701 - Do infants with omphalocele delivered at term have better outcomes than those delivered preterm?

Publication Number: 1678.701

Melissa Andrianov, Cleveland Clinic Children's, Cleveland, OH, United States; Mohsen A.A.. Farghaly, Cleveland Clinic Children's, Cleveland, OH, United States; Hatem Eltaly, Cleveland Clinic Children’s, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland, Cleveland, OH, United States; HANY ALY, Cleveland Clinic Children's Hospital, Cleveland, OH, United States

Background: There is a paucity of literature surrounding the ideal timing of delivery for infants with omphalocele to optimize neonatal outcomes based on gestational age at delivery.

Objective: To examine the prevalence of necrotizing enterocolitis (NEC), need for abdominal wall repair surgery (AWR), length of hospital stay (LOS), and mortality associated with omphalocele in infants, stratified by gestational age (GA) at birth.

Design/Methods: We used the National Inpatient Sample (NIS) dataset produced by the healthcare cost and utilization project (HCUP) for the years 2016-2022. We identified clinical diagnoses using respective international classification of diseases version 10 (ICD10). We identified omphalocele using ICD10: Q79.2. We excluded infants < 34 weeks gestational age (GA), or birth weight (BW) < 1500g, infants with Trisomy 13 or 18, infants with complex congenital heart disease (CHD), congenital diaphragmatic hernia (CDH), severe brain or lung anomalies, or neural tube defects (NTD). We compared outcomes of omphalocele between different GA categories using logistic regression models to control potential confounding variables.

Results: The weighted sample included 26,272,741 total infants. There were 7716 infants with omphalocele (0.02%). After applying exclusion criteria, 5238 infants remained, of which, 45% were female, 44% were Caucasian, 97% were singleton, and 5% were small for gestational age (SGA). Prevalence of omphalocele amongst this cohort was 0.02%, 0.06%, 0.08%, and 0.11% amongst infants born at or after 37 weeks, at 36 weeks, at 35 weeks, and at 34 weeks GA, respectively. The overall prevalence of NEC among all infants with omphalocele was 4.8%. Preterm infants had a significantly higher incidence of NEC compared to term infants, Table (1). About 23% of infants born with omphalocele were transferred out of the birth hospital. Of the remaining 4033 non-transferred infants, AWR surgery was performed on 41% of them. The overall mortality for all infants who did not receive AWR surgery was 6.7%, while the mortality amongst those who did receive AWR was 2.43%. Mortality did not differ significantly by GA and is depicted in Table (1). Mean LOS did not differ significantly by GA except among those who were managed conservatively without surgery, Table (1).

Conclusion(s): Infants with omphalocele, if delivered preterm, have a higher incidence of NEC and longer LOS if managed conservatively without AWR, compared to term infants (born at or after 37 weeks GA). However, mortality did not significantly differ between the groups based on GA at birth.

Table 1: Adverse outcomes among infants with omphalocele stratified by gestational age.
Outcomes in infants 34-36 weeks were compared to term infants (>37wk) using logistic regression models to calculated adjusted odds ratios (aOR), 95% confidence intervals (CI) and p values. Confounding factors controlled for are sex, birth weight, presence of chorioamnionitis, neonatal sepsis, respiratory compromise, or pulmonary hypertension.