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Characteristics associated with abdominal wall defects in neonates
Characteristic | Gastroschisis | Omphalocele |
---|---|---|
Location of defect | Right of umbilicus or lateral to cord | Midline including umbilicus and umbilical ring |
Covering membrane | No | Yes |
Size of defect | 3 to 5 cm | 4 to 10 cm |
Umbilical cord insertion | Body wall at normal location | Omphalocele membrane |
Herniated abdominal organs | Small bowel | Bowel and sometimes liver, occasionally other organs |
Associated major congenital anomalies | Rare | Frequent (50%-70%) |
Associated congenital syndrome | Rare | Common (approximately 30%) |
Intestinal atresia | 10% to 20% | Rare |
Prognostic factors | Condition of bowel | Associated anomalies |
Mortality | Less than 5% | 20% to 30% |
Bowel appearance | Matted, foreshortened, edematous, exudative | Normal |
Malrotation | Often present | Often present |
Small abdominal wall cavity | Present | Present |
Postoperative gastrointestinal dysfunction | Prolonged ileus common | Often normal |
Global incidence | Increasing | Stable |
Maternal age | Younger than 20 years | Average |
Surgical management | Urgent | Not urgent with intact membrane |
Mean gestational age at spontaneous delivery | 34 to 36 weeks’ gestation | Term or near term |
Male to female ratio | 1:1 | 1.5:1 |
Elevated maternal alpha fetoprotein levels | Almost always markedly elevated | Often elevated |
Sources
Data from Ledbetter DJ: Congenital abdominal wall defects and reconstruction in pediatric surgery: gastroschisis and omphalocele. Surg Clin North Am. 92(3):713-27, 2012, Table 1; Walther AE et al: Newborn abdominal wall defects. In: Wyllie R et al, eds: Pediatric Gastrointestinal and Liver Disease. 5th ed. Philadelphia, PA: Elsevier; 2016:654-65.e4, Table 58-1; Gamba P et al: Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg. 23(5):283-90, 2014, Table 3; Prefumo F et al: Fetal abdominal wall defects. Best Pract Res Clin Obstet Gynaecol. 28(3):391-402, 2014, Table 1; and Christison-Lagay ER et al: Neonatal abdominal wall defects. Semin Fetal Neonatal Med. 16(3):164-72, 2011, Table 1.