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MINERVA PEDIATRICA

A Journal on Pediatrics, Neonatology, Adolescent Medicine,
Child and Adolescent Psychiatry


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Minerva Pediatrica 2017 Nov 21

DOI: 10.23736/S0026-4946.17.05109-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Predictors of mortality in neonates with giant-omphaloceles

Amulya K. SAXENA 1 , Maja RAICEVIC 2

1 Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster NHS Fdn Trust, Imperial College London, London, UK; 2 Clinic for Pediatric Surgery and Orthopedic Nis, Clinical Center Nis, Nis, Serbia


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INTRODUCTION: This analysis was performed a review of giant-omphaloceles to determine the predictors of mortality.
EVIDENCE ACQUISITION: Pubmed® and KoBson databases were searched for terms "giant" "omphalocele" and "mortality". Primary end points included mortality correlation with gestational age (GA), birth weight (BW), eviscerated organs, associated anomalies and management. To calculate mean and median values IBM SPSS version 23.0 was used.
EVIDENCE SYNTHESIS: After de-duplication and review search revealed 42 articles of which 23 met our inclusion criteria with 396 giant-omphaloceles for this analysis. Median gestational age (GA) was 36 weeks for all neonates (range 21-41); 21 neonates were reported as premature with median (GA) 33,5 ( range 21-36) and median birth weight (BW) for all was 3100g (range 1100-4100g). The diameter of abdominal wall defect was 4-15cm with the average size of 7.6cm except for nongiant giant omphaloceles (n=7) where the defect was measuring between 2.7 and 4cm. Amniotic sac contents beside intestines included liver n=154, stomach n=11, spleen n=2, pancreas n=1, gallbladder n=5 and 5 giant omphaloceles were reported to contain only liver; sac was ruptured in n=22. Giant omphaloceles were associated with a variety of other anomalies, most often with cardiac anomalies n=93 (23.4%) and pulmonary hypoplasia and/or pulmonary hypertension n=39 (9.8%). Management included conservative treatment n=264 (66.6%), primary closure n=17 (4.3%), staged closures n=98 (24.7%) primary or staged closure n=17(4.3%). The most frequent complication was sepsis n=52. There were 90 (22.7%) lethal outcomes, 6 lethal outcomes in neonates even before final closure could be achieved and 12 in prematures. Leading cause of mortality was sepsis n=51(56.6%), the cause of lethal outcome was not reported in 8 cases.
CONCLUSIONS: Giant-omphaloceles have a leathal outcome in 1/5th neonates. Predictors of mortality included pulmonary hypoplasia and respiratory failure with prematurity and ruptured sacs implicated within this group. Sepsis was the independent iatrogenic factor in mortality.


KEY WORDS: Giant omphaloceles - Mortality - Management - Outcomes - Predictors

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Publication History

Article first published online: November 20, 2017
Manuscript accepted: November 13, 2017
Manuscript received: October 1, 2017

Cite this article as

Saxena AK, Raicevic M. Predictors of mortality in neonates with giant-omphaloceles. Minerva Pediatr 2017 Nov 21. DOI: 10.23736/S0026-4946.17.05109-X

Corresponding author e-mail

amulya.saxena@nhs.net