Ch. 34 Infant Born with Abdominal Wall Defect

Question 1

Etiology of gastroschisis vs. omphalocele

Answer 1

Gastroschisis:

• Result from a vascular accident within umbilical ring, leading to a local defect in developing body wall and evisceration
• _**Note: elevated AFP_

Omphalocele:

• Arrest of lateral-body fold migration and body wall closure during organogenesis

Question 2

Which condition is more urgent? Why?

Answer 2

At onset: gastroschisis

Long term: omphalocele… associated conditions: Pentalogy of Cantrell, trisomy 13, trisomy 18

Question 3

Workup

Next step?

Answer 3

Postpartum stabilization = top priority for infants born with gastroschisis and omphalocele

Correct metabolic disturbances…. monitor fluids, urine output

Perform XRay to evaluate general anatomy and positions of implanted devices (i.e., endotracheal tubes, central venous catheters)

Omphalocele:
Stabilized infants with omphalocele undergo echo to evaluate for associated congenital cardiac defects

Large defects require construction of Silastic “silo” to house and protect bowel

BOTH = IMMEDIATE SURGERY AFTER BIRTH