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

Abstract

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.