Neonatal care in patients with giant ompholocele: arduous management but favorable outcomes

Mitanchez, Delphine; Walter-Nicolet, E.; Humblot, A.; Rousseau, Véronique; Révillon, Y; Hubert, Philippe

doi:10.1016/j.jpedsurg.2010.04.011

Cited by 41 publications

(33 citation statements)

References 16 publications

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“…This definition was established by the consensus of the fetal pediatric surgeons because definitions based on defect size were not considered useful. Our definition of GO is different from the more commonly used classification of omphaloceles by the diameter of the abdominal wall opening [5,9] because in our experience measuring only the diameter of the abdominal wall defect is inadequate as large amount of abdominal viscera and liver may be eviscerated even through a narrow defect in the abdominal wall.…”

Section: Methodsmentioning

confidence: 90%

“…Over the last 2 decades, advances in surgical technique and neonatal intensive care have reduced the overall mortality for GO. Despite these improvements in survival, GO is associated with variable degrees of pulmonary hypoplasia which may lead to respiratory insufficiency, prolonged intensive care support, assisted ventilation, possible tracheostomy in order to maintain ventilation and oxygenation, and possible delayed abdominal wall closure [2,4,5]. In addition, children with GO have been reported to experience ongoing medical and surgical morbidities, including impaired musculoskeletal development, gastroesophageal reflux disease, nutritional problems, failure to thrive, and significant neurodevelopmental delays [2,4,5,6,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Fetal MRI-Calculated Total Lung Volumes in the Prediction of Short-Term Outcome in Giant Omphalocele: Preliminary Findings

et al. 2012

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Objective: To determine the value of fetal MRI-calculated total lung volumes (TLV) in the prediction of short-term outcome in patients with giant omphalocele (GO). Material and Methods: We reviewed all cases of GO undergoing fetal MRI after 21 weeks’ gestation and receiving postnatal care at our institution between 2003 and 2010. Observed/expected (O/E) TLV was calculated using age-matched TLV normograms [Radiology 2001;219:236–241]. Postnatal outcomes were stratified based on O/E TLV above or below 50% of expected. Results: Seventeen GO cases fulfilled the entry criteria. The mean age at fetal MRI evaluation was 25.8 ± 4.8 weeks’ gestation. The mean GO TLV (21.0 ± 13.2) was lower than age-matched population norms (p < 0.001), resulting in a mean O/E TLV of 52.3 ± 16.8%. The mean gestational age at delivery was 36.8 ± 1.6 weeks. Overall survival was 94%. Fourteen (88%) infants underwent staged reduction, and 2 underwent silver sulfadiazine treatment and delayed repair. Infants with ≤50% of predicted O/E TLV (n = 11, 65%) had lower Apgar scores at birth (p = 0.03), prolonged ventilatory support (p = 0.004), delayed oral intake (p = 0.03), and longer hospitalization (p = 0.03) compared to patients with ≥50% of expected O/E TLV. Two infants (both O/E TLV <50%) required tracheostomy placement. Conclusion: In the assessment of GO fetuses, MRI-based O/E TLV of <50% was predictive of increased postnatal morbidity.

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Section: Methodsmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Fetal MRI-Calculated Total Lung Volumes in the Prediction of Short-Term Outcome in Giant Omphalocele: Preliminary Findings

et al. 2012

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“…An omphalocele is often described as being giant when the abdominal wall defect size is >5 cm, or when there is more than 50 or 75 % of the liver within the sac (Mitanchez et al, 2010). The mortality rate is very high, from 0 % to 46 %, due to infections, intestinal obstruction, or pulmonary or renal failure, and there is a high frequency of associated anomalies (Bauman et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Celio-mesenteric Trunk Associated with Giant Omphalocele: Surgical Consequences

et al. 2017

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LAQUIEVRE, A.; HITIER, M.; PETIT, T.; RAVASSE, P. & ROD, J.Celio-mesenteric trunk associated with giant omphalocele: surgical consequences. Int. J. Morphol., 35(3):938-941, 2017. SUMMARY:We report the first case of a newborn presenting with a celio-mesenteric trunk variation associated with a giant omphalocele. The celio-mesenteric trunk was unexpected and unseen during the staged surgical closure. After partial reintegration of the liver, the newborn presented refractory hypovolemia with anuria, leading to redo surgery. This procedure revealed ischemia of the liver and necrosis of the entire gastrointestinal tract except the colon. Despite treatment, including liver externalization, the infant did not survive. The autopsy revealed a celio-mesenteric trunk, a rare anomaly characterized by a common origin of the celiac axis and the superior mesenteric artery from the aorta. This association may explain the dramatic consequences of the staged closure procedure. Awareness of the association of celio-mesenteric trunk and omphalocele would allow the surgeon to take extra care during this delicate surgery.

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“…Primitive reintegration of large omphalocele often leads to immediate postoperative death by cardiovascular failure or a long neonatal resuscitation [14]. Primitive surgery can also leads to serious post operative complications as liver ischemic necrosis, small bowel necrosis with long hospital stay.…”

Section: Citationmentioning

confidence: 99%

Techniques and Results of the Conservative Treatment of Giant Omphalocele with 2% Disodium Aqueous Eosin

2014

Clinics in Mother and Child Health

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Aim: Describe the techniques and results of the conservative treatment of giant omphalocele with aqueous eosin. Material and Methods:It was a 15 years conservative treatment retrospective study of giant omphalocele with 2% disodium eosin aqueous. The technique consisted of the twice a day application of 2% eosin on the omphalocele bag (sterile solution for cutaneous application). The technique was taught to the mother to continue with the outpatient care. We studied the duration of hospitalization, the learning curve of the technique through the mother, the intercurrent complications, the complete epithelialization percentage and the mortality.Results: A total number of 173 giant omphaloceles had a conservative treatment with 2% aqueous eosin. The average length of hospitalization was 21 ± 6 days. The learning curve of the application of the aqueous eosin on the bag omphalocele through the mother was 10 ± 3 days. Complications of treatment were 22% functional bowel obstruction and 18% infection of the omphalocele bag. The complete epithelialization of the omphalocele bag after the application of the 2% aqueous eosin was 68.5%. The mortality was observed in 25.5% of cases. Conclusion:The giant omphalocele conservative treatment with aqueous eosin is a simple, efficient technique and a good alternative to surgery. The learning through the mother reduces the length of hospital stay.

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Neonatal care in patients with giant ompholocele: arduous management but favorable outcomes

Cited by 41 publications

References 16 publications

Fetal MRI-Calculated Total Lung Volumes in the Prediction of Short-Term Outcome in Giant Omphalocele: Preliminary Findings

Fetal MRI-Calculated Total Lung Volumes in the Prediction of Short-Term Outcome in Giant Omphalocele: Preliminary Findings

Celio-mesenteric Trunk Associated with Giant Omphalocele: Surgical Consequences

Techniques and Results of the Conservative Treatment of Giant Omphalocele with 2% Disodium Aqueous Eosin

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