primary closure versus staged closure. METHODS A retrospective chart review of all neonates diagnosed with omphalocele from 2002 to 2013 with prenatal ultrasounds available (n=30) was conducted. Omphalocele ratio was defined as omphalocele diameter/abdominal circumference (OD/AC). Data collected included primary versus staged closure, time to full feeds, duration of mechanical ventilation, and length of stay (LOS). Long-term outcomes and quality of life were also reported. RESULTS ROC curve analysis generated optimal OD/AC ratio of 0.26. Twenty of 30 patients had a ratio less than this cutoff. Sixty percent (12/20) in the low-ratio group achieved primary closure versus zero (0/10) in the high-ratio group (p=0.001). Time on mechanical ventilation was 15.8 days (low-ratio) versus 79 days (high-ratio) (p=0.05). LOS was 33.8 days (low-ratio) versus 85.6 days (high-ratio) (p=0.119). PedsQL™ mean score was 85.5 ± 11.0 (n=20) at long-term follow-up. Readmission rates yielded no difference. CONCLUSIONS The omphalocele ratio is a promising predictor of postnatal outcomes.
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Affiliation(s)
- Jason A Fawley
- Medical College of Wisconsin, Milwaukee WI, USA; Children's Hospital of Wisconsin, Milwaukee WI, USA
| | | | - Melissa A Christensen
- Medical College of Wisconsin, Milwaukee WI, USA; Children's Hospital of Wisconsin, Milwaukee WI, USA
| | - Lisa Rein
- Medical College of Wisconsin, Milwaukee WI, USA
| | - Amy J Wagner
- Medical College of Wisconsin, Milwaukee WI, USA; Children's Hospital of Wisconsin, Milwaukee WI, USA.
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Systemic hypertension in giant omphalocele: An underappreciated association. J Pediatr Surg 2015; 50:1477-80. [PMID: 25783355 DOI: 10.1016/j.jpedsurg.2015.02.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the incidence, severity and duration of systemic hypertension in infants born with giant omphalocele (GO). METHODS A retrospective review of patients born from 2003 through 2013 with a GO or intestinal atresia (control population) and managed at a single institution was performed. The hospital course was reviewed including all blood pressures, method of omphalocele repair, requirement for antihypertensive medications and renal function. RESULTS Forty-five GO and 20 control patients met criteria for the study. Thirty-three GO patients underwent Schuster repair and 12 GO patients underwent delayed repair after epithelialization. Overall, 78% of GO patients had episodes of hypertension (82% Schuster and 67% delayed repair) compared to 15% of control patients (P<0.001). The majority of episodes were transient and occurred in the postoperative period (97%). Hypertension was persistent in 4 GO patients. These patients required antihypertensive medication at discharge, which was discontinued as an outpatient. No patient demonstrated significant evidence of renal abnormalities as indicated by renal ultrasound, urinalysis and/or serum creatinine level at the time of hypertension. CONCLUSION Episodes of systemic hypertension are frequent in patients with GO. Episodes are often post-operative, transient and can be present in patients undergoing either a delayed or Schuster repair. A small subset of patients will have persistent hypertension requiring antihypertensive medication that can be weaned off in an outpatient setting.
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Abstract
Prenatal detection of a wide variety of anomalies and masses of the gastrointestinal tract is now possible. Prenatal imaging with ultrasonography and in selected cases magnetic resonance imaging provides invaluable information to the referring obstetrician, the maternal fetal medicine specialist, the neonatologist and pediatrician who will care for the child after birth, the surgeons and pediatric specialists who will repair or manage a prenatally detected anomaly, and of course to the parents, allowing them to prepare psychologically and financially for the specific interventions that may be needed for their child. Additional screening for associated anomalies can take place, route of delivery can be decided, and arrangements for delivery in an appropriate setting can be made. Prenatal detection also allows for consideration for pregnancy termination. This article will give a broad overview of anomalies of the gastrointestinal tract that can be detected prenatally and their imaging appearance postnatally.
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Peters NCJ, Visser 't Hooft ME, Eggink AJ, Tibboel D, Ursem N, Wijnen RMH, Bonsel GJ, Cohen-Overbeek TE. Prenatal Prediction of the Type of Omphalocele Closure by Different Medical Consultants. Fetal Diagn Ther 2015; 39:40-9. [PMID: 26066620 DOI: 10.1159/000430439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/27/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To evaluate differences between consultants of different disciplines in the prenatal prediction of the type of postnatal surgical closure of an omphalocele. MATERIAL AND METHODS Twenty-one images of prenatally detected omphaloceles prior to 24 weeks of gestation were included. A standardized form provided known prenatal information and an ultrasound image for each case. Nineteen consultants were asked to assess the probability of primary closure of an omphalocele and to state which information was the most important for their assessment. RESULTS Primary closure (13/21 images) was predicted correctly in 5/13 images. The number of correct predictions per image ranged from 63 to 89%. The type of closure was predicted correctly in 7/8 images of cases which were not closed primarily, ranging from 58 to 84% correct predictions per image. There was no significant difference between consultants of different disciplines. Individual accuracy ranged from 10 to 62%. The consultants regarded omphalocele content as the most important information (34%) for counseling. DISCUSSION The consultants did not differ in their prenatal judgment of the primary closure of an omphalocele. The consultants tended to be too negative in their assessment, since 75% assessed the probability of primary closure overall to be <60%, whereas 62% of the cases were primarily closed. Omphalocele content was the most important information for the consultants' judgment.
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Affiliation(s)
- Nina C J Peters
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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GAD65/GAD67 double knockout mice exhibit intermediate severity in both cleft palate and omphalocele compared with GAD67 knockout and VGAT knockout mice. Neuroscience 2015; 288:86-93. [DOI: 10.1016/j.neuroscience.2014.12.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/11/2014] [Accepted: 12/13/2014] [Indexed: 12/24/2022]
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Patient characteristics are important determinants of neurodevelopmental outcome during infancy in giant omphalocele. Early Hum Dev 2015; 91:187-93. [PMID: 25676186 DOI: 10.1016/j.earlhumdev.2014.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/26/2014] [Accepted: 12/28/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine patient-specific factors as potential predictors of neurodevelopmental (ND) outcome in children with giant omphalocele (GO). MATERIALS Between 06/2005 and 07/2012, 31 consecutive GO survivors underwent ND assessment using the BSID-III at a median of 24months (range 6-35). ND delay was defined by a score of ≤84 in any composite score. Severe impairments were defined as a score of ≤69 in at least one domain. Correlations between ND outcome and patient-specific factors were analyzed by one-way ANOVA, chi-square, or logistic regression as appropriate. RESULTS The mean cognitive score (86.8±16.8) was in the low average range. Mean language (83.2±21.1) and motor (81.5±16.2) scores were below average. Forty-six-percent scored within the average range for all scales. Mild deficits were found in 19%, and 35% had severe delays in at least one domain. Hypotonicity was present in 55%. Autism was suspected/confirmed in 13%. Predictors of lower ND scores were prolonged ventilator support (P<0.01), high-frequency oscillatory ventilation (P<0.01), tracheostomy placement (P<0.001), O2 supplementation at day of life 30 (P<0.02), pulmonary hypertension (P<0.02), delayed enteral feeding (P=0.01), need for feeding tube (P<0.001), GERD (P=0.05), abnormal BAER hearing screen (P<0.006), prolonged hospitalization (P=0.01), and failure to thrive (P=0.001). Autism was associated with delays in cognitive and language outcomes (P<0.03). Delayed staged closure (P=0.007), older age at final repair (P=0.03), and hypotonicity (P=0.02) were associated with motor dysfunction. CONCLUSIONS Neurological impairments were present in more than half of GO survivors. Disease severity was associated with ND dysfunction. Autism and hypotonicity were often co-morbidities with ND delays and poor motor function.
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Akinkuotu AC, Sheikh F, Cass DL, Zamora IJ, Lee TC, Cassady CI, Mehollin-Ray AR, Williams JL, Ruano R, Welty SE, Olutoye OO. Are all pulmonary hypoplasias the same? A comparison of pulmonary outcomes in neonates with congenital diaphragmatic hernia, omphalocele and congenital lung malformation. J Pediatr Surg 2015; 50:55-9. [PMID: 25598093 DOI: 10.1016/j.jpedsurg.2014.10.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Patients with congenital diaphragmatic hernias (CDH), omphaloceles, and congenital lung malformations (CLM) may have pulmonary hypoplasia and experience respiratory insufficiency. We hypothesize that given equivalent lung volumes, the degree of respiratory insufficiency will be comparable regardless of the etiology. METHODS Records of all fetuses with CDH, omphalocele, and CLM between January 2000 and June 2013 were reviewed. MRI-based observed-to-expected total fetal lung volumes (O/E-TFLV) were calculated. An analysis of outcomes in patients with O/E-TFLV between 40% and 60%, the most inclusive range, was performed. RESULTS 285 patients were evaluated (161, CDH; 24, omphalocele; 100, CLM). Fetuses with CDH had the smallest mean O/E-TFLV. CDH patients were intubated for longer and had a higher incidence of pulmonary hypertension. Fifty-six patients with the three diagnoses had an O/E-TFLV of 40%-60%. The need for ECMO, supplemental oxygen at 30days of life, and 6-month mortality were similar among groups. CDH patients had a significantly longer duration of intubation and higher incidence of pulmonary hypertension than the other two diagnoses. CONCLUSION Given equivalent lung volumes (40%-60% of expected), CDH patients require more pulmonary support initially than omphalocele and CLM patients. In addition to lung volumes, disease-specific factors, such as pulmonary hypertension in CDH, also contribute to pulmonary morbidity and overall outcome.
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Affiliation(s)
- Adesola C Akinkuotu
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Fariha Sheikh
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Darrell L Cass
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Irving J Zamora
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Timothy C Lee
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Christopher I Cassady
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Amy R Mehollin-Ray
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Jennifer L Williams
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Stephen E Welty
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
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Abstract
The abdominal wall is an integral component of the chest wall. Defects in the ventral abdominal wall alter respiratory mechanics and can impair diaphragm function. Congenital abdominal wall defects also are associated with abnormalities in lung growth and development that lead to pulmonary hypoplasia, pulmonary hypertension, and alterations in thoracic cage formation. Although infants with ventral abdominal wall defects can experience life-threatening pulmonary complications, older children typically experience a more benign respiratory course. Studies of lung and chest wall function in older children and adolescents with congenital abdominal wall defects are few; such investigations could provide strategies for improved respiratory performance, avoidance of respiratory morbidity, and enhanced exercise ability for these children.
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Affiliation(s)
- Howard B Panitch
- Professor of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Division of Pulmonary Medicine, The Children's Hospital of Philadelphia.
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Abstract
PURPOSE OF REVIEW To review prognostic parameters reported recently in the evaluation of abdominal wall defects in the first trimester. RECENT FINDINGS Evaluation of abdominal wall defects in the first trimester is based principally on associated structural or chromosomal anomalies. In the case of gastroschisis, which is rarely associated with other anomalies, evaluation of prenatal or postnatal outcome is based mainly on the course of pregnancy. In the case of isolated omphalocele in the first trimester, recent studies have evaluated parameters that could help predict prenatal or postnatal outcome. SUMMARY We review recent studies using new parameters to diagnose abdominal wall defects in the first trimester and to provide early prenatal counselling to parents regarding prenatal and postnatal prognosis.
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Kiyohara MY, Brizot ML, Liao AW, Francisco RP, Tannuri AC, Krebs VL, Zugaib M. Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome? Fetal Diagn Ther 2013; 35:44-50. [DOI: 10.1159/000355936] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
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Tassin M, Descriaud C, Elie C, Debarge VH, Dumez Y, Perrotin F, Benachi A. Omphalocele in the first trimester: prediction of perinatal outcome. Prenat Diagn 2013; 33:497-501. [DOI: 10.1002/pd.4102] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mikaël Tassin
- Department of Obstetrics, Necker Hospital; Universite Paris Descartes; Paris France
| | - Céline Descriaud
- Department of Obstetrics and Gynecology; University of Tours; Tours France
| | - Caroline Elie
- Department of Obstetrics, Necker Hospital; Universite Paris Descartes; Paris France
| | | | - Yves Dumez
- Department of Obstetrics, Necker Hospital; Universite Paris Descartes; Paris France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology; University of Tours; Tours France
| | - Alexandra Benachi
- Department of Obstetrics, Necker Hospital; Universite Paris Descartes; Paris France
- Department of Obstetrics and Gynecology; Hôpital Antoine Béclère; Clamart France
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Danzer E, Hedrick HL, Rintoul NE, Siegle J, Adzick NS, Panitch HB. Assessment of early pulmonary function abnormalities in giant omphalocele survivors. J Pediatr Surg 2012; 47:1811-20. [PMID: 23084189 DOI: 10.1016/j.jpedsurg.2012.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/02/2012] [Accepted: 06/10/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Infants with giant omphalocele (GO) are at increased risk for persistent respiratory insufficiency, yet information regarding the systematic assessment of their lung function is limited. We performed a group of pulmonary function tests (PFTs) including spirometry, fractional lung volume measurements, assessment of bronchodilator responsiveness, and passive respiratory mechanics in GO survivors during infancy and early childhood to evaluate the nature and degree of pulmonary dysfunction. MATERIAL AND METHODS Between July 2004 and June 2008, 30 consecutive GO survivors were enrolled in our interdisciplinary follow-up program. Forty-seven percent (14/30) underwent PFT during follow-up evaluation using the raised volume rapid thoracic compression technique to measure forced expiratory flows and bronchodilator responsiveness, body plethysmography to calculate lung volumes, and the single breath occlusion technique to measure passive mechanics of the respiratory system. RESULTS The mean age at PFT assessment was 19.3 ± 19.7 months (range, 1.0-58). Mean forced vital capacity and mean forced expiratory volume in the first 0.5 second were significantly reduced compared with published normative values (P = .03 and P < .01, respectively). Total lung capacity was significantly reduced (P < .001), whereas functional residual capacity, residual volume, and residual volume to total lung capacity ratio were within the normative range (P = .21, P = .34, and P = .48, respectively). Among the 46% who demonstrated significant bronchodilator responsiveness, there were greater increases in the mean percentage changes in flow at 25% to 75% (P = .01), flow at 75% (P < .001), and flow at 85% (P < .001) compared with those participants that did not respond. Specific compliance was reduced, whereas specific conductance increased, compared with published normal results. CONCLUSIONS Abnormalities of pulmonary function in GO survivors include lung volume restriction without airway obstruction, an increased likelihood of airway hyperresponsivness, and reduced respiratory system specific compliance. Early recognition of pulmonary functional impairment in GO survivors could help to develop targeted treatment strategies to reduce the risk of subsequent pulmonary morbidity.
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Affiliation(s)
- Enrico Danzer
- Department of Surgery, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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The Eccentricities of Nourishing the Infant With Abdominal Anomalies. TOP CLIN NUTR 2012. [DOI: 10.1097/tin.0b013e3182628933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Abdominal wall defects (AWDs) are a common congenital surgical problem in fetuses and neonates. The incidence of these defects has steadily increased over the past few decades due to rising numbers of gastroschisis. Most of these anomalies are diagnosed prenatally and then managed at a center with available pediatric surgical, neonatology, and high-risk obstetric support. Omphaloceles and gastroschisis are distinct anomalies that have different management and outcomes. There have been a number of recent advances in the care of patients with AWDs, both in the fetus and the newborn, which will be discussed in this article.
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Kristensen K, Hjuler T, Ravn H, Simões EAF, Stensballe LG. Chronic diseases, chromosomal abnormalities, and congenital malformations as risk factors for respiratory syncytial virus hospitalization: a population-based cohort study. Clin Infect Dis 2012; 54:810-7. [PMID: 22247121 DOI: 10.1093/cid/cir928] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Little is known about how chronic conditions other than prematurity, heart disease, and Down syndrome affect the risk and severity of hospitalization for respiratory syncytial virus (RSV). We assess the risk and severity of RSV hospitalization in children with chronic conditions in this register-based, population-based cohort study. METHODS Data on RSV tests, maternal smoking, siblings, single parenthood, mode of delivery, gestational age at birth, major surgery, asthma diagnosis, chronic conditions, and hospitalization and discharge dates were obtained from the Danish RSV database, the National Patient and Birth Registries, and the Civil Registration System. STATISTICS Cox regression models were used to estimate incidence rate ratios (IRRs) for RSV hospitalization between groups stratified by sex and date of birth. Duration of RSV hospitalization was analyzed in a linear regression and reported as geometric mean ratios. RESULTS A total of 391 983 children aged 0-23 months were included in the analysis. A total of 10,616 (2.7%) had a diagnosis for chronic disease. IRRs (95% confidence intervals) for RSV hospitalization in children with any congenital or acquired chronic condition were 2.18 (2.01-2.36) and 2.25 (1.94-2.61), respectively. Several new risk factors for RSV hospitalization, including malformations, interstitial lung disease, neuromuscular disease, liver disease, chromosomal abnormalities, congenital immunodeficiencies, and inborn errors of metabolism, were identified. Duration of RSV hospitalization was increased in many chronic conditions. CONCLUSIONS Chronic disease per se is an important risk factor for RSV hospitalization.
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Affiliation(s)
- Kim Kristensen
- Paediatric Clinic 2, Statens Serum Institut, Copenhagen, Denmark.
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Abstract
In the critical care environment, what begins as cure-oriented and life-extending treatment may become unsuccessful in overcoming the patient's increasingly complex pathophysiology. A case from the neonatal intensive care unit is presented and used to elaborate upon care transitions toward palliative and supportive care that can be rendered in the hospital, at home or in a hospice facility. Successful transitions may rest upon anticipatory guidance by the primary physician and team, or a consultant, to facilitate and enable parents and team members alike in addressing the hard realities that cure, or even successful ICU discharge, is unlikely. A simple mechanism of addressing and accommodating a family's wishes is provided.
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Montero FJ, Simpson LL, Brady PC, Miller RS. Fetal omphalocele ratios predict outcomes in prenatally diagnosed omphalocele. Am J Obstet Gynecol 2011; 205:284.e1-7. [PMID: 22071066 DOI: 10.1016/j.ajog.2011.06.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/10/2011] [Accepted: 06/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate whether ratios considering omphalocele diameter relative to fetal biometric measurements perform better than giant omphalocele designation at predicting inability to achieve neonatal primary surgical closure. STUDY DESIGN Cases of fetal omphalocele that underwent evaluation between May 2003 and July 2010 were identified. Inclusion was restricted to live births with plan for postnatal repair. Omphalocele diameter upon antenatal ultrasound was compared with abdominal circumference, femur length, and head circumference, yielding the respective omphalocele (O)/abdominal circumference (AC), O/femur length (FL), and O/head circumference (HC) ratios. The absolute measurements were used to classify giant lesions. Omphalocele ratios and giant omphalocele designations were evaluated as predictors of inability to achieve primary repair. RESULTS Among 25 included cases, staged or delayed closure occurred in 52%. With an optimal cutoff of 0.21 or greater, O/HC best predicted the primary outcome (sensitivity, 84.6%; specificity, 58.3%; odds ratio, 7.7). The O/HC of 0.21 or greater outperformed giant designations. CONCLUSION The O/HC of 0.21 or greater best predicted staged or delayed omphalocele closure. Giant omphalocele designation, regardless of definition, poorly predicted outcome.
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Christison-Lagay ER, Kelleher CM, Langer JC. Neonatal abdominal wall defects. Semin Fetal Neonatal Med 2011; 16:164-72. [PMID: 21474399 DOI: 10.1016/j.siny.2011.02.003] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Gastroschisis and omphalocele are the two most common congenital abdominal wall defects. Both are frequently detected prenatally due to routine maternal serum screening and fetal ultrasound. Prenatal diagnosis may influence timing, mode and location of delivery. Prognosis for gastroschisis is primarily determined by the degree of bowel injury, whereas prognosis for omphalocele is related to the number and severity of associated anomalies. The surgical management of both conditions consists of closure of the abdominal wall defect, while minimizing the risk of injury to the abdominal viscera either through direct trauma or due to increased intra-abdominal pressure. Options include primary closure or a variety of staged approaches. Long-term outcome is favorable in most cases; however, significant associated anomalies (in the case of omphalocele) or intestinal dysfunction (in the case of gastroschisis) may result in morbidity and mortality.
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Kleinrouweler C, Kuijper C, van Zalen-Sprock M, Mathijssen I, Bilardo C, Pajkrt E. Characteristics and Outcome and the Omphalocele Circumference/Abdominal Circumference Ratio in Prenatally Diagnosed Fetal Omphalocele. Fetal Diagn Ther 2011; 30:60-9. [DOI: 10.1159/000323326] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 12/03/2010] [Indexed: 11/19/2022]
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Usui N, Kanagawa T, Kamiyama M, Tani G, Kinugasa-Taniguchi Y, Kimura T, Fukuzawa M. Current status of negative treatment decision-making for fetuses with a prenatal diagnosis of neonatal surgical disease at a single Japanese institution. J Pediatr Surg 2010; 45:2328-33. [PMID: 21129539 DOI: 10.1016/j.jpedsurg.2010.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 08/12/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE The termination of pregnancy because of fetal abnormalities in Japan has not been described. The aim of the present study was to analyze the current status and to evaluate the medical and ethical relevance in our institution for negative treatment decision-making for fetuses demonstrating neonatal surgical disease with a prenatal diagnosis. MATERIALS AND METHODS The medical records of 209 fetuses with a prenatal diagnosis from 1999 to 2008 were retrospectively reviewed. The cases with a negative treatment policy were analyzed according to the potential for survival. The negative treatment policies were defined as those in which the pregnancy was not actively continued, including elective termination of pregnancy and palliative or limited treatment that are primarily provided after birth. RESULTS The selected treatment policies were active in 162 cases and negative in 46 cases. Thirty-three cases with negative policies were in the second-half period of pregnancy. The potential for survival was high in 5 cases, moderate in 11 cases, and nonviable in 30 cases. Eight of the nonviable cases underwent either limited or palliative treatment, whereas the remaining 38 fetuses were aborted. CONCLUSIONS The negative treatment policies in the nonviable fetuses were considered to be medically and ethically relevant. However, the number of cases with negative policies increased over the last 5 years and is therefore associated with complex ethical issues.
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Affiliation(s)
- Noriaki Usui
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
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Mitanchez D, Walter-Nicolet E, Humblot A, Rousseau V, Revillon Y, Hubert P. Neonatal care in patients with giant ompholocele: arduous management but favorable outcomes. J Pediatr Surg 2010; 45:1727-33. [PMID: 20713230 DOI: 10.1016/j.jpedsurg.2010.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 04/01/2010] [Accepted: 04/23/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objectives of the study were to provide a review of patients with giant omphalocele managed in a single institution (2001-2006), focusing on medical management in the neonatal period, and to evaluate short-term outcomes. METHODS Data from 14 neonates with giant ompholocele (abdominal wall defect >5 cm and/or containing liver) and the absence of malformation and chromosomal anomalies during fetal screening were retrospectively reviewed. All were intubated and sedated before surgical treatment. Initial management consisted of progressive reduction of the herniated organs by gentle compression. After sequential reduction, abdominal wall closure was attempted at the skin and fascia level and, when necessary, with a Gore-Tex patch. RESULTS Median gestational age was 39 weeks (38-40), and median birth weight was 3100 g (2470-3700). Median age at closure was 6 days (0-20). A central Gore-Tex patch was inserted in 10 cases. Median ventilation length was 26 days (2-78). Full enteral diet was achieved after an average of 33 days (8-82), and median time until discharge from the intensive care unit was 24.5 days (11-85). Nine patients developed sepsis in the postoperative course. In 10 patients, at least 1 associated malformation was diagnosed in the postnatal course, among which cardiac and diaphragmatic defects were the most common. Survival rate was 85.7%. CONCLUSION Mortality rate of giant omphalocele without chromosomal anomaly or major malformations is low when treated by gradual reduction of the contents. Parents should be informed of the long hospitalization in the intensive care unit at birth, the potential nonthreatening associated malformations to be diagnosed after birth, and the high risk of sepsis.
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Affiliation(s)
- Delphine Mitanchez
- Service de néonatologie, Hôpital Armand-Trousseau, 26 avenue du Docteur Arnold Netter, 75571 Paris, Cedex 12, France.
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Mitanchez D, Champion V, Walter-Nicolet E. [Abdominal wall defects]. Arch Pediatr 2010; 17:818-9. [PMID: 20654909 DOI: 10.1016/s0929-693x(10)70127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- D Mitanchez
- Faculté de Médecine, AP-HP, Hôpital Armand-Trousseau, Service de Néonatologie, Université Pierre-et-Marie-Curie, Paris, France.
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