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Comparison of outcomes of infants with giant omphaloceles over two decades
R E Witt1, M Singhal1, A J Vachharajani1
1Department of Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA.
Insights
Outcomes for infants with giant omphalocele (GO) did not improve with advanced treatments like pulmonary vasodilators and ECMO. Infants requiring prolonged mechanical ventilation in the second epoch did not survive, highlighting the need for informed care decisions.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Critical Care
Background:
- Giant omphalocele (GO) presents significant management challenges in neonates.
- Pulmonary hypertension is a major complication impacting outcomes in infants with GO.
- Advances in neonatal care include selective pulmonary vasodilators and extracorporeal membrane oxygenator (ECMO) support.
Purpose of the Study:
- To compare outcomes of infants with giant omphalocele (GO) across two decades.
- To evaluate the impact of selective pulmonary vasodilators and ECMO on pulmonary hypertension management in GO patients.
- To assess changes in survival and length of stay for infants with GO.
Main Methods:
- Retrospective review of medical records for 59 infants diagnosed with GO between 1996 and 2016.
- Classification of GO cases into isolated or associated with minor/major anomalies.
- Definition of GO as a defect ≥5cm and/or with liver within the sac.
Main Results:
- The duration of invasive mechanical ventilation was significantly shorter for survivors in the second epoch (p=0.03), not exceeding seven days.
- No significant differences were observed in survival to NICU discharge between the two epochs.
- Length of stay (LOS) did not differ significantly between infants in the two study periods.
Conclusions:
- Infants with GO requiring >7 days of mechanical ventilation did not survive in the second epoch.
- Selective pulmonary vasodilators and ECMO did not improve overall survival rates for infants with GO.
- Findings can inform prenatal and postnatal counseling for families regarding goals of care in complex neonatal surgical cases.
Background:
The purpose of this study was to compare the outcomes of infants with giant omphalocele (GO) born in two different epochs over two decades at a single institution. Specifically, it examined whether the utilization of selective pulmonary vasodilators and extracorporeal membrane oxygenator (ECMO) in the management of pulmonary hypertension in the second epoch were associated with improved outcomes.
Methods:
The medical records of all patients diagnosed with GO at a large children's hospital from January 1, 1996 to December 31, 2016 were reviewed and divided into two epochs. Patients were classified as having an isolated GO or GO with minor or major associated anomalies. GO was defined as a defect more than or equal to 5 cm in size and/or liver in the sac.
Results:
During the study period, 59 infants with GO were identified. The duration of invasive mechanical ventilation was significantly shorter among the survivors from the second epoch (p = 0.03), with none greater than seven days. There were no significant differences in the outcomes of survival to NICU discharge and length of stay (LOS) between infants in the two epochs.
Conclusions:
Infants with GO who required invasive mechanical ventilation for more than seven days did not survive in the second epoch. Survival did not improve with use of selective pulmonary vasodilators and ECMO. This information could be shared with families during prenatal and postnatal counselling to facilitate informed decision making regarding goals of care.
