Manohar Krishna, Mesfin Fikir M, Belchos Jessica, Brown Brandon P, Colgate Cameron, Timsina Lava, Brown Joshua, Tullar Rachel, Gray Brian W
Department of Surgery, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA.
The Fetal Center at Riley Children's Health, Indianapolis, IN, USA.
J Perinatol. 2025 May 16. doi: 10.1038/s41372-025-02321-1.
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.
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.
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%.
This study identified prenatal MRI findings associated with mortality and deferred repair, aiding in risk prediction and family counseling.
处理脐膨出在产前咨询和围产期护理中存在挑战。我们假设特定的胎儿磁共振成像（MRI）结果可以预测这些患者的发病率和死亡率。
我们分析了2006年至2022年显示脐膨出的胎儿MRI研究，并对病历进行了回顾性审查。使用单变量和多变量分析将预测变量与结果相关联，并使用尤登指数（Youden's J statistic）优化受试者操作特征（ROC）曲线。
在46例脐膨出患者中，89%存活至出生，总死亡率为37%。死亡率的显著预测因素包括胃/脾疝出、严重畸形、脐膨出相关综合征、胎膜破裂、观察到的/预期的胎儿肺总体积较低（O/E TFLV）以及肝脏疝出百分比增加。延迟修复的需求与肝脏/胃疝出和“巨大脐膨出”相关。ROC分析确定O/E TFLV < 42%和肝脏疝出>77%为死亡率切点，而肝脏疝出>51%提示需要延迟修复。
本研究确定了与死亡率和延迟修复相关的产前MRI结果，有助于风险预测和家庭咨询。
