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Beyond the womb: prenatal MRI's prognostic abilities for morbidity and mortality in neonates with omphaloceles
Krishna Manohar1,2, Fikir M Mesfin1,2, Jessica Belchos1,3
1Department of Surgery, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA.
Background:
Managing omphaloceles poses challenges in prenatal consultation and perinatal care. We hypothesized that specific fetal MRI findings could predict morbidity and mortality in these patients.
Methods:
We analyzed fetal MRI studies demonstrating omphaloceles from 2006 to 2022 and conducted a retrospective review of medical records. Predictor variables were correlated with outcomes using univariate and multivariate analyses, and Receiver Operating Characteristic (ROC) curves were optimized with Youden's J statistic.
Results:
Among 46 omphalocele patients, 89% survived to birth, with an overall mortality rate of 37%. Significant predictors of mortality included stomach/spleen herniation, severe anomalies, omphalocele-associated syndromes, membrane rupture, lower observed/expected total fetal lung volume (O/E TFLV), and increased percentage of liver herniation. The need for deferred repair correlated with liver/stomach herniation and "giant-omphalocele." ROC analysis identified mortality cut points at O/E TFLV < 42% and liver herniation >77%, while deferred repair was indicated at liver herniation >51%.
Conclusion:
This study identified prenatal MRI findings associated with mortality and deferred repair, aiding in risk prediction and family counseling.
Insights
Fetal MRI can predict omphalocele outcomes. Specific findings like herniated organs and lung volume predict mortality and the need for delayed repair, improving prenatal counseling.
Area of Science:
- Medical imaging
- Prenatal diagnosis
- Pediatric surgery
Background:
- Omphalocele management presents significant challenges in prenatal and perinatal care.
- Predicting morbidity and mortality in fetuses with omphalocele is crucial.
Purpose of the Study:
- To investigate the predictive value of fetal MRI findings for omphalocele patient outcomes.
- To identify specific MRI markers associated with mortality and the need for deferred repair.
Main Methods:
- Retrospective analysis of fetal MRI studies and medical records from 2006-2022.
- Correlation of predictor variables with outcomes using univariate/multivariate analyses.
- Optimization of Receiver Operating Characteristic (ROC) curves with Youden's J statistic.
Main Results:
- Among 46 omphalocele patients, 89% survived to birth with a 37% mortality rate.
- Significant mortality predictors included stomach/spleen herniation, severe anomalies, syndromes, membrane rupture, low O/E TFLV, and high liver herniation percentage.
- Deferred repair correlated with liver/stomach herniation and giant omphalocele; ROC analysis identified mortality cut points (O/E TFLV <42%, liver herniation >77%) and deferred repair indication (liver herniation >51%).
Conclusions:
- Prenatal MRI findings can effectively predict omphalocele-associated mortality.
- Specific MRI metrics aid in identifying fetuses requiring deferred surgical repair.
- These findings enhance risk prediction and facilitate informed family counseling.
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