Determinants of mortality in neonatal abdominal wall defects: A comparative analysis of gastroschisis and omphalocele

Abstract

Aim: To evaluate determinants of mortality and morbidity in neonates with abdominal wall defects and to assess the clinical implications of reclassifying umbilical cord hernias as minor omphalocele.

Methods: This retrospective cohort study included 70 neonates managed at a tertiary pediatric surgery center. Patients were classified as gastroschisis (n=26) and omphalocele (n=44), with umbilical cord hernias included in the latter group. Demographic, perinatal, maternal, transport-related, surgical, and postoperative variables were analyzed. Statistical significance was defined as p<0.05.

Results: Mortality was significantly higher in gastroschisis compared to omphalocele (38.5% vs 18.2%). Prematurity was associated with increased mortality when all patients were analyzed collectively (p<0.01). Birth weight was a determinant of mortality in gastroschisis (p=0.012) but not in omphalocele. Associated anomalies were strongly related to mortality in the omphalocele group. Vaginal delivery was associated with higher mortality (p<0.01) and delayed feeding (p<0.012). Antenatal diagnosis improved survival (p<0.01), whereas admission hypothermia was strongly associated with mortality (p<0.01). Primary repair was associated with improved survival and earlier enteral feeding. Notably, none of the patients who achieved enteral feeding died.

Conclusion: Gastroschisis and omphalocele differ fundamentally in outcome determinants. Mortality in gastroschisis is driven primarily by bowel-related pathology, whereas outcomes in omphalocele are largely influenced by associated anomalies. Modifiable factors, particularly hypothermia, early stabilization, and perioperative management, play a critical role in improving survival and postoperative recovery.