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Delayed management of giant omphalocele using silver sulfadiazine cream: an 18-year experience
Sigmund H Ein1, Jacob C Langer
1Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8. a_ein@istar.ca
Insights
Topical silver sulfadiazine (SSD) cream is effective for treating giant omphalocele in infants when immediate surgical closure isn't possible. This method shows excellent outcomes for managing this complex congenital condition.
Area of Science:
- Neonatal Surgery
- Pediatric Surgery
- Dermatology
Background:
- Giant omphalocele presents significant challenges in neonatal care.
- Immediate surgical closure is often not feasible for large omphaloceles.
Purpose of the Study:
- To evaluate the efficacy of topical silver sulfadiazine (SSD) cream.
- To assess outcomes in infants with giant omphalocele treated with SSD.
Main Methods:
- A cohort of 20 infants with giant omphalocele (>10 cm diameter) were treated with SSD cream.
- Treatment involved topical application for a mean of 6 months.
- Delayed ventral hernia repair was planned post-initial treatment.
Main Results:
- 14 out of 20 infants (70%) survived, with a mean hospital stay of 14 weeks.
- Common complications included pulmonary hypoplasia and sepsis.
- 12 survivors underwent ventral hernia repair, with 2 recurrences.
Conclusions:
- Topical SSD cream is associated with excellent outcomes for giant omphalocele.
- It serves as a viable initial treatment when immediate closure is not an option.
- This approach facilitates management of complex neonatal surgical cases.
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.