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Patient case: Omphalocele

Discussion

A 2-day-old full-term male newborn is admitted to the neonatal intensive care unit (NICU) following delivery via caesarean section. The baby was born with a visible abdominal wall defect, where a portion of his intestines and liver are protruding through the base of the umbilical cord but are covered by a thin, transparent sac. The baby’s Apgar scores were normal, and he is otherwise stable, breathing on his own without respiratory distress.

The parents report no complications during pregnancy, and prenatal ultrasounds had detected the abdominal wall defect, confirming the diagnosis of omphalocele. The baby’s heart and lungs were thoroughly examined and showed no signs of associated abnormalities, although further imaging is planned to rule out any additional congenital issues.

A diagnosis of omphalocele is confirmed. This condition involves the protrusion of abdominal organs through the umbilical ring, covered by a protective membrane. The paediatric surgical team discusses treatment options with the family, explaining that surgical repair is necessary to close the abdominal wall defect and return the organs to the abdomen. The timing of surgery will depend on the baby’s stability and the size of the defect. In this case, the sac appears intact, and the surgery is planned for the coming days.

The parents are reassured that with proper surgical management and close monitoring, the prognosis for their baby is good. The NICU team will continue supportive care, ensuring that the baby remains stable until surgery. A multidisciplinary team will follow the infant closely, as omphalocele can sometimes be associated with other congenital conditions. The parents are provided with information on what to expect in the coming days.

Questions
1. What is the main characteristic of omphalocele in this newborn?

A) Abdominal organs protruding through the umbilical cord covered by a sac

B) Abdominal organs exposed without a protective covering

C) A defect in the diaphragm leading to organ displacement

D) Herniated bowel loops in the groin area

2. How was the diagnosis of omphalocele initially made?

A) During a routine neonatal examination

B) Through prenatal ultrasound

C) After the baby presented with respiratory distress

D) Based on family history of congenital defects

3. What is the primary treatment for omphalocele in this case?

A) Hormonal therapy

B) Surgical repair of the abdominal wall defect

C) Antibiotic treatment

D) Observation and delayed intervention

4. What is the most important factor for determining the timing of surgery in this newborn?

A) The baby's feeding tolerance

B) The size of the defect and the baby’s stability

C) The baby's weight at birth

D) The presence of associated cardiac anomalies

Reveal answers

Answers

1. A

2. B

3. B

4. B

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