Conservative management of giant omphalocele with topical povidone-iodine and its effect on thyroid function.
OBJECTIVE
The aim of the study was to evaluate topical povidone-iodine as a bridge to delayed fascial closure of giant omphaloceles with emphasis on its effect on thyroid function.


METHODS
Newborns from a single institution with giant omphaloceles treated with topical povidone-iodine for a 10-year period were reviewed. Recorded data included sex, associated anomalies, length of stay, frequency of povidone-iodine application, thyroid function tests, frequency of laboratory draws, and thyroid supplementation administration.


RESULTS
Six neonates with giant omphaloceles were treated with povidone-iodine. Thyroid function testing occurred weekly as inpatients and monthly as outpatients, with abnormal values normalized by the subsequent laboratory draw. One patient demonstrated persistent hypothyroidism and subsequently died secondary to cardiac complications, but this infant's newborn thyroid screening suggested congenital hypothyroidism. Five patients remained euthyroid and ultimately achieved fascial closure without the need for a prosthetic implant. None of these patients had abnormal outpatient thyroid tests nor did they require thyroid hormone supplementation.


CONCLUSIONS
Topical povidone-iodine promotes escharification and epithelialization of the omphalocele sac. Because transient hypothyroidism may occur, thyroid function studies may guide inpatient therapy. After sac desiccation, systemic effects of iodine are minimal and thyroid supplementation is not necessary. Topical povidone-iodine is an effective initial strategy for giant omphaloceles and does not produce clinically significant hypothyroidism.
Whitehouse
Jill S
JS
Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Gourlay
David M
DM
Masonbrink
Abbey R
AR
Aiken
John J
JJ
Calkins
Casey M
CM
Sato
Thomas T
TT
Arca
Marjorie J
MJ
D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006554:Hernia, Umbilical / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011206:Povidone-Iodine / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013961:Thyroid Gland / Q000187:drug effects* / Q000254:growth & development / Q000378:metabolism; D013963:Thyroid Hormones / Q000097:blood*; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D013963:Thyroid Hormones; D011206:Povidone-Iodine