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Objective To explore the application of childbirth cooperative management model of giant omphalocele (GO). Methods From January 2020 to December 2023, prenatal, prenatal and postpartum treatment data were retrospectively reviewed for 76 GO neonates. During a follow-up period of (9-36) month, healing of abdominal wall incision, feeding and growth were recorded. Results Prenatal ultrasonography offered a definite diagnosis and prenatal chromosome and genetic screening showed no abnormalities. As recommended by antepartum multi-disciplinary treatment (MDT), termination was performed for cloaca malformation (n = 1), spinal malformation (n = 1) and pedicle syndrome (n = 1) And pregnancy was terminated due to complex heart malformation (n = 2) and 71 cases continued pregnancy. In the whole group, capsule was wrapped in delivery room. There were capsule rupture ( n = 2 antenatal and labor each), hypoglycemia on admission (n = 1) and hypothermia (n = 1). The whole group included intestinal malrotation (n = 68), Meckel's diverticulum (n = 2) atrial septal defects (n = 6), ventricular septal defects (n = 4), patent ductus arteriosus (n = 8) esophageal atresia (n = 2), diaphragmatic hernia (n = 1), bronchopulmonary dysplasia (n = 8) and pulmonary hypertension (n = 10) The interventions included conservative measures (n = 7), primary repair (n = 35), second stage repair (n = 27), staged repair (n = 2) and combined surgery n = 3 diaphragmatic hernia, n = 1 ; esophageal atresia, n = 2 . There were NEC (n = 1), pneumonia atelectasis (n = 5), incision infection (n = 3) and intestinal obstruction (n = 5) (hepatic caudate lobe compression during conservative period, n = 1 intestinal adhesion during conservative treatment, n = 1 ; adhesive intestinal obstruction post-operation, n = 3 . During treatment period, 66 patients were discharged and 5 died in hospital (pulmonary hypertension, n = 1 cardiac insufficiency, n = 1 ; severe pneumonia, n = 2 ; abdominal space syndrome, n = 1 ) . During follow-ups, death was due to accidental vomiting & asphyxia (n = 1) and severe pneumonia from gastroesophageal reflux (n = 1) Two cases of pulmonary hypertension were transferred to external hospital for treatment and the remainders recovered well. Conclusions The above integration mode may provide early interventions and effective managements of neonatal GO. [ABSTRACT FROM AUTHOR]

Background: Bile atresia is children’s leading cause of cirrhosis. Its high morbidity and mortality are explained by its complications, including gastrointestinal bleeding and portal hypertension. Umbilical hernia has been embryologically and clinically associated with portal hypertension and cirrhosis; however, the clinical evolution of patients with bile atresia and umbilical hernia is unknown, so the aim of the study is to describe this link. Objective: To determine the prevalence of the coexistence of AVB and HU in patients in a tertiary hospital, and describe the clinical evolution of these patients with respect to the presence/absence of HU as a strategy in the search for prognostic factors of morbidity and mortality. Material and methods: This is an observational, descriptive, retrospective, and longitudinal study that included patients with bile atresia in a tertiary pediatric hospital. The variables related to bile atresia were analyzed, and the clinical evolution was described according to the presence or absence of UH. Results: 56 patients with AVB were included, of which 69.6% were women. Portal hypertension occurred in 80.4%, with the presence of collateral venous network, STD, ascites and hepatomegaly being the indirect clinical data mostly presented. The frequency of coexistence of HU and AVB was 75%. Portal hypertension, collateral venous network, digestive tract bleeding, ascites and small esophageal varices were the variables significantly more prevalent in patients with HU. Conclusions: Patients with bile atresia have a greater possibility of developing umbilical hernia and that it is associated with a more advanced evolution of portal hypertension and its associated signs and complications. [ABSTRACT FROM AUTHOR]

Serious acupuncture-related complications are rare in infants. We experienced a case of a 58-day-old infant with an umbilical hernia who received acupuncture from a non-professional guardian. Upon initial examination in the emergency department, the omentum protruded through the skin defect caused by acupuncture performed on top of the hernia. The infant underwent emergency surgery, and subsequently recovered uneventfully.

Introduction: Giant omphalocele poses a conflict between eviscerated content and abdominal capacity, with associated risks such as compartment syndrome or cardiovascular compromise., Clinical Case: We present the case of a prenatally diagnosed hepato-omphalocele, without associated abnormalities. At week 37, botulinum toxin was injected in the right hemiabdomen under fetal and maternal sedation. Following Cesarean section, scheduled at week 39, injection was completed in the left hemiabdomen, and full hepatic content reduction and total amnion inversion were achieved. Definitive repair with component separation was carried out on day 8 postnatally, and the patient was discharged on day 14., Discussion: Botulinum toxin induces muscle relaxation, which can help reintroduce the eviscerated content within the abdominal cavity. The maximum effect is achieved following two weeks, which means prenatal injection may favor early amnion inversion, thus reducing hospital stay.

Objective: To investigate the clinical characteristics of omphalocele, and to assess the risk factors associated with adverse outcomes. Methods: A retrospective cohort study was conducted. Clinical data of 224 patients diagnosed with omphalocele, who were hospitalized at Children's Hospital, Zhejiang University School of Medicine from January 2013 to December 2022, were collected. Based on their discharge outcomes, the patients were classified into 2 groups: favorable outcomes and unfavorable outcomes. χ 2 test, continuity correction χ 2 test, Fisher exact probability method, and Mann-Whitney U test were used for intergroup comparisons. Logistic regression analysis was performed to identify risk factors associated with adverse outcomes in omphalocele. Results: Among the 224 patients with omphalocele, 126 were male. A total of 208 patients (92.9%) had favorable outcomes, while 16 patients (7.1%) had unfavorable outcomes. In the unfavorable outcomes group, 14 patients had giant omphaloceles, while 100 patients had giant omphaloceles in the favorable outcomes group. The rates of herniation of more than 2 intra-abdominal organs in the hernial sac, congenital heart defects, patent ductus arteriosus, pulmonary hypertension, sepsis and infection of the hernial sac, were all higher in the unfavorable outcomes group compared to the favorable outcomes group (all P< 0.05). Patients with unfavorable outcomes had longer mechanical ventilation time, duration of oxygen use, duration of parenteral nutrition, hospital stays, and higher rates of parenteral nutrition-associated cholestasis compared to those with favorable outcomes (all P< 0.01). Multivariate Logistic regression analysis indicated that pulmonary hypertension ( OR =9.39, 95% CI 1.20-73.32), sepsis ( OR =8.59, 95% CI 1.32-55.86), and congenital heart defects ( OR =6.55, 95% CI 1.11-38.73) were all independent risk factors for adverse outcomes in omphalocele (all P< 0.05). Conclusions: Infants with omphalocele are prone to complications such as cardiovascular malformations, infections, and pulmonary hypertension. Adverse outcomes in omphalocele are associated with pulmonary hypertension, sepsis, and congenital heart defects.

ABSTRACT To relate omphalocele and biliary atresia and investigate possible embryological correlations that justify the simultaneous occurrence. A female preterm newborn diagnosed as omphalocele; cesarean delivery, weight 2,500g, 46 XX karyotype. Initially, the newborn remained fasting and on parenteral nutrition, and enteral diet was introduced later, with good acceptance. On the 12th day of life, the newborn presented direct hyperbilirubinemia, increased levels of liver enzymes and fecal acholia, with a presumptive diagnosis of biliary atresia. However, the ultrasound was inconclusive, due to anatomical changes resulting from omphalocele. A surgical approach was chosen on the 37th day of life aiming to confirm diagnosis of biliary atresia and to repair omphalocele. During the surgical procedure, structural alterations compatible with biliary atresia were observed, later confirmed by pathological examination; a hepatoportoenterostomy was performed and the omphalocele was corrected. She evolved well in the postoperative period, with a decrease in direct bilirubin and liver enzymes, as well as resolution of fecal acholia, and was discharged in good clinical condition. This is a bizarre and extremely rare association, but the prognosis may be good when an early diagnosis is made and surgery performed, besides support and clinical management to prevent complications in the perioperative period. Although the pathogenesis of the diseases has not been fully defined yet, there is, to date, no direct relation between them. The association between omphalocele and biliary atresia is extremely uncommon, with only two published cases.