Clinical context (Paraumbilical defect with uncovered extruded bowel — no sac; high fluid/heat loss; cover with saline gauze and plastic wrap, NPO, NG, IV fluids, urgent surgery — do NOT force bowel back)
First-line therapy
Saline gauze + plastic wrap + NPO + NG + IV fluids + urgent surgical transfer • —
Duration: Until transfer / definitive care · ABCDE; warm environment; cover exposed bowel with warm saline-soaked gauze then occlusive plastic wrap over defect; NPO; NG to decompress; aggressive IV isotonic fluids (third-space losses high); avoid pressure on bowel; urgent pediatric surgery — primary closure or silo at center
Max 2000 mg/dose · Duration: 7–10 days · Prophylactic antibiotics controversial — commonly started at surgical centers when bowel edema/ischemia or delayed closure; follow receiving NICU protocol (APSA)
Clinical notes
• Recognition: defect right of umbilicus, exposed bowel without sac — distinguish from omphalocele (covered central sac, often liver).
• Primary care priorities: prevent hypothermia, dehydration, and bowel desiccation — saline gauze + plastic wrap is standard.
• Do NOT: force bowel back into abdomen, clamp or tie bowel, give oral feeds, leave bowel exposed to air.
• Associated intestinal atresia in ~10% — surgical evaluation at center.
• Urgent transfer to pediatric surgery NICU — outcomes depend on bowel condition and sepsis prevention.
• APSA — Gastroschisis management (2024)
• AAP — Abdominal wall defects (2024)
• WHO Pocket Book — Newborn surgical emergencies (2022)
