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Parata G, Vial Y, Addor MC, Pellegrinelli JM, Wildhaber BE. Anatomic parameters of omphaloceles and their association with anatomic, genetic, or syndromic malformations: a retrospective study. Pediatr Surg Int 2024; 40:136. [PMID: 38780818 PMCID: PMC11116210 DOI: 10.1007/s00383-024-05717-w] [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] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE This retrospective study aims to describe anatomical parameters of omphaloceles and to analyze their association with anatomical, genetic, or syndromic malformations. METHODS Cases were selected from digital records of two university centers, a certified regional registry and personal records. Patients from 1998 to 2018 with omphalocele and live birth (LB), termination of pregnancy due to fetal anomaly (TOPFA) and fetal death (FD) were included. Cases born outside Western Switzerland and/or with upper or lower coelosomy were excluded. RESULTS We analyzed 162 cases with the following distribution: 57 (35%) LB, 91 (56%) TOPFA and 14 (9%) FD. TOPFA was significantly more frequently performed in cases with non-isolated omphalocele, i.e., omphaloceles with associated major malformations (especially cardiovascular and genitourinary), genetic/chromosomal anomalies, or syndromes. For LB, associated anatomical malformations, genetic or chromosomal anomalies were not significantly associated with the size of the omphalocele or the liver involvement. CONCLUSIONS The proportion of cases resulting in TOPFA was higher among fetuses with major malformations, genetic or chromosomal anomalies. Despite the large size of this cohort, and in contrary to previous publications, the size of the omphalocele and/or liver involvement does not allow for conclusions regarding the presence or number of associated malformations, genetic or chromosomal anomalies.
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Affiliation(s)
- Gallien Parata
- Service médico-chirurgical de pédiatrie, Hôpital du Valais, Sion, Switzerland
| | - Yvan Vial
- Service of Obstetrics, Department of Woman-Mother-Child, University Medical Centre CHUV, Lausanne, Switzerland
| | - Marie-Claude Addor
- Service of Genetics, Department of Woman-Mother-Child, University Medical Centre CHUV, Lausanne, Switzerland
| | - Jean-Marie Pellegrinelli
- Division of Obstetrics, Department of Pediatrics, Gynecology, and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
| | - Barbara E Wildhaber
- Division of Child and Adolescent Surgery, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, University of Geneva, 6, Rue Willy Donzé, 1205, Geneva, Switzerland.
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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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Nishie EN, Osmundo Junior GDS, Mohamed SHM, Tannuri ACA, Gibelli MABC, Carvalho WBD, Peres SV, Francisco RPV, Brizot MDL. Three-Dimensional Ultrasound Evaluation of Lung Volume in Fetuses with Abdominal Wall Defect. Fetal Diagn Ther 2023; 50:259-268. [PMID: 37379809 DOI: 10.1159/000531594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/01/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Abdominal wall defects (AWDs) interfere with postnatal respiratory parameters. We aimed to evaluate lung volume (LV) in fetuses with AWD using three-dimensional (3D) ultrasound (US) and to correlate AWD with the type (omphalocele and gastroschisis) and size of the defect and neonatal morbidity and mortality. METHODS This prospective observational study included 72 pregnant women with fetuses with AWD and a gestational age <25 weeks. The data on abdominal volume, 3D US LV, and herniated volume were acquired every 4 weeks up to 33 weeks. LV was compared with normal reference curves and correlated with abdominal and herniated volumes. RESULTS Omphalocele (p < 0.001) and gastroschisis (p < 0.001) fetuses had smaller LV than normal fetuses. LV was positively correlated with abdominal volume (omphalocele, r = 0.86; gastroschisis, r = 0.88), whereas LV was negatively correlated with omphalocele-herniated volume/abdominal volume (p < 0.001, r = -0.51). LV was smaller in omphalocele fetuses that died (p = 0.002), were intubated (p = 0.02), or had secondary closure (p < 0.001). In gastroschisis, a smaller LV was observed in fetuses discharged using oxygen (p = 0.002). CONCLUSION Fetuses with AWD had smaller 3D LV than normal fetuses. Fetal abdominal volume was inversely correlated with LV. In omphalocele fetuses, a smaller LV was associated with neonatal mortality and morbidity.
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Affiliation(s)
- Estela Naomi Nishie
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil,
| | - Gilmar de Souza Osmundo Junior
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Samirah Hosney Mahmoud Mohamed
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Ana Cristina Aoun Tannuri
- Division of Neonatology, Department of Pediatrics, Hospital das Clínicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Stela Verzinhasse Peres
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Maria de Lourdes Brizot
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
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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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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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Abstract
Abdominal wall defects are common congenital anomalies with the most frequent being gastroschisis and omphalocele. Though both are the result of errors during embryologic development of the fetal abdominal wall, gastroschisis and omphalocele represent unique disorders that have different clinical sequelae. Gastroschisis is generally a solitary anomaly with postnatal outcomes related to the underlying integrity of the prolapsed bowel. In contrast, omphalocele is frequently associated with other structural anomalies or genetic syndromes that contribute more to postnatal outcomes than the omphalocele defect itself. Despite their embryological differences, both gastroschisis and omphalocele represent anomalies of fetal development that benefit from multidisciplinary and translational approaches to care, both pre- and postnatally. While definitive management of abdominal wall defects currently remains in the postnatal realm, advancements in prenatal diagnostics and therapies may one day change that. This review focuses on recent advancements, novel techniques, and current controversies related to the prenatal diagnosis and management of gastroschisis and omphalocele.
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Affiliation(s)
- Christina M Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amy J Wagner
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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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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8
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Peters NCJ, Hijkoop A, Lechner RL, Eggink AJ, van Rosmalen J, Tibboel D, Wijnen RMH, IJsselstijn H, Cohen-Overbeek TE. The validity of the viscero-abdominal disproportion ratio for type of surgical closure in all fetuses with an omphalocele. Prenat Diagn 2019; 39:1070-1079. [PMID: 31410858 PMCID: PMC6899735 DOI: 10.1002/pd.5546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/21/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the predictive value of the fetal omphalocele circumference/abdominal circumference (OC/AC) ratio for type of surgical closure and survival and to describe the trajectory of OC/AC ratio throughout gestation. METHODS This cohort study included all live-born infants prenatally diagnosed with an omphalocele in our tertiary centre (2000-2017) with an intention to treat. The OC/AC ratio and liver position were determined using 2D ultrasound at three periods during gestation (11-16, 17-26, and/or 30-38 weeks). Primary outcome was type of closure; secondary outcome was survival. In the secondary analyses, the predictive value of the OC/AC-ratio trend for type of closure and survival was assessed. RESULTS Primary closure was performed in 37/63 (59%) infants, and 54/63 (86%) survived. The OC/AC ratio was predictive for type of closure and survival in all periods. Optimal cut-off values for predicting closure decreased throughout gestation from 0.69 (11-16 weeks) to 0.63 (30-38 weeks). Repeated OC/AC-ratio measurements were available in 33 (73%) fetuses. The trend of the OC/AC ratio throughout gestation was not significantly associated with type of closure. All infants without liver herniation underwent primary closure. CONCLUSION Type of omphalocele surgical closure and survival can be predicted prenatally on the basis of the OC/AC ratio and liver herniation independent of associated anomalies. LEARNING OBJECTIVE The reader will be able to use the OC/AC ratio throughout gestation in all omphalocele cases for prediction of type of closure and survival and thus patient counselling.
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Affiliation(s)
- Nina C J Peters
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annelieke Hijkoop
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rosan L Lechner
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alex J Eggink
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Dick Tibboel
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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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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Abstract
The importance of defining and implementing a culture of safety in pediatric surgery is being increasingly seen as essential to decreasing complications and improving outcomes. The concept of a safety culture is a universal one, but the elements of such a culture are different for every disease and anomaly treated. In this paper, I will review these elements as they pertain to the treatment of abdominal wall defects starting from fetal evaluation to post-discharge care.
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Affiliation(s)
- Sherif Emil
- Department of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Room B04.2028, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada.
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Hijkoop A, Peters NCJ, Lechner RL, van Bever Y, van Gils-Frijters APJM, Tibboel D, Wijnen RMH, Cohen-Overbeek TE, IJsselstijn H. Omphalocele: from diagnosis to growth and development at 2 years of age. Arch Dis Child Fetal Neonatal Ed 2019; 104:F18-F23. [PMID: 29563149 DOI: 10.1136/archdischild-2017-314700] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the prenatal frame of reference of omphalocele (ie, survival of fetuses) with that after birth (ie, survival of liveborn neonates), and to assess physical growth and neurodevelopment in children with minor or giant omphalocele up to 2 years of age. DESIGN We included fetuses and neonates diagnosed in 2000-2012. Physical growth (SD scores, SDS) and mental and motor development at 12 and 24 months were analysed using general linear models, and outcomes were compared with reference norms. Giant omphalocele was defined as defect ≥5 cm, with liver protruding. RESULTS We included 145 fetuses and neonates. Of 126 (87%) who were diagnosed prenatally, 50 (40%) were liveborn and 35 (28%) survived at least 2 years. Nineteen (13%) neonates were diagnosed after birth. Of the 69 liveborn neonates, 52 (75%) survived and 42 children (81% of survivors) were followed longitudinally. At 24 months, mean (95% CI) height and weight SDS were significantly below 0 in both minor (height: -0.57 (-1.05 to -0.09); weight: -0.86 (-1.35 to -0.37)) and giant omphalocele (height: -1.32 (-2.10 to -0.54); weight: -1.58 (-2.37 to -0.79)). Mental development was comparable with reference norms in both groups. Motor function delay was found significantly more often in children with giant omphalocele (82%) than in those with minor omphalocele (21%, P=0.002). CONCLUSIONS The prenatal and postnatal frames of reference of omphalocele differ considerably; a multidisciplinary approach in parental counselling is recommended. As many children with giant omphalocele had delayed motor development, we recommend close monitoring of these children and early referral to physical therapy.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nina C J Peters
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rosan L Lechner
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Yolande van Bever
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Dick Tibboel
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Roux N, Jakubowicz D, Salomon L, Grangé G, Giuseppi A, Rousseau V, Khen-Dunlop N, Beaudoin S. Early surgical management for giant omphalocele: Results and prognostic factors. J Pediatr Surg 2018; 53:1908-1913. [PMID: 29803304 DOI: 10.1016/j.jpedsurg.2018.04.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Giant omphalocele often represents a major surgical challenge and is reported with high mortality and morbidity rates. The aim of this study was to assess the outcome of neonates with giant omphalocele managed with early operative surgical treatment, and subsequently to identify possible factors that could alter the prognosis. METHODS We reviewed the medical records of 29 consecutive newborns with prenatally diagnosed giant omphalocele. In these cases one of two procedures had been performed: either staged closure after silo, or immediate closure with a synthetic patch. The cases were separated into 2 groups: Isolated giant omphalocele (IO group) and giant omphalocele associated with malformation (NIO group). RESULTS Infants in the IO group had a lower size of the omphalocele (p<0,001), a shorter hospital stay (95 days [45-915] vs. 41.5 days [10-110] p= 0, 02), and a shorter median ventilation length (10 days [1-33] vs. 27, 5 [6-65] p = 0, 05). In the NIO group, 5 cases displayed a significantly more difficult course than the others. They were compared to the remaining cases for prenatal and anatomic features. Four factors associated with greater morbidity were identified: CONCLUSIONS: Isolated omphalocele, even containing the whole liver, has a very good prognosis with early surgical treatment. Without associated anomalies, 95% of giant omphaloceles can be discharged with a median of 41.5 days in hospital. However, associated anomalies (especially cardiopathies) may burden the prognosis and should be both carefully assessed during pregnancy and taken into account in parental information. TYPE OF STUDY Retrospective Study LEVEL OF EVIDENCE: Level I.
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Affiliation(s)
- Nathalie Roux
- Department of Obstetrics, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Déborah Jakubowicz
- Department of Paediatric Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Laurent Salomon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Gilles Grangé
- Department of Obstetrics, Maternité Port Royal, APHP, Paris, France
| | - Agnès Giuseppi
- Department of Neonatal Medecine, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Véronique Rousseau
- Department of Paediatric Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Naziha Khen-Dunlop
- Department of Paediatric Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Sylvie Beaudoin
- Department of Paediatric Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France.
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Fetal anterior abdominal wall defects: prenatal imaging by magnetic resonance imaging. Pediatr Radiol 2018; 48:499-512. [PMID: 29550866 DOI: 10.1007/s00247-017-3914-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/01/2017] [Accepted: 05/23/2017] [Indexed: 12/28/2022]
Abstract
Abdominal wall defects range from the mild umbilical cord hernia to the highly complex limb-body wall syndrome. The most common defects are gastroschisis and omphalocele, and the rarer ones include the exstrophy complex, pentalogy of Cantrell and limb-body wall syndrome. Although all have a common feature of viscera herniation through a defect in the anterior body wall, their imaging features and, more important, postnatal management, differ widely. Correct diagnosis of each entity is imperative in order to achieve appropriate and accurate prenatal counseling and postnatal management. In this paper, we discuss fetal abdominal wall defects and present diagnostic pearls to aid with diagnosis.
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Diemon N, Funke K, Möllers M, Hammer K, Steinhard J, Sauerland C, Müller V, Klockenbusch W, Schmitz R. Thorax-to-head ratio and defect diameter-to-head ratio in giant omphaloceles as predictor for fetal outcome. Arch Gynecol Obstet 2016; 295:325-330. [PMID: 27834001 DOI: 10.1007/s00404-016-4236-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the relationship between the thorax diameter and defect diameter of giant omphaloceles as a predictor for fetal outcome. METHODS In a retrospective study, 17 fetuses with isolated giant omphaloceles were included for evaluation. The anterior-posterior thorax diameter and the defect diameter were measured from ultrasound images. For analysis, the thorax-to-head ratio (T/HC), the defect diameter-to-head ratio (DD/HC), and the quotient of the defect diameter and the thorax diameter (DD/T) were calculated. The days of ventilation (t ventilation), the duration until hospital discharge (t hospital), and the type of treatment were recorded as outcome parameters. RESULTS No relationship was found between the calculated ratios (T/HC, DD/HC, or DD/T) and neither t hospital (r = -0.418, p = 0.095; r = -0.153, p = 0.556; and r = -0.023, p = 0.929; respectively) nor t ventilation (r = -0.391, p = 0.121; r = 0.041, p = 0.875; and r = 0.121, p = 0.645, respectively). The type of postnatal treatment was not associated with the three calculated ratios or t hospital (r = 0.155, p = 0.553; r = 0.019, p = 0.942; and r = 0.012, p = 0.965; r = -0.009, p = 0.973, respectively). In 53% of cases, t hospital was delayed due to additional and independent postnatal complications. CONCLUSION Thorax diameter or defect diameter of giant omphaloceles is not predictive for fetal outcome. The perinatal care of these abdominal wall defects still remains a multidisciplinary challenge, but the outcome of giant omphaloceles is favorable at experienced centers.
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Affiliation(s)
- Nina Diemon
- Department of Obstetrics and Gynecology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Katrin Funke
- Department of Pediatric Surgery, University Hospital of Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kerstin Hammer
- Department of Obstetrics and Gynecology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Johannes Steinhard
- Department of Fetal Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Volker Müller
- Department of Pediatric Surgery, University Hospital of Münster, Münster, Germany
| | - Walter Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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15
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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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17
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Howell H, Fox TB. First Trimester Diagnosis of Omphalocele. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479315581900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Normal physiologic herniation of the fetal bowel is often seen on first trimester sonogram. An omphalocele is an abdominal wall defect that occurs as a result of herniation into the umbilical cord and is often associated with chromosomal anomalies. This case report presents an omphalocele seen in the first trimester and discusses how to differentiate this finding from normal physiologic bowel herniation.
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Affiliation(s)
| | - Traci B. Fox
- Thomas Jefferson University, Philadelphia, PA, USA
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18
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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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Blood vessel matrix seeded with cells: a better alternative for abdominal wall reconstruction-a long-term study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:890613. [PMID: 25705696 PMCID: PMC4326343 DOI: 10.1155/2015/890613] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/31/2014] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to present abdominal wall reconstruction using a porcine vascular graft seeded with MSC (mesenchymal stem cells) on rat model. MATERIAL AND METHODS Abdominal wall defect was prepared in 21 Wistar rats. Acellular porcine-vascular grafts taken from aorta and prepared with Triton X were used. 14 aortic grafts were implanted in place, of which 7 grafts were seeded with rat MSC cells (Group I), and 7 were acellular grafts (Group II). As a control, 7 standard polypropylene meshes were used for defect augmentation (Group III). The assessment method was performed by HE and CD31 staining after 6 months. The mechanical properties have been investigated by Zwick&Roell Z0.5. RESULTS The strongest angiogenesis and lowest inflammatory response were observed in Group I. Average capillaries density was 2.75, 0.75, and 1.53 and inflammatory effect was 0.29, 1.39, and 2.72 for Groups I, II, and III, respectively. The means of mechanical properties were 12.74 ± 1.48, 7.27 ± 1.56, and 14.4 ± 3.7 N/cm in Groups I and II and control, respectively. CONCLUSIONS Cell-seeded grafts have better mechanical properties than acellular grafts but worse than polypropylene mesh. Cells improved mechanical and physiological properties of decellularized natural scaffolds.
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20
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Mlczoch E, Carvalho JS. Interrupted inferior vena cava in fetuses with omphalocele. Case series of fetuses referred for fetal echocardiography and review of the literature. Early Hum Dev 2015; 91:1-6. [PMID: 25460249 DOI: 10.1016/j.earlhumdev.2014.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/07/2014] [Accepted: 11/01/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Congenital heart disease is reported in 15-45% of omphalocele cases. Associated abnormalities of systemic veins have occasionally been reported in children and rarely documented in the fetus. We report a case series of interrupted inferior vena cava (Int-IVC) in association with omphalocele and review the literature. METHODS From our fetal database we identified all cases of omphalocele referred for fetal echocardiography (FE) between 1997 and 2012. We reviewed pre and postnatal medical records and performed a literature search from 1975 to present to identify previous relevant publications. RESULTS Of 9627 fetuses referred for FE, 34 had an omphalocele. Gestational age at FE was 17(+6) to 26(+4)weeks. Seven of the 34 fetuses were shown to have an Int-IVC with azygos continuation to a right-sided superior vena cava (SVC). The heart was structurally normal in all but one case. The abdominal wall defect was large and contained liver in all. There were three fetal demises and one neonatal death. Three cases were operated successfully. Since 1975, we identified 12 publications reporting omphalocele with systemic venous abnormalities. Abnormal IVC angulation may lead to surgical complications. Failure of IVC formation is likely to be a developmental rather than a situs abnormality. Int-IVC with a dilated azygos influences venous access and may predispose to venous thrombosis. CONCLUSION We have documented an association between large omphalocele and Int-IVC with azygos continuation to the SVC. In this small series, this did not have surgical implications. It will however, influence route of any future cardiac catheterisation and may have long-term implications.
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Affiliation(s)
- Elisabeth Mlczoch
- Fetal Medicine Unit, St George's Hospital NHS Trust, London, UK; Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
| | - Julene S Carvalho
- Fetal Medicine Unit, St George's Hospital NHS Trust, London, UK; Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK; St George's University of London, UK.
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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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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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