Prenatal and Postnatal Determinants of Outcome in Neonates with Omphalocele: A 25-Year Single-Center Cohort Study

Background: Omphalocele is a congenital defect of the anterior abdominal wall frequently associated with additional anomalies that substantially influence neonatal outcomes. Cardiovascular and pulmonary abnormalities are among the most clinically relevant factors affecting survival, yet their relative prognostic contribution remains incompletely characterized in smaller regional cohorts. Methods: This retrospective observational study included 50 neonates with omphalocele treated at a tertiary pediatric surgery center in Northeastern Romania between 2000 and 2025. Demographic characteristics, associated congenital anomalies, surgical management, and clinical outcomes were analyzed. Comparisons were performed between isolated and non-isolated omphalocele cases and according to the presence of cardiac and pulmonary anomalies. Univariate logistic regression was used to evaluate associations between associated anomalies and mortality. Results: Associated congenital anomalies were present in the majority of patients. Cardiac malformations were identified in 68% of cases, pulmonary anomalies in 22%, and combined cardiopulmonary anomalies in 20%. Overall mortality was substantial. Mortality was higher in non-isolated compared with isolated omphalocele, although this difference did not reach statistical significance. Univariate analysis showed that pulmonary anomalies were significantly associated with increased mortality (OR = 4.31, 95% CI: 1.20–15.50, p = 0.025), whereas cardiac anomalies alone were not significantly associated with mortality. Combined cardiopulmonary anomalies were associated with an increased mortality risk without reaching statistical significance. Conclusions: In this cohort, pulmonary anomalies were strongly associated with increased mortality among neonates with omphalocele. These findings suggest that detailed prenatal and postnatal pulmonary assessment may contribute to improved risk stratification and multidisciplinary management in affected neonates. The results should be interpreted in the context of the study’s retrospective design and limited sample size.