title: Delayed management of giant omphalocele using silver sulfadiazine cream: an 18-year experience.
abstract: OBJECTIVE
  To assess the value of topical silver sulfadiazine (SSD) cream in the treatment of babies with a giant omphalocele.
  
  
  METHODS
  From 1991 to 2008 inclusive, 20 infants with giant omphalocele (defined as >10 cm diameter) were treated with SSD, leaving a large ventral hernia to be repaired at a later date.
  
  
  RESULTS
  There were 12 boys and 8 girls. Thirteen had prenatal ultrasound diagnosis at a mean gestational age of 23 weeks. The mean gestational age at delivery was 37 weeks, and mean birth weight was 2.5 kg. Nineteen had other anomalies and/or medical problems, 18 of them multiple. The most common was pulmonary hypoplasia (70%). Mechanical ventilation and/or oxygen treatment was required in 15 (75%) for a mean of 10 weeks. SSD was used as primary sac treatment in 5 and secondary treatment in 15 (after Silon pouch 11, Op-site 3, povidone-iodine 1). Six omphalocele sacs were ruptured within the first 5 days of life. SSD was used for a mean of 6 months at a cost of $1 per day. Complications included 2 instances of staphylococcal sepsis and 1 jejunal perforation inside a Silon pouch. Six (30%) died from pulmonary hypoplasia at a mean age of 18 weeks. There were 14 (70%) survivors who went home after a mean of 14 weeks. Of the 14 survivors, 12 had ventral hernias repaired (18 operations with 2 recurrences), and 2 remain with their original ventral hernia.
  
  
  CONCLUSIONS
  Initial topical coverage with SSD is associated with excellent outcomes for infants with giant omphalocele who cannot undergo immediate closure.
authors.affiliation: Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8. a_ein@istar.ca
authors.forename: Sigmund H
authors.initials: SH
authors.lastname: Ein
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
mesh_terms: D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016527:Drug Costs; D005260:Female; D006554:Hernia, Umbilical / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009824:Ointments; D009864:Ontario; D012189:Retrospective Studies; D012837:Silver Sulfadiazine / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D009824:Ointments; D012837:Silver Sulfadiazine