Beyond the womb: prenatal MRI's prognostic abilities for morbidity and mortality in neonates with omphaloceles.

BACKGROUND

Managing omphaloceles poses challenges in prenatal consultation and perinatal care. We hypothesized that specific fetal MRI findings could predict morbidity and mortality in these patients.

METHODS

We analyzed fetal MRI studies demonstrating omphaloceles from 2006 to 2022 and conducted a retrospective review of medical records. Predictor variables were correlated with outcomes using univariate and multivariate analyses, and Receiver Operating Characteristic (ROC) curves were optimized with Youden's J statistic.

RESULTS

Among 46 omphalocele patients, 89% survived to birth, with an overall mortality rate of 37%. Significant predictors of mortality included stomach/spleen herniation, severe anomalies, omphalocele-associated syndromes, membrane rupture, lower observed/expected total fetal lung volume (O/E TFLV), and increased percentage of liver herniation. The need for deferred repair correlated with liver/stomach herniation and "giant-omphalocele." ROC analysis identified mortality cut points at O/E TFLV < 42% and liver herniation >77%, while deferred repair was indicated at liver herniation >51%.

CONCLUSION

This study identified prenatal MRI findings associated with mortality and deferred repair, aiding in risk prediction and family counseling.