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. 2025 Dec;45(12):1700-1706.
doi: 10.1038/s41372-025-02321-1. Epub 2025 May 16.

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

Krishna Manohar  1   2 , Fikir M Mesfin  1   2 , Jessica Belchos  1   3 , Brandon P Brown  2   4 , Cameron Colgate  1 , Lava Timsina  1 , Joshua Brown  1 , Rachel Tullar  1 , Brian W Gray  5   6
Affiliations

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

Krishna Manohar et al. J Perinatol. 2025 Dec.

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.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Postnatal course of patient with omphalocele.
This figure displays the postnatal course of patients who underwent fetal MRI between 2006 and 2022. Six patients died at birth, with 3 dying at an outside-system hospital. An additional 5 patients passed away within 24 h. During the next month, 12 patients had a primary repair, and 23 patients underwent deferred repair. Of those, 20 had a delayed repair and 3 had a staged repair. Thirty patients were alive at discharge.
Fig. 2
Fig. 2. Receiver operating characteristic curves for predictors for mortality and deferred repair.
Receiver operating characteristic curves were used to determine predictive cutoff points of MIR variables by using O/E TFLV ratio and % Liver Herniation for mortality and using % Liver Herniation to predict deferred repair.
See this image and copyright information in PMC

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