ECMO-/ECLS

Bladder &/or cloacal exstrophy
Skeletal

Chromosomal

Trisomy 21

Beckwith-Wiedemann

Syndrome

Gastrointestinal

Diaphragmatic hernia

Malrotation

Pentalogy of Cantrell:

omphalocele combined with

ectopia cordis

Management in the Delivery Room
Establish an airway if infant in respiratory distress. Place an orogastric tube for
gastric decompression. If the sac is not ruptured, carefully wrap herniated viscera in
warm saline-soaked Kerlix. BE CAREFUL NOT TO DISRUPT AN INTACT SAC.
If a ruptured omphalocele is present, the initial management is similar to
gastroschisis. Place the baby feet first into a “bowel bag” and tie the bag loosely around
the axilla. BE VERY CAREFUL NOT TO INJURE THE LIVER, since this can cause
significant and potentially fatal (in preemies) bleeding.

Management in the NICU
In the NICU, vascular access is established. The baby’s fluid status should be
monitored. A sepsis work-up should be considered, especially in ruptured omphalocele
patients. Administration of intravenous antibiotics such as ampicillin and gentamycin
should be considered.