Major Omphalocele

Experience with Topical Honey Treatment in a Tertiary Health Center in North Central Nigeria

Abstract

Background

Major omphalocele are a source of neonatal morbidity and mortality.Primary surgicalclosure is the ideal management in developed nations with advanced neonatal care but floaded with dismal results in poorly equipped centers. The conservative care by the use of escharotic agents is ideal for this centers. Topical wound care with Honey has demonstrated safety and shown impressive outcome. The aim is to show our experience in the care of major omphalocele with topical use of Honey as escharotic agent.

Material and methods

This is a 10 year retrospective study of neonates admitted into the Special Baby Care Unit of Jos University Teaching Hospital clinically diagnosed with unruptured major omphalocele from January 2008 to June 2018. The wounds were dressed daily with gauze soaked in 10-20 mls of Honey. The wound was observed for the presence of infection,rupture,mean durations of complete separation of the eschar and complete epithelialization(healing). The age at presentation,gender and weight were assessed.

Result

A total of 36 neonates were treated. There were 17(42.2%)males and 19(52.8%)females (M:F=1:1.1) with a mean age of presentation of 54.28 hours(S.D 67.007). The mean weight was 3.025Kg(S.D 0.4150). Risk of sepsis was present in 9(25%) and associated sepsis was present in 14(38.9%). Associated congenital malformations were detected in 11(30.6%). Eleven(30.6%) developed complications with sepsis for 81.8% of the total complications. Ten(27.8%) died before assessing for eschar separation. Sepsis and prematurity accounted for majority of the cause of death. The mean duration of eschar separation was 31.9 days(S.D 10.566). The mean duration of complete epithelialization(healing) was 12.19 weeks(S.D 1.059). Gender, age at presentation,risk of sepsis,associated sepsis at presentation and associated congenital malformation did not demonstrate significant association with either eschar separation nor complete epithelializatin. One patienthad rupture of the omphalocele sac.

Conclusion

Honey is a safe and effective escharotic agent in the conservative management of major omphalocele. The procedure is easy,simple, practical,less expensive, not requiring equipment and can be used in limited resource cemters.