Omphalocele is a birth defect in which the intestines and possibly other abdominal organs, such as the liver, protrude outside the body through a hole in the belly button. These organs are contained in a peritoneal sac with a thin membrane. Infants born with this condition often have other accompanying congenital defects including cardiovascular or genitourinary problems. This is a rare condition that only affects 1 in every 4,000 – 7,000 live births.
During gestational weeks 6 -10, the intestines grow and push out of the abdomen by the umbilical cord. By week 11, if the intestines do not return, the result is an omphalocele. While the exact cause of omphalocele is unknown, it is believed by researchers that some factors (advanced maternal age, smoking and drinking alcohol during pregnancy, use of selective serotonin reuptake inhibitors during pregnancy and obesity) may increase the risk of the development of this and other birth defects.
Patient will be free from infection; patient will have adequate nutrition; patient will be free from intestinal obstruction
Perform a complete nursing assessment of systems: heart, lungs, skin, neurologic and genitourinary system
Infants born with this condition often have other accompanying congenital defects including cardiovascular or genitourinary problems. Some patients may have central nervous system defects as well.
Cover sac with saline-soaked sterile gauze and plastic bowel bag
This helps to prevent loss of fluids and to keep the intestines moist to prevent drying/damage.
Assess appearance of omphalocele
Measure sac, note changes in color, presence of organs (liver) within the sac, twisting of intestines or defects in the sac
Monitor patient for temperature fluctuations and signs of hypothermia or fever.
Initiate IV access
Loss of fluids can be detrimental to the infant. Maintain adequate hydration.
Provide access for administration of antibiotics if necessary and sedation for surgery. Central access may be required for TPN.
Evaluate nutritional needs and manage TPN if required
The infant may require TPN for nutrition while the intestines are being decompressed, since the enteral route will be unavailable.
Insert nasogastric tube for decompression
The intestines should be decompressed to decrease stress on the intestines and to decrease the size of the intestines within the sac. This will help the infant’s chances of not requiring surgical intervention.
Prepare patient for intubation / manage endotracheal tube and ventilator
Infants with omphalocele may experience respiratory distress or require sedation and intubation to protect their respiratory system.
Prepare patient for surgery
Surgery may be done all at once or in stages to protect the internal organs and prevent obstruction
Perform dressings and care of omphalocele as appropriate
Sterile dressings will be used to protect the sac and the infant from infection
Provide education for parents / caregivers of patient and instructions for home care
For more information, visit www.nursing.com/cornell
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