Can Prenatal Ultrasonographic Markers Predict Enteral Feeding Tolerance in Neonates With Fetal Omphalocele?

OBJECTIVE: This study aimed to identify prenatal ultrasonographic predictors of enteral feeding tolerance in neonates with omphaloceles.

METHOD: This retrospective cohort study included all live-born neonates prenatally diagnosed with omphalocele at Emma Children's Hospital/Amsterdam UMC approximately 2004-2024. Prenatal ultrasonographic data included fetal ascites, omphalocele circumference/abdominal circumference (OC/AC) ratio, extracorporeal liver, polyhydramnios and associated structural anomalies. Associations with enteral feeding tolerance, measured by duration of parenteral nutrition (PN) and time to achieve full enteral feeds (FEF), and the need for tube feeding post-admission were analyzed using linear and logistic regression.

RESULTS: Forty-two neonates were included (42.9% male). Median time to FEF was 10.0 days (IQR = 5.8-14.5) and median PN duration 5.0 days (IQR = 0.0-10.5). At discharge, 28.6% required full or partial nasogastric tube feeding. Polyhydramnios was excluded due to low prevalence (n = 1). Fetal ascites predicted longer PN duration (ratio 4.05, 95% CI [1.57, 10.60]) and tube feeding post-admission (OR 9.27, 95% CI [1.47, 58.40]). A higher OC/AC ratio predicted a longer time to FEF (ratio 4.39, 95% CI [1.54, 12.69]). No associations were found for extracorporeal liver or associated structural anomalies.

CONCLUSION: Fetal ascites and a higher OC/AC ratio were predictive of delayed enteral feeding tolerance. While full enteral feeds were achieved within 2 weeks, 29% required tube feeding after discharge.