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      Accuracy and impact of prenatal diagnosis in infants with omphalocele

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          Abstract

          Background

          Associated anomalies in omphalocele are common, but to which extent these anomalies are diagnosed before or after birth is less well documented.

          Aim

          To investigate the different types of associated anomalies, long-term survival and the extent whether these are diagnosed pre- or postnatally in children with a prenatal diagnosis of omphalocele at a single institution.

          Materials and methods

          Retrospective review of all pregnancies with omphalocele managed and/or born at our institution between 2006 and 2016.

          Results

          A total of 42 cases with prenatally diagnosed omphalocele were identified. Of those 14 (31%) decided to terminate the pregnancy (TOP). Of the remaining 28 that continued, 12 were giant omphaloceles. The overall mortality rate was 18, 25% for giant and 12% for non-giant omphaloceles. 64% had associated anomalies. Only 1/3 of these anomalies is diagnosed prenatally.

          Conclusion

          The rate of associated malformations that are diagnosed postnatally is high, but the majority was malformations with a minor clinical significance or impact on future health. Beckwith–Wiedemann syndrome was present only in cases of non-giant omphalocele in our cohort.

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          Most cited references21

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          Prevalence, Correlates, and Outcomes of Omphalocele in the United States, 1995–2005

          To examine the trends in the prevalence, epidemiologic correlates, and 1-year survival of omphalocele using 1995-2005 data from the National Birth Defects Prevention Network in the United States.
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            Frequency of anomalies and hospital outcomes in infants with gastroschisis and omphalocele.

            Gastroschisis and omphalocele are the most common anterior abdominal wall defects affecting infants. There are few large cohort studies describing the frequency of associated anomalies in infants with these 2 conditions. We describe associated anomalies and outcomes in infants with these defects using a large, multi-center clinical database.
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              Omphalocele and gastroschisis and associated malformations.

              The etiology of gastroschisis and omphalocele is unclear and their pathogenesis is controversial. Because previous reports have inconsistently noted the type and frequency of malformations associated with omphalocele and gastroschisis, we assessed these associated malformations ascertained between 1979 and 2003 in 334,262 consecutive births. Of the 86 patients with omphalocele, 64 (74.4%) had associated malformations. These included patients with chromosomal abnormalities (25, 29.0%); non-chromosomal syndromes including Beckwith-Wiedemann syndrome, Goltz syndrome, Marshall-Smith syndrome, Meckel-Gruber syndrome, Oto-palato-digital type II syndrome, CHARGE syndrome, and fetal valproate syndrome; malformation sequences, including ectopia cordis, body stalk anomaly, exstrophy of bladder, exstrophy of cloaca, and OEIS (Omphalocele, Exstrophy of bladder, Imperforate anus, Spinal defect); malformation complexes including Pentalogy of Cantrell, and non-syndromic multiple congenital anomalies (MCA) (26, 30.2%). Malformations of the musculoskeletal system (31, 23.5%), urogenital system (27, 20.4%), cardiovascular system (20, 15.1%), and central nervous system (12, 9.1%) were the most common other congenital malformations in patients with omphalocele and non-syndromic MCA. Of the 60 patients with gastroschisis, 10 (16.6%) had associated malformations. In contrast to omphalocele, gastroschisis was rarely associated with a complex pattern of malformation, that is, one each (1.7%) with a chromosomal abnormality (trisomy 21), sequence (amyoplasia congenita), unspecified dwarfism, and 7 (11.7%) with MCA. We observed a striking difference in the prevalence of total malformations (74.4% vs. 16.6%, P < 0.001) and specific patterns of malformations associated with omphalocele and gastroschisis which emphasizes the need to evaluate all patients with omphalocele and gastroschisis for possible associated malformations. Malformation surveillance programs should be aware that the malformations associated with omphalocele can be often classified into a recognizable malformation syndrome or pattern (44.2%). 2008 Wiley-Liss, Inc.
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                Author and article information

                Contributors
                Carmen.mesas.burgos@ki.se
                Journal
                Pediatr Surg Int
                Pediatr. Surg. Int
                Pediatric Surgery International
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0179-0358
                1437-9813
                10 April 2018
                10 April 2018
                2018
                : 34
                : 6
                : 629-633
                Affiliations
                [1 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Center for Fetal Medicine, , Karolinska University Hospital, ; Stockholm, Sweden
                [2 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Department of Pediatric Surgery, S3:03, , Karolinska University Hospital, ; 17176 Stockholm, Sweden
                Article
                4265
                10.1007/s00383-018-4265-x
                5954074
                29637257
                58dc9574-4325-409e-af74-a35200a5c73c
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 6 April 2018
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2018

                Pediatrics
                omphalocele,exomphalos,prenatal,malformations,beckwith–wiedemann syndrome
                Pediatrics
                omphalocele, exomphalos, prenatal, malformations, beckwith–wiedemann syndrome

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