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Prenatal and Postnatal Determinants of Outcome in Neonates with Omphalocele: A 25-Year Single-Center Cohort Study
Dina Al Namat1, Delia Hînganu1, Adrian Romulus Roșca2
1Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.
Insights
Pulmonary anomalies significantly increase mortality in neonates with omphalocele, highlighting the need for thorough pulmonary assessments to improve outcomes for these complex congenital defects.
Area of Science:
- Pediatric Surgery
- Neonatology
- Congenital Anomalies
Background:
- Omphalocele is a congenital anterior abdominal wall defect often accompanied by other anomalies.
- Cardiovascular and pulmonary issues significantly impact neonatal survival in omphalocele cases.
- The prognostic impact of these associated anomalies needs further characterization.
Purpose of the Study:
- To analyze the prognostic contribution of cardiac and pulmonary anomalies in neonates with omphalocele.
- To evaluate the association between omphalocele type (isolated vs. non-isolated) and mortality.
- To identify factors influencing outcomes in a regional cohort.
Main Methods:
- Retrospective observational study of 50 neonates with omphalocele (2000-2025).
- Analysis of demographic data, associated anomalies, surgical management, and outcomes.
- Univariate logistic regression to assess the association between anomalies and mortality.
Main Results:
- Majority of patients had associated congenital anomalies.
- Pulmonary anomalies were significantly linked to increased mortality (OR=4.31, p=0.025).
- Cardiac anomalies alone did not show a significant association with mortality.
Conclusions:
- Pulmonary anomalies are a strong predictor of increased mortality in neonates with omphalocele.
- Detailed pulmonary assessment is crucial for risk stratification and management.
- Findings underscore the importance of multidisciplinary care for omphalocele.
Abstract:
Background: Omphalocele is a congenital defect of the anterior abdominal wall frequently associated with additional anomalies that substantially influence neonatal outcomes. Cardiovascular and pulmonary abnormalities are among the most clinically relevant factors affecting survival, yet their relative prognostic contribution remains incompletely characterized in smaller regional cohorts. Methods: This retrospective observational study included 50 neonates with omphalocele treated at a tertiary pediatric surgery center in Northeastern Romania between 2000 and 2025. Demographic characteristics, associated congenital anomalies, surgical management, and clinical outcomes were analyzed. Comparisons were performed between isolated and non-isolated omphalocele cases and according to the presence of cardiac and pulmonary anomalies. Univariate logistic regression was used to evaluate associations between associated anomalies and mortality. Results: Associated congenital anomalies were present in the majority of patients. Cardiac malformations were identified in 68% of cases, pulmonary anomalies in 22%, and combined cardiopulmonary anomalies in 20%. Overall mortality was substantial. Mortality was higher in non-isolated compared with isolated omphalocele, although this difference did not reach statistical significance. Univariate analysis showed that pulmonary anomalies were significantly associated with increased mortality (OR = 4.31, 95% CI: 1.20-15.50, p = 0.025), whereas cardiac anomalies alone were not significantly associated with mortality. Combined cardiopulmonary anomalies were associated with an increased mortality risk without reaching statistical significance. Conclusions: In this cohort, pulmonary anomalies were strongly associated with increased mortality among neonates with omphalocele. These findings suggest that detailed prenatal and postnatal pulmonary assessment may contribute to improved risk stratification and multidisciplinary management in affected neonates. The results should be interpreted in the context of the study's retrospective design and limited sample size.
