Risk Factors Associated Respiratory Insufficiency and Long-term Ventilator Support in Neonates with Omphalocele

Hyo Won Kim; Seung Hyun Shin; Hae Kyung Woo; Eui Kyung Choi; In Gu Song; Young Hwa Jung; Seung Han Shin; Eu-Kyung Kim; Han-Suk Kim

doi:10.14734/PN.2016.27.3.158

Journal List > Perinatology > v.27(3) > 1071325

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Shin, Woo, Choi, Song, Jung, Shin, Kim, and Kim: Risk Factors Associated Respiratory Insufficiency and Long-term Ventilator Support in Neonates with Omphalocele

Original Article

Perinatology 2016; 27(3): 158-161.

Published online: 30 September 2016

DOI: https://doi.org/10.14734/PN.2016.27.3.158

Risk Factors Associated Respiratory Insufficiency and Long-term Ventilator Support in Neonates with Omphalocele

Hyo Won Kim, MD¹, Seung Hyun Shin, MD¹, Hae Kyung Woo, MD¹, Eui Kyung Choi, MD¹, In Gu Song, MD¹, Young Hwa Jung, MD^1,², Seung Han Shin, MD^1,³, Eu-Kyung Kim, MD, PhD^1,³, Han-Suk Kim, MD, PhD^1,³

¹Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

²Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

³Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to: Seung Han Shin, MD. Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro Jongnogu, Seoul 110-799, Korea. Tel: +82-2-2072-7230, Fax: +82-2-2072-0590, revival421@snu.ac.kr

Received 12 July 2016 Revised 19 August 2016 Accepted 1 September 2016

(open-access, http://creativecommons.org/licenses/by-nc/4.0/):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The objective of this study was to determine factors associated with respiratory insufficiency and long term ventilator-support in newborn with omphalocele.

Methods

Medical records of neonates with omphalocele in the neonatal intensive care unit (NICU) in Seoul National University Children's Hospital between April 2000 and March 2016 were reviewed retrospectively.

Results

A total of 44 neonates were enrolled. Infants intubated within 24 hours after birth (early intubated group, n=21) and not intubated within 24 hours after birth (late intubated group n=23) were compared. Duration of ventilator care, duration of total parenteral nutrition administration, duration of NICU stay and mortality rate were higher in the early intubated group. The early intubated group had lower gestational age, lower birth weight, lower 1min and 5min Apgar score and higher mortality rate with longer duration of mechanical ventilator support than late intubated group. Persistent pulmonary hypertension and small for gestational age were related to the duration of ventilator support.

Conclusion

It is important to predict and prevent of respiratory insufficiency and prolongation of invasive mechanical ventilation in neonates with omphalocele. It is needed to diagnose pulmonary hypertension and respiratory failure after birth in early stages. Further prospective large cohort studies are needed to determine the pathophysiology of respiratory insufficiency and ventilator dependency of neonates with omphalocele reducing morbidity.

Keywords: Omphalocele, Respiratory insufficiency, Pulmonary hypertension

Figures and Tables

Table 1

Demographics of Study Population

Parameters	Initiation of intubation & MV		P-value
Parameters	Early intubated group ≤24hr after birth (n=21)	Late intubated group >24hr after birth (n=23)	P-value
Gestational age (week)	36⁺⁴±3⁺³	37⁺⁶±1⁺⁵	0.105
Birth weight (kg)	2.60±0.85	3.19±0.59	0.010
AS 1 min	4.6±2.2	6.2±1.6	0.010
AS 5 min	6.7±1.8	7.7±1.2	0.036
Female	13 (61.9)	10 (43.4)	0.222
C/S	12 (57.1)	14 (60.8)	0.802
PROM	6 (28.5)	3 (13.0)	0.202
Preeclampsia	0 (0)	1 (4.3)	0.334
SGA	9 (42.8)	4 (17.3)	0.064
Containing organ (No.)	6 (28.5)	3 (13.0)	0.202
Associated anomaly	10 (47.6)	11 (47.8)	0.989
CHD	10 (47.6)	2 (8.69)	0.004
PPHN	5 (23.8)	1 (4.3)	0.060
Sac size on X-ray/birth weight (cm/kg)	3.42±1.3	2.69±0.6	0.710
Height of thoracic cage/birth weight (cm/kg)	2.53±0.9	2.03±0.3	0.020

Abbreviations: AS, apgar score; C/S, cesarean section; PROM, premature rupture of membrane; SGA, small for gestational age; CHD, congenital heart disease; PPHN, persistent pulmonary hypertension

Table 2

Clinical Courses of Study Population

Parameters	Initiation of intubation & MV		P-value
Parameters	Early intubated group ≤24hr after birth (n=21)	Late intubated group >24hr after birth (n=23)	P-value
Timing of operation after birth (day)	63.1(±103.9)	239.2 (±248.2)	0.022
TPN administration (day)	48.0 (±67.3)	11.0 (±10.2)	0.013
Achievement of full enteral feeding (day)	28.3 (±31.0)	11.9 (±10.2)	0.019
NICU stay (day)	73.8 (±94.5)	21.2 (±22.9)	0.013
Invasive ventilator support (day)	45.8 (±88.3)	5.2 (±16.7)	0.036
TPN induced cholestasis	3 (14.2)	0 (0)	0.060
Culture proven sepsis	3 (14.2)	1 (4.3)	0.252
Mortality	8 (38.0)	1 (4.3)	0.006

Abbreviation: TPN, total parenteral nutrition

Table 3

Continuous Variables Related to the Duration of Ventilator Support

	Spearman's ρ	P-value
Gestational age (week)	−0.3749	0.012
Weight (kg)	−0.4569	0.002
AS 1min	−0.3927	0.008
AS 5min	−0.3907	0.009
Mean height of thoracic cage/birth weight (cm/kg)	0.3304	0.029

Abbreviation: AS, apgar score

References

1. Benjamin B, Wilson GN. Anomalies associated with gastroschisis and omphalocele: analysis of 2825 cases from the Texas Birth Defects Registry. J Pediatr Surg. 2014; 49:514–519.

2. Biard JM, Wilson RD, Johnson MP, Hedrick HL, Schwarz U, Flake AW, et al. Prenatally diagnosed giant omphaloceles: short- and long-term outcomes. Prenat Diagn. 2004; 24:434–439.

3. Christison-Lagay ER, Kelleher CM, Langer JC. Neonatal abdominal wall defects. Semin Fetal Neonatal Med. 2011; 16:164–172.

4. Hershenson MB, Brouillette RT, Klemka L, Raffensperger JD, Poznanski AK, Hunt CE. Respiratory insufficiency in newborns with abdominal wall defects. J Pediatr Surg. 1985; 20:348–353.

5. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988; 16:128–140.

6. Tassin M, Descriaud C, Elie C, Houfflin Debarge V, Dumez Y, Perrotin F, et al. Omphalocele in the first trimester: prediction of perinatal outcome. Prenat Diagn. 2013; 33:497–501.

7. Corey KM, Hornik CP, Laughon MM, McHutchison K, Clark RH, Smith PB. Frequency of anomalies and hospital outcomes in infants with gastroschisis and omphalocele. Early Hum Dev. 2014; 90:421–424.

8. Edwards EA, Broome S, Green S, Douglas C, McCall E, Nuthall G, et al. Long-term respiratory support in children with giant omphalocele. Anaesth Intensive Care. 2007; 35:94–98.

9. Ein SH, Rubin SZ. Gastroschisis: primary closure or Silon pouch. J Pediatr Surg. 1980; 15:549–552.

10. Frolov P, Alali J, Klein MD. Clinical risk factors for gastroschisis and omphalocele in humans: a review of the literature. Pediatr Surg Int. 2010; 26:1135–1148.

11. Henrich K, Huemmer HP, Reingruber B, Weber PG. Gastroschisis and omphalocele: treatments and long-term outcomes. Pediatr Surg Int. 2008; 24:167–173.

12. Islam S. Clinical care outcomes in abdominal wall defects. Curr Opin Pediatr. 2008; 20:305–310.

13. Kelly KB, Ponsky TA. Pediatric abdominal wall defects. Surg Clin North Am. 2013; 93:1255–1267.

14. Kitchanan S, Patole SK, Muller R, Whitehall JS. Neonatal outcome of gastroschisis and exomphalos: a 10-year review. J Paediatr Child Health. 2000; 36:428–430.

15. Mann S, Blinman TA, Douglas Wilson R. Prenatal and postnatal management of omphalocele. Prenat Diagn. 2008; 28:626–632.

16. McNair C, Hawes J, Urquhart H. Caring for the newborn with an omphalocele. Neonatal Netw. 2006; 25:319–327.

17. Mitanchez D, Walter-Nicolet E, Humblot A, Rousseau V, Revillon Y, Hubert P. Neonatal care in patients with giant ompholocele: arduous management but favorable outcomes. J Pediatr Surg. 2010; 45:1727–1733.

18. Panitch HB. Pulmonary complications of abdominal wall defects. Paediatr Respir Rev. 2015; 16:11–17.

19. Stoll C, Alembik Y, Dott B, Roth MP. Risk factors in congenital abdominal wall defects (omphalocele and gastroschisi): a study in a series of 265,858 consecutive births. Ann Genet. 2001; 44:201–208.

20. Stoll C, Alembik Y, Dott B, Roth MP. Omphalocele and gastroschisis and associated malformations. Am J Med Genet A. 2008; 146A:1280–1285.

21. Towne BH, Peters G, Chang JH. The problem of "giant" omphalocele. J Pediatr Surg. 1980; 15:543–548.

22. Tsakayannis DE, Zurakowski D, Lillehei CW. Respiratory insufficiency at birth: a predictor of mortality for infants with omphalocele. J Pediatr Surg. 1996; 31:1088–1090.

23. Danzer E, Victoria T, Bebbington MW, Siegle J, Rintoul NE, Johnson MP, et al. Fetal MRI-calculated total lung volumes in the prediction of short-term outcome in giant omphalocele: preliminary findings. Fetal Diagn Ther. 2012; 31:248–253.

24. Partridge EA, Hanna BD, Panitch HB, Rintoul NE, Peranteau WH, Flake AW, et al. Pulmonary hypertension in giant omphalocele infants. J Pediatr Surg. 2014; 49:1767–1770.

TOOLS

Similar articles