N/IICU Clinical Pathway for Evaluation and Treatment of Neonates and Infants with Beckwith-Wiedemann Syndrome

Care Prior to Transport or Admission to CHOP

Initial referral through CHOP Transport Call
Epic Chat PHL Genetics BWS
  • Making the Diagnosis
  • History and Physical Examination
  • Assess for BWS Features
  • Genetic Testing
BWS Clinical Features (use .bwschart to score)
Cardinal Features
2 pts for each feature
Suggestive Features
1 pt for each feature
  • Macroglossia
  • Omphalocele
  • Lateralized overgrowth/hemihypertrophy
  • Wilms tumor or nephroblastomatosis
  • Hyperinsulinism
  • Adrenal cortex cytomegaly
  • Placental mesenchymal dysplasia
  • Pancreatic adenomatosis
  • Macrosomia (birth wt > 2 SD above mean)
  • Facial nevus simplex
  • Polyhydramnios/placentomegaly
  • Ear creases/pits
  • Transient Hypoglycemia, lasting < 1 wk
  • Typical BWS tumors:
    • Neuroblastoma
    • Rhabdomyosarcoma
    • Unilateral Wilms tumor
    • Hepatoblastoma
    • Adrenocortical carcinoma
    • Pheochromocytoma
  • Nephromegaly/hepatomegaly
  • Umbilical hernia and/or diastasis recti
Consult Genetics
If clinical score ≥ 4 or if only feature is lateralized overgrowth,
send Epic Secure Chat to PHL Genetics BWS
Obtain AFP and Abdominal Ultrasound
Consult Case Management/Social Work
Identify and resolve Potential Barriers to Discharge
Discharge and Case Management
Complete safety fast and sleep study prior to discharge
Posted: August 2020
Last Revised: March 2024
Editors: Clinical Pathways Team