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Elhedai H, Arul GS, Yong S, Nagakumar P, Kanthimathinathan HK, Jester I, Chaudhari M, Jones TJ, Stumper O, Seale AN. Outcomes of patients with exomphalos and associated congenital heart diseases. Pediatr Surg Int 2022; 39:12. [PMID: 36441283 DOI: 10.1007/s00383-022-05296-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Exomphalos is an anterior abdominal wall defect resulting in herniation of contents into the umbilical cord. Severe associated chromosomal anomalies and congenital heart disease (CHD) are known to influence mortality, but it is not clear which cardiac anomalies have the greatest impact on survival. METHODS We performed a retrospective review of the treatment and outcome of patients with exomphalos over a 30-year period (1990-2020), with a focus on those with the combination of exomphalos major and major CHD (EMCHD). RESULTS There were 123 patients with exomphalos identified, 59 (48%) had exomphalos major (ExoMaj) (defect > 5 cm or containing liver), and 64 (52%) exomphalos minor (ExoMin). In the ExoMaj group; 17% had major CHD (10/59), M:F 28:31, 29% premature (< 37 weeks, 17/59) and 14% had low birth-weight (< 2.5 kg, 8/59). In the ExoMin group; 9% had major CHD (6/64), M:F 42:22, 18% premature and 10% had low birth-weight. The 5-year survival was 20% in the EMCHD group versus 90% in the ExoMaj with minor or no CHD [p < 0.0001]. Deaths in the EMCHD had mainly right heart anomalies and all of them required mechanical ventilation (MV) for pulmonary hypoplasia prior to cardiac intervention. In contrast, survivors did not require mechanical ventilation prior to cardiac intervention. CONCLUSION EMCHD is associated with high mortality. The most significant finding was high mortality in those with right heart anomalies in combination with pulmonary hypoplasia, especially if pre-intervention mechanical ventilation is required.
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Affiliation(s)
- H Elhedai
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - G S Arul
- Department of Paediatric Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - S Yong
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - P Nagakumar
- Department of Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - H K Kanthimathinathan
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Clinical Advisor, Paediatric Intensive Care National Audit, University of Leicester, Leicester, UK
| | - I Jester
- Department of Paediatric Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M Chaudhari
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - T J Jones
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - O Stumper
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - A N Seale
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.,College of Medical and Dental Science, Institute of Cardiovascular Sciences, Congenital Heart Disease Research Group, University of Birmingham, Birmingham, UK
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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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3
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Neglected Exomphalos Major: Despair to Hope. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03488-z] [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] Open
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Matcovici M, Stoica I, Burhamah W, Alshafei A, Murphy R, Sue T, Muntean A, Awadalla S. Predictors of long-term respiratory insufficiency of exomphalos major. J Pediatr Surg 2021; 56:1583-1589. [PMID: 33454084 DOI: 10.1016/j.jpedsurg.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Exomphalos major (EM) is associated with significant morbidity and even mortality with an important risk of long-term pulmonary disease. AIM To assess the outcomes of exomphalos in a single tertiary pediatric unit and to identify prognostic factors for patients with respiratory insufficiency who still require ventilatory assistance at six months. MATERIAL AND METHODS All infants admitted to our institution over a 10-year period (2005 to 2015) with exomphalos were retrospectively reviewed. EM was defined when the abdominal wall defect measured >= 5 cm and/or contained liver within the sac. Data were collected on patient demographics, prenatal course and imaging, birth information, immediate and long-term outcomes. Those with long-term respiratory insufficiency were identified as the primary outcome and reviewed to assess prognostic factors. A p value of ≤0.05 was regarded as significant. Data are quoted as median(range). RESULTS A total of 46 infants were diagnosed with exomphalos during the study period, with most (n = 30, 65%) defined as exomphalos major. Respiratory complications occurred in 16 (35%) with 8 (50%) of these requiring long-term (≥6 months) mechanical ventilation and 5 (31%) required a tracheostomy. On univariate analysis, resuscitation at birth (p = 0.0004), birth weight <3000 g (p = 0.008), use of nitric oxide (p = 0.004), high frequency oscillatory ventilation (HFOV) (p = 0.001), pulmonary hypoplasia (p<0.0001) and pulmonary hypertension (PHTN) (p = 0.02) were significantly associated with respiratory insufficiency. The strongest predictive model for ventilation support at six months was resuscitation at birth in combination with PH (OR = 1.57). Five infants (11%) died at 5(1-122) days. CONCLUSIONS In patients with EM, the presence of pulmonary hypertension along with resuscitation at birth are the most important prognostic factors for long-term respiratory insufficiency. Acknowledgement of these factors allows for better parental counselling regarding respiratory outcomes.
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Affiliation(s)
- Melania Matcovici
- Department of Paediatric Surgery, Temple Street Children University Hospital, Dublin, Ireland.
| | - Ionica Stoica
- Department of Paediatric Surgery, Temple Street Children University Hospital, Dublin, Ireland
| | - Waleed Burhamah
- Department of Paediatric Surgery, Temple Street Children University Hospital, Dublin, Ireland
| | - AbdulRahman Alshafei
- Department of Paediatric Surgery, Our Lady's Children University Hospital Crumlin, Dublin, Ireland
| | - Rebecca Murphy
- Department of Paediatric Surgery, Temple Street Children University Hospital, Dublin, Ireland
| | - Tea Sue
- Department of Paediatric Surgery, Our Lady's Children University Hospital Crumlin, Dublin, Ireland
| | - Ancuta Muntean
- Department of Paediatric Surgery, Temple Street Children University Hospital, Dublin, Ireland
| | - Sami Awadalla
- Department of Paediatric Surgery, Temple Street Children University Hospital, Dublin, Ireland
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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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Ogundoyin OO, Ajao AE. Changing trend in the management of omphalocoele in a tertiary hospital of a middle-income country. Afr J Paediatr Surg 2021; 18:143-147. [PMID: 34341197 PMCID: PMC8362914 DOI: 10.4103/ajps.ajps_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The peri-operative management of omphalocoele in low- and middle-income countries is challenging owing to non-availability of neonatal intensive care units and equipment needed for the care of this anomaly. AIM This study examined our experience in the management of omphalocoele and compared the pattern and outcome with a similar study from the same centre conducted four decades ago. METHODS A retrospective study of neonates managed for omphalocoele from 2003 to 2017 (Group A) was performed. Their demographic characteristics, clinical presentation, management modality and outcome were obtained and statistical analysis was performed to determine the predictors of mortality. The findings were also compared with the findings of a similar study (Group B) published from this centre four decades ago from 1973 to 1978. RESULTS A total of 95 patients were managed in Group A and 33 in Group B. Their ages ranged from 1 to 15 days with a median age of 1 day and a median gestational age at birth of 37 weeks (range - 36-43 weeks) in Group A and 5-72 h in Group B. There were 54 (56.8%) boys and 41 (43.2%) girls in Group A and 17 (51.5%) boys and 16 (48.5%) girls in Group B. Rupture of the sac was observed in 18 (18.9%) patients in Group A and 13 (39.4%) in Group B. Operative management was adopted for 55 (57.9%) patients in Group A compared to 14 (42.4%) in Group B. Mortality was recorded in 16 (16.8%) patients in Group A and 16 (48.5%) in Group B. Following further analysis in Group A, management outcome was noted to be significantly associated with the state of the sac (P = 0.011), presence of associated sepsis (P = 0.002) at presentation and management modality (P = 0.048) with only associated sepsis independently predicting mortality. CONCLUSION Although epidemiological trend and clinical presentation are still similar, management outcome has improved over the years.
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Hepatoomphalozelen – eine interdisziplinäre Herausforderung. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Abstract
Objective The aim of the study was to present the clinical outcomes of patients diagnosed with giant omphalocele, treated with early primary closure combined with bandaging and povidone-iodine staining and powder spray antibiotics. Materials and methods The study included a total of 22 infants with omphalocele. The omphalocele sacs of the patients were cleaned daily with topical povidone-iodine. A powdered spray antibiotic combination was then applied topically twice a day and the sac was wrapped in a sterile elastic bandage. Following the observation of eschar formation and epithelization, the patients were operated on in the early period and the sac was removed by placing a graft. Results Evaluation was made of a total of 14 female and eight male patients with mean duration of conservative monitoring of 11 days and mean total hospital stay of 35. The mean giant omphalocele (GO) defect size of the patients followed-up was 10 cm. Since seven of the patients in the present study died in the 1st week, conservative and elastic bandages were applied for the GO treatment of 15 patients for 9-14 days. After the conservative follow-up, it was determined that the patients who were applied with a graft at an average of 11 days were hospitalized for an average of 24 days postoperatively. Conclusion In conclusion, it is possible to reduce the length of hospital stay with primary closure in the early period by providing faster epithelialization with the combination of povidone-iodine and antibiotic powder together with elastic bandage application in infants with GO.
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9
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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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10
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Shoeib F, Gebran S, Alshihi M, Hassan M, Abdulrashid S, Saqi Z. Use of hyaluronic acid-derived dermal substitute for skin reconstruction in giant omphalocele. ANNALS OF PEDIATRIC SURGERY 2014. [DOI: 10.1097/01.xps.0000445133.67605.d7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Nicoara CD, Singh M, Jester I, Reda B, Parikh DH. Medicated Manuka honey in conservative management of exomphalos major. Pediatr Surg Int 2014; 30:515-20. [PMID: 24599698 DOI: 10.1007/s00383-014-3490-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to assess the effectiveness of Manuka honey ointment and dressings in the conservative management of exomphalos major (EM). METHODS A retrospective review of five patients with EM who underwent non-operative management with Manuka honey ointments and dressings was carried out to assess the time to complete epithelialisation, time to full feeds, hospital stay, adverse effects, complications and outcome. RESULTS The skin epithelialisation over the EM sac was achieved in a median of 63 days (48-119). The median time to full enteral feed was 13 days (3-29). The median hospital stay was 66 days (21-121). No adverse effects were noted related to Manuka honey. Three patients had pulmonary hypoplasia requiring prolonged hospitalization; one of those died with respiratory complications at home after achieving complete epithelialisation. The follow-up was a median 16 months (6-22). Two patients did not require repair of the ventral hernia. One patient had ventral hernia repair at 16 months with excellent cosmesis. The remaining patient is awaiting repair. CONCLUSION This is the first description of the use of medicated Manuka honey ointment and impregnated dressings in the conservative management of EM. This treatment is safe, efficacious and promotes wound healing with favorable outcome.
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Morrow D, Schelonka R, Krol A, Davies M, Kuang A. Type V aplasia cutis congenita: case report, review of the literature, and proposed treatment algorithm. Pediatr Dermatol 2013; 30:e208-13. [PMID: 22472005 DOI: 10.1111/j.1525-1470.2012.01742.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aplasia cutis congenita (ACC) is the congenital absence of skin. There are a number of different classifications based on distribution and associated findings. Type V ACC is unique in that the lesions are typically symmetric and found primarily on the trunk but can also include the upper and lower extremities. Type V is associated with the loss of a monozygotic co-twin during the late first or early second trimester. Here we present an extensive case of type V ACC and a review of the literature, including a summary of treatment and outcomes. From the available literature, it appears that there is no benefit from early surgical intervention, and therefore we propose a treatment algorithm that starts with conservative management.
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Affiliation(s)
- Daniel Morrow
- Division of NeonatologyDepartment of PediatricsDepartment of Pediatric Dermatology, Doernbecher Neonatal Care Center, Oregon Health and Science University, Portland, OregonCasey Eye Institute, Oregon Health and Science University, Portland, OregonDepartment of Pediatric Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, Oregon
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Carnaghan H, Roberts T, Savery D, Norris FC, McCann CJ, Copp AJ, Scambler PJ, Lythgoe MF, Greene ND, DeCoppi P, Burns AJ, Pierro A, Eaton S. Novel exomphalos genetic mouse model: the importance of accurate phenotypic classification. J Pediatr Surg 2013; 48:2036-42. [PMID: 24094954 PMCID: PMC4030649 DOI: 10.1016/j.jpedsurg.2013.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/18/2013] [Accepted: 04/21/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rodent models of abdominal wall defects (AWD) may provide insight into the pathophysiology of these conditions including gut dysfunction in gastroschisis, or pulmonary hypoplasia in exomphalos. Previously, a Scribble mutant mouse model (circletail) was reported to exhibit gastroschisis. We further characterise this AWD in Scribble knockout mice. METHOD Homozygous Scrib knockout mice were obtained from heterozygote matings. Fetuses were collected at E17.5-18.5 with intact amniotic membranes. Three mutants and two control fetuses were imaged by in amnio micro-MRI. Remaining fetuses were dissected, photographed and gut length/weight measured. Ileal specimens were stained for interstitial cells of Cajal (ICC), imaged using confocal microscopy and ICC quantified. RESULTS 127 fetuses were collected, 15 (12%) exhibited AWD. Microdissection revealed 3 mutants had characteristic exomphalos phenotype with membrane-covered gut/liver herniation into the umbilical cord. A further 12 exhibited extensive AWD, with eviscerated abdominal organs and thin covering membrane (intact or ruptured). Micro-MRI confirmed these phenotypes. Gut was shorter and heavier in AWD group compared to controls but morphology/number of ICC was not different. DISCUSSION The Scribble knockout fetus exhibits exomphalos (intact and ruptured), in contrast to the original published phenotype of gastroschisis. Detailed dissection of fetuses is essential ensuring accurate phenotyping and result reporting.
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Affiliation(s)
| | - Tom Roberts
- Centre for Advanced Biomedical Imaging, University College London, London, UK,Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, UK
| | | | - Francesca C. Norris
- Centre for Advanced Biomedical Imaging, University College London, London, UK,Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, UK
| | | | | | | | - Mark F. Lythgoe
- Centre for Advanced Biomedical Imaging, University College London, London, UK
| | | | | | | | - Agustino Pierro
- UCL Institute of Child Health, London, UK,Division of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Eaton
- UCL Institute of Child Health, London, UK,Corresponding author.
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Delayed management of giant omphalocele using silver sulfadiazine cream: an 18-year experience. J Pediatr Surg 2012; 47:494-500. [PMID: 22424344 DOI: 10.1016/j.jpedsurg.2011.08.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 08/22/2011] [Accepted: 08/22/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE To assess the value of topical silver sulfadiazine (SSD) cream in the treatment of babies with a giant omphalocele. METHODS From 1991 to 2008 inclusive, 20 infants with giant omphalocele (defined as >10 cm diameter) were treated with SSD, leaving a large ventral hernia to be repaired at a later date. RESULTS There were 12 boys and 8 girls. Thirteen had prenatal ultrasound diagnosis at a mean gestational age of 23 weeks. The mean gestational age at delivery was 37 weeks, and mean birth weight was 2.5 kg. Nineteen had other anomalies and/or medical problems, 18 of them multiple. The most common was pulmonary hypoplasia (70%). Mechanical ventilation and/or oxygen treatment was required in 15 (75%) for a mean of 10 weeks. SSD was used as primary sac treatment in 5 and secondary treatment in 15 (after Silon pouch 11, Op-site 3, povidone-iodine 1). Six omphalocele sacs were ruptured within the first 5 days of life. SSD was used for a mean of 6 months at a cost of $1 per day. Complications included 2 instances of staphylococcal sepsis and 1 jejunal perforation inside a Silon pouch. Six (30%) died from pulmonary hypoplasia at a mean age of 18 weeks. There were 14 (70%) survivors who went home after a mean of 14 weeks. Of the 14 survivors, 12 had ventral hernias repaired (18 operations with 2 recurrences), and 2 remain with their original ventral hernia. CONCLUSIONS Initial topical coverage with SSD is associated with excellent outcomes for infants with giant omphalocele who cannot undergo immediate closure.
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Sinha CK, Kader M, Dykes E, Said AJ. An 18 years' review of exomphalos highlighting the association with malrotation. Pediatr Surg Int 2011; 27:1151-4. [PMID: 21681582 DOI: 10.1007/s00383-011-2930-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This was a retrospective 18 years' review of infants with exomphalos with particular attention to its association with malrotation. MATERIALS AND METHODS We reviewed all exomphalos cases presenting to our neonatal surgery unit, from October 1991 to September 2009. Data were presented as median and range values. Categorical data were analyzed using Fisher's exact tests and P value of ≤0.05 was considered as significant. RESULTS Forty-two infants with exomphalos (E. major 23, E. minor 19) were treated during this period. The incidence of surgically confirmed malrotation was 45% in E. major and 31% in E. minor. CONCLUSION The association of malrotation in exomphalos major and exomphalos minor infants is alarmingly high and supports the need to actively exclude this abnormality, either operatively or radiologically.
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Osifo OD, Ovueni ME, Evbuomwan I. Omphalocele management using goal-oriented classification in African centre with limited resources. J Trop Pediatr 2011; 57:286-8. [PMID: 20923791 DOI: 10.1093/tropej/fmq093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2000-09, 96 children comprising 57 males and 39 females who were presented between 2 h and 1 week of birth with omphalocele were prospectively managed using goal-oriented classification at the University of Benin Teaching Hospital, Nigeria. All were born through spontaneous vaginal delivery, out of which 9 (9.4%) were preterm. Eighty-two (85.4%) mothers in villages with no supervised antenatal care/delivery and/or prenatal diagnosis presented their babies late. Thirty-three (34.4%) babies in group A, with defect size ≤ 4.5 cm and intact sac, were managed conservatively and had fascial closure after neonatal period, resulting in 32 (97%) survivors. Forty-two (43.8%) babies in group B, with defect size > 4.5 cm and intact sac, were managed conservatively and had fascial closures for 9 months to 5 years, resulting in 40 (95.2%) survivors. Group C comprised of 21 (21.9%) babies with defect of any size/ruptured sac and who had immediate repair, resulting in two (9.5%) survivors owing to lack of facilities (p < 0.0001). Hospital delivery and provision of facilities are advocated.
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Affiliation(s)
- Osarumwense David Osifo
- Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
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17
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van Eijck FC, Aronson DA, Hoogeveen YL, Wijnen RMH. Past and current surgical treatment of giant omphalocele: outcome of a questionnaire sent to authors. J Pediatr Surg 2011; 46:482-8. [PMID: 21376197 DOI: 10.1016/j.jpedsurg.2010.08.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 07/02/2010] [Accepted: 08/10/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Operative treatment of giant omphalocele (OC) is still a challenge for pediatric surgeons. We were interested to ascertain whether published operative techniques for giant OC once advocated by their authors were still being used by these authors and whether the techniques had been modified or even abandoned for other techniques. METHODS Relevant studies concerning the treatment of giant OC were identified by an electronic search. Publication date of the articles was from 1967 to 2009. A questionnaire was sent to the first author or coauthor, unless contact details were unavailable. The described surgical techniques were categorized into primary closure, staged closure, and delayed closure. RESULTS Almost half of the authors (42%), independent of the initial technique used (primary, staged, or delayed closure), changed or stopped using their technique after the publication of the article. The change was not to one particular proven better technique. Herniation rate was lower in delayed closure (9% delayed vs 18% staged vs 58% primary). CONCLUSIONS The results of the questionnaire did not show a generally accepted method of treatment after more than 30 years of innovations in managing patients with a giant OC. There are generally 2 main treatment modalities: staged closure and delayed closure. Because of the lack of large patient numbers and late follow-up, long-term results of the published techniques are needed, and randomized multicenter trials based on these outcomes are recommended. Until then, we remain dependent on expert opinions.
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Affiliation(s)
- Floortje C van Eijck
- Department of Surgery, Division of Paediatric Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Lewis N, Kolimarala V, Lander A. Conservative management of exomphalos major with silver dressings: are they safe? J Pediatr Surg 2010; 45:2438-9. [PMID: 21129562 DOI: 10.1016/j.jpedsurg.2010.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 08/01/2010] [Accepted: 08/04/2010] [Indexed: 11/19/2022]
Abstract
Historically, some dressings used in exomphalos major were associated with toxicity. These have been abandoned in favor of safer dressings. Silver toxicity has not been described following the use of silver dressings in infants. We, however, found disconcerting serum silver levels in 2 consecutive patients during treatment with silver salt containing dressings.
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Affiliation(s)
- Nicola Lewis
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom.
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