P. E. Lau1, C. S. Bernardo1, O. O. Olutoye1,2, D. L. Cass1,2, S. M. Cruz1, T. C. Lee1,2, S. Nuthakki2 1Baylor College Of Medicine,Pediatric Surgery,Houston, TX, USA 2Texas Children’s Hospital,Pediatrics,Houston, TX, USA
Introduction: Perinatal management of patients with giant omphaloceles(GO) can be challenging and be associated with mortality and morbidity. The purpose of this study was to assess the gastrointestinal outcomes in these patients, specifically time to attaining full enteral and oral feeding milestones.
Methods: We performed a retrospective chart review of patients with omphalocele from 1/2003 –2/2014. Patients were classified into isolated, omphalocele with minor or major anomalies categories. Major anomalies were defined as a cardiac defect requiring immediate medical or surgical treatment, congenital diaphragmatic hernias, and major chromosomal abnormalities. All other anomalies were classified as minor. Giant omphalocele was defined as >50% of liver in the sac. Feeding milestones were defined as the time to attain 120 ml/kg/d of enteral/oral feeds. We also evaluated length of stay, days on mechanical ventilation, need for tracheostomy, days of TPN, use of motility agent and achivement of full oral feeds prior to discharge.
Results:Of 82 live born patients, 53 survived to discharge. Patients with major anomalies had significant longer length of stay, delayed feeding milestones and were less likely to feed orally compared to patients with minor and isolated omphaloceles(Table 1). Respiratory morbidity of patients with major anomalies was more severe as shown by a higher rate of tracheostomies and longer length on mechanical ventilation. Patients with GO(n=25) had longer length of stay(36vs13, p=0.002), took longer to reach full enteral feeds(22vs10 days, p=0.015), had more days of TPN(17vs10 day, p=0.022). Fourteen(56%) of the patients with GO did not reach full PO feeds compared to six(21%) in the other group(p=0.045). Three(12%) patients with GO had G-tubes and six(24%) patients required motility agents. No motility agents or G-tubes were observed in non-giant omphalocele group.
Conclusion:The presence of major anomalies and GO appears to be a strong predictor in prolonging the achievement of full enteral feeds with obvious need for longer duration of TPN. Patients with isolated omphaloceles and patients with minor anomalies achieved full oral feeds at similar times, length of stay is longer with minor patients. This is likely related to the poor pulmonary status of these patients. Patients without GO are less likely to be treated with motility agents or need a g-tube. These findings are important for counseling parents and for the design perinatal interventions to improve outcomes on these patients.
