title: Systemic hypertension in giant omphalocele: An underappreciated association.
abstract: OBJECTIVE
  To evaluate the incidence, severity and duration of systemic hypertension in infants born with giant omphalocele (GO).
  
  
  METHODS
  A retrospective review of patients born from 2003 through 2013 with a GO or intestinal atresia (control population) and managed at a single institution was performed. The hospital course was reviewed including all blood pressures, method of omphalocele repair, requirement for antihypertensive medications and renal function.
  
  
  RESULTS
  Forty-five GO and 20 control patients met criteria for the study. Thirty-three GO patients underwent Schuster repair and 12 GO patients underwent delayed repair after epithelialization. Overall, 78% of GO patients had episodes of hypertension (82% Schuster and 67% delayed repair) compared to 15% of control patients (P<0.001). The majority of episodes were transient and occurred in the postoperative period (97%). Hypertension was persistent in 4 GO patients. These patients required antihypertensive medication at discharge, which was discontinued as an outpatient. No patient demonstrated significant evidence of renal abnormalities as indicated by renal ultrasound, urinalysis and/or serum creatinine level at the time of hypertension.
  
  
  CONCLUSIONS
  Episodes of systemic hypertension are frequent in patients with GO. Episodes are often post-operative, transient and can be present in patients undergoing either a delayed or Schuster repair. A small subset of patients will have persistent hypertension requiring antihypertensive medication that can be weaned off in an outpatient setting.
authors.affiliation: The Division of Pediatric General, Thoracic, and Fetal Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: peranteauw@email.chop.edu.
authors.forename: William H
authors.initials: WH
authors.lastname: Peranteau
authors.affiliation: The Division of Pediatric General, Thoracic, and Fetal Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Sasha J
authors.initials: SJ
authors.lastname: Tharakan
authors.affiliation: The Division of Pediatric General, Thoracic, and Fetal Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Emily
authors.initials: E
authors.lastname: Partridge
authors.affiliation: The Division of Pediatric General, Thoracic, and Fetal Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Herkert
authors.affiliation: The Division of Pediatric General, Thoracic, and Fetal Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Rintoul
authors.affiliation: The Division of Pediatric General, Thoracic, and Fetal Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.affiliation: The Division of Pediatric General, Thoracic, and Fetal Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.affiliation: The Division of Pediatric General, Thoracic, and Fetal Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006554:Hernia, Umbilical / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: Abdominal wall defect; Congenital; Giant omphalocele; Schuster; Systemic hypertension