Approach Considerations

Transfer
Placing a warm, moist laparotomy pad over the exposed intestine intuitively
makes sense. The problem is that a warm, moist lap pad rapidly becomes a
cold, wet lap pad; consequently, the author prefers covering the intestine with
a dry lap pad and wrapping the baby's torso in such a way as to avoid pulling
or kinking the bowel mesentery.
If intravenous (IV) access can be obtained, IV fluids and antibiotics should be
administered, and the stomach should be decompressed with a nasogastric
tube.
Drug therapy
Drug therapy is determined by the exigencies of caring for an ill premature
baby.
Omphalocele
An intact omphalocele sac protects the intestine from contact with the
amniotic fluid; hence, these babies can be fed much earlier following closure
of the abdominal wall defect. Babies with giant omphaloceles have prolonged
hospitalizations, because of the difficulty in obtaining closure and respiratory
failure, which requires prolonged mechanical ventilation and a tracheotomy.
Gastroschisis
Primary closure of the abdominal wall defect is possible only if inflammation of
the intestine is minimal; even so, it is usually several weeks before the baby
tolerates enteral feedings.
If closure of the abdominal wall defect necessitates use of a silo to contain the
eviscerated intestine, the silo should be removed within a week because of
the risk of wound infection (see the image below).
 Silo closure of a baby with
gastroschisis.
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Parenteral nutrition is used until the baby passes "starvation stools." If this has
not occurred within 3-4 weeks, a mechanical obstruction, rather than an ileus,
should be suspected; Upper GI/small bowel radiography should be performed
to assess the transit of contrast through the intestinal tract. If this study
demonstrates an intestinal obstruction, laparotomy is indicated.

Next: Medical Care

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