Formal saline versus honey as escharotic in the conservative management of major omphaloceles.

Abstract

The use of honey as an escharotic agent in the conservative management of omphalocele major has not been widely explored in spite of its proven benefits in chronic wound management. We explored the use of local honey as an escharotic agent by comparing its use with 2.5% formal saline in the conservative management of major omphaloceles at the Lagos University Teaching Hospital, Lagos, Nigeria. From January 2006 to December 2009, 43 consecutive newborns with intact omphalocele major were alternately assigned into either Honey (H) or formal saline (FS) group. The membrane cover of each omphalocele was painted with the allotted group agent once every 48 h. The occurrence of faecal fistulas, rupture of eschar, intestinal obstruction as well as the mean duration of full wound healing, infection rates and overall mortality rates were compiled for the two groups. Eighteen newborns were assigned to the FS group while 25 others were prospectively enrolled into the H group. The age, sex and weight of newborns in both groups at presentation were comparable. Three omphaloceles (16.7%) ruptured and eviscerated among the FS group during the study while 1 (4%) of these occurred in the H group. Four (22.2%) cases of faecal fistula occurred in the FS group while none was recorded in the H group. One (5.6%) patient in the FS group developed small bowel stricture. This was not recorded in the honey group. Overall, there were 8 (44.4%) complications in the FS group and 1 (4%) in the H group. There was no statistical difference between the two groups concerning the occurrence of fistulae, sac rupture or bowel stricture. However, overall number of complications was statistically more in the FS group when compared to the H group (P < 0.05). Wounds in the H group healed within a mean period of 34.4 ± 4.9 days while those in the FS group healed within a mean period of 45.7 ± 6.8 days P < 0.01). Honey is a good escharotics agent in the conservative management of major omphaloceles. Honey promotes faster healing and unlike 2.5% formal saline, is not significantly associated with faecal fistulas, rupture or bowel stricture.