Predicting adverse neonatal outcomes in fetuses with abdominal wall defects using prenatal risk factors

Nicholas, Sara; Stamilio, David M.; Dicke, Jeffery M.; Gray, Diana L.; Macones, George A.; Odibo, Anthony O.

doi:10.1016/j.ajog.2009.06.032

Cited by 59 publications

(71 citation statements)

References 18 publications

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“…We therefore advocate that the OD/AC ratio established antenatally is a useful replacement for the subjective assessment of giant omphaloceles based on description of liver herniation or estimation of >75% of liver herniation [11,12,16]. Moreover, our data show that this is a useful parameter in the prediction of both mortality and morbidity.…”

Section: Discussionmentioning

confidence: 78%

Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome?

Kiyohara

Brizot²,

Liao³

et al. 2013

Fetal Diagn Ther

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Objective: To evaluate the fetal omphalocele diameter/abdominal circumference ratio (OD/AC) as a predictor of adverse perinatal outcome. Methods: Analysis involving 47 singleton pregnancies with fetal omphalocele, normal karyotype and absence of other major abnormalities. The OD/AC ratio was determined antenatally by ultrasound and the best cutoff for the prediction of neonatal death was determined by receiver operating characteristic curve analysis. Additional secondary outcomes included need for oral intubation in the first 24 h of life, two-step surgery or use of synthetic mesh, reoperation, parenteral feeding and need for respiratory assistance >21 days, time to first oral feed, and time to hospital discharge. Results: Fetal OD/AC did not change significantly with gestational age. Postnatal death occurred in 10 (21.3%) cases and the best cutoff for prediction was an OD/AC ratio ≥0.26. In pregnancies with the first ultrasound evaluation performed before 31 weeks' gestation and an OD/AC ≥0.26, the likelihood ratio for needing intubation in the first 24 h of life was 2.6 (95% CI: 1.2-5.7), needing two-step surgery or use of mesh was 4.9 (95% CI: 1.9-14.4), and postnatal death was 4 (95% CI: 1.9-7.5). Conclusion: A fetal ultrasound OD/AC ratio ≥0.26 is associated with increased postnatal morbidity and mortality.

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Section: Discussionmentioning

confidence: 78%

Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome?

Kiyohara

Brizot²,

Liao³

et al. 2013

Fetal Diagn Ther

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“…In contrast, among the cases without polyhydramnios, only 62.5% had other anomalies or an underlying disease. Nicholas et al [7] reported that exteriorization of the liver is a significant predictor of adverse neonatal outcome. Hidaka et al [8] also reported that extracorporeal liver might be associated with more life-threatening anomalies, amniotic fluid volume abnormalities and a higher rate of mortality than an intracorporeal liver.…”

Section: Discussionmentioning

confidence: 99%

Congenital Omphalocele and Polyhydramnios: A Study of 52 Cases

et al. 2011

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Introduction: Unlike gastroschisis, congenital omphalocele is often associated with other anomalies and is frequently complicated by polyhydramnios. We examined the relationships between polyhydramnios, pregnancy outcome and fetal prognosis.Patients and Methods: Clinical data from cases diagnosed antenatally with congenital omphalocele from 1993 to 2006 were analyzed retrospectively. Results: Fifty-two cases were diagnosed antenatally with congenital omphalocele, and 38 of these pregnancies resulted in delivered infants. Of these 38 pregnancies, 55.3% were preterm births before 37 weeks of gestation. The mean birth weight was 2,148 g (n = 38). Associated anomalies were recognized in 29 cases (76.3%), including 13 cases (34.2%) of chromosomal aberrations. There were 2 cases of trisomy 13, 10 cases of trisomy 18 and 1 case of trisomy 21. Polyhydramnios was detected in 14 cases (36.8%), and other anomalies were present in all of these cases. Discussion: For antenatal evaluation in cases of congenital omphalocele, it is important to examine the fetus for associated anomalies or underlying disease, especially when polyhydramnios is detected.

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“…No association has previously been reported between low birth weight and mortality in newborns with gastroschisis [6,19,20,21]. However, controversy exists regarding neonatal morbidity in these neonates with low birth weight.…”

Section: Discussionmentioning

confidence: 99%

“…However, controversy exists regarding neonatal morbidity in these neonates with low birth weight. Japaraj et al [6] and Nelson et al [21] did not find an association with increased morbidity, whereas Chen et al [20] and Nicholas et al [19] observed an increased number of surgical complications and longer hospital stays.…”

Section: Discussionmentioning

confidence: 99%

Fetal Growth Pattern and Prediction of Low Birth Weight in Gastroschisis

et al. 2015

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Objectives: To examine growth patterns and predictions of low birth weight in gastroschisis fetuses. Methods: This is a retrospective study of isolated fetal gastroschisis before week 24. Ultrasound fetal biometric parameters - head circumference (HC), abdominal circumference (AC), femur length, HC/AC ratio and estimated fetal weight (EFW) - were plotted against normal growth charts. The percentage difference in mean values between normal and gastroschisis fetuses was determined. The growth deficit for each ultrasound parameter was calculated for the fetuses with 1 examination in each designated period (period I: weeks 20-25⁺⁶; period II: weeks 26-31⁺⁶; period III: from week 32 until term). For low birth weight prediction, measurements below the 10th percentile in periods I and II were tested. Results: Seventy pregnancies were examined. For all fetal parameters, the mean measurements were lower in fetuses with gastroschisis (p < 0.005). The EFW revealed an increased growth deficit between the periods (p = 0.030). HC was predictive of low birth weight in period II (OR = 6.07; sensitivity = 70.8%; specificity = 71.4%). Conclusions: Fetuses with gastroschisis present a reduced growth pattern, and it appears that no growth recovery occurs after the growth restriction has been established. Between week 26 and week 31⁺⁶, an HC measurement below the 10th percentile is associated with an increased risk of low birth weight.

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Predicting adverse neonatal outcomes in fetuses with abdominal wall defects using prenatal risk factors

Cited by 59 publications

References 18 publications

Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome?

Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome?

Congenital Omphalocele and Polyhydramnios: A Study of 52 Cases

Fetal Growth Pattern and Prediction of Low Birth Weight in Gastroschisis

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