Clinical context (Congenital midline abdominal wall defect with herniated bowel/liver covered by sac — often associated anomalies (cardiac, chromosomal, Beckwith-Wiedemann); urgent pediatric surgery transfer)
First-line therapy
Cover sac with saline gauze + prevent heat loss + NPO + urgent transfer • —
Duration: Until transfer / definitive care · ABCDE; warm radiant heater/incubator; cover sac with warm saline-soaked gauze then dry sterile dressing — do NOT apply pressure or attempt reduction; NPO, NG if vomiting; IV fluids; avoid trauma to sac; urgent pediatric surgery and screen for associated anomalies
Supportive care only — antibiotics if sac rupture or infection • —
Duration: Until definitive repair · Prophylactic antibiotics not routine for intact sac — add ampicillin + gentamicin if sac rupture, omphalitis, or systemic signs (AAP, APSA)
Clinical notes
• Recognition: central abdominal mass covered by translucent sac (may contain liver and bowel) at umbilicus — distinguish from gastroschisis (paraumbilical defect, uncovered bowel).
• Primary care: prevent hypothermia and fluid loss; keep sac moist and protected; NPO; large omphalocele may need staged repair at tertiary center.
• Associated anomalies: echocardiography and chromosomal evaluation often required — communicate suspicion on transfer.
• Do NOT: force bowel into abdomen, clamp umbilical cord close to sac, apply tight dressings, or give oral feeds.
• Urgent transport to pediatric surgery center with neonatal capability.
• APSA — Omphalocele and abdominal wall defects (2024)
• AAP — Newborn abdominal wall defects (2024)
• WHO Pocket Book — Newborn surgical emergencies (2022)
