Omphalocele

Hey guys, in this lesson we are going to be talking about a congenital anomaly called Omphalocele.

So, an omphalocele is a birth defect where intestines and stomach organs protrude through the umbilicus and are enclosed in a peritoneal sac. This actually happens in utero during about the 9th or 10th week of development. They are usually classified as being either mild or severe. A mild omphalocele is when only the intestines are involved. A severe omphalocele contains intestines and organs, like the liver. Other birth defects are often associated with a severe omphalocele- the two to be on the lookout for are cardiac defects and also lung problems, like small lung size.

So initially the most important thing to determine is if the omphalocele is mild or severe. We need to know if other organs are involved to help determine treatment. Once we know this we can better plan our nursing care. If it is a severe omphalocele we know we need to pay close attention to cardiac and lung function- assessing their respiratory rate and work of breathing.

The next thing you want to assess is the newborns temperature. They are going to be losing a lot of heat through the exposed bowels and could quickly become hypothermic.

They are also losing a lot of fluid through the exposed bowels so we have to assess their fluid status, looking for signs of dehydration.

And as you can imagine having part of their bowels exposed they are at increased risk for infection, this is especially true if the peritoneal sac is broken.

These babies are obviously going to need surgery. But before the baby can be taken to surgery it’s really important to keep the omphalocele clean and wet. So it needs to be covered with a sterile gauze that has been soaked in saline. Remember they are at risk for dehydration and hypothermia so we need to give fluids and keep them warm. Also keep in mind they are likely to have cardiac and lung problems so you’ve got to pay really close attention to their respiratory status.

If the omphalocele is small surgery will happen pretty quickly after birth. If the omphalocele is severe it will take several surgeries that need to be spread out over time. This is because their abdominal cavities and thoracic cavities are usually too small to immediately accommodate the organs being moved inside, so they have to wait until the baby grows and they can move the organs back in without trouble.

After they have surgery they will probably need to be on Parenteral nutrition until their bowels are ready to tolerate food. An issue that kids with severe omphalocele often face is difficulty with feedings. Because they have to be fed through and IV, they can miss all of these really important milestones for oral development and this really makes feeding difficult. They may have a lot of issues with textures and be really picky about their diet. So it’s really important that we provide support and keep an eye on their weight.

Your priority nursing concepts for a patient with an omphalocele are gastrointestinal and liver metabolism, elimination and infection control.

Okay, lets go over the key points for this lesson on omphaloceles. First, you’ve got to know that an omphalocele is when abdominal contents herniate through the belly button and are covered in a peritoneal sac. This can either be mild or severe. Kids with severe omphalocele often have cardiac and lung issues as well. The major complications to be on the lookout for are hypothermia, dehydration and infection.

Prior to surgery make sure the omphalocele is covered in wet gauze to keep it from getting infected and drying out.

After surgery they will probably need parenteral feeds. They can have a lot of issues with feeding so make sure to keep an eye on their weight as they are recovering!

That's it for our lesson on how to care for an infant with an omphalocele. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!