What steps should be taken when transferring patients with pediatric omphalocele and gastroschisis (abdominal wall defects)?

Updated: Nov 05, 2019
  • Author: James G Glasser, MD, MA, FACS; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Answer

When transferring infants with ventral abdominal body wall defects, covering the intestines with warm, moist lap pads seems reasonable, but the heat is soon dissipated. A better approach is to:

  • Cover the intestines with a nonadherent, semi-permeable membrane (eg, plastic cling wrap such as Saran Wrap). Then,
  • Wrap dry Kerlex dressing around the intestines, including the infant's torso, so that the intestines are situated just above the abdominal wall defect. Then,
  • Place the infant in a bowel bag.

This technique minimizes the loss of heat and moisture from the exposed intestines, as well as protects the mesentery from twisting or stretching. [22] A radiant warmer should only be used if the intestines are protected.

Intravenous fluids are administered to counter evaporative and third space (GI tract) losses; an orogastric tube is placed to prevent gastric distention from swallowed air. Antibiotics are indicated, in view of the open peritoneal cavity and exposed bowel.


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