Oops!  Sorry!  I've been working too many hours....I apologize, but realized
after I hit the send button that I was describing the open sac on the spinal
column and not the open sac of the gut.  Omphalocele is failure of the GI
tract to return to the abdominal cavity by 10-11 weeks' in fetal development.
 Abdominal organs may herniate into the umbilicus and usually are covered by
a protective sac, though sometimes the sac is absent.  Like MM, this defect
is failure of the fetal structures to normally close and the condition leaves
the infant very vulnerable to infection.  The broad-spectrum antibiotics are
used, the feedings are delayed until recovery from surgery, the tolerance of
feedings can be difficult, especially with formula, and the size of the
actual defect can vary.  Besides having nothing by mouth until surgery is
performed, this infant will usually have a large bore nasogastric tube placed
to low intermittent suction so as to drain the GI system of mucous.  This
loss of mucous can deplete the infant's electrolyte balance, so often times
it is replaced by intravenous fluids to balance the electrolytes based on lab
findings.  Again, the site is wrapped with a sterile, moist dressing until
surgery takes place so that irreversible damage is prevented as a result of
oxygen being shunted away from the site to protect the brain.  The course of
feedings is the same; gradually increasing as tolerated.  And, again,
breastmilk is like medicine for this infant.  It is necessary for his
recovery since he is highly susceptible for feeding intolerance and
infection.  The course of recovery can be lengthy (at least several weeks),
but once recovered and taking feedings by mouth, there is no reason this baby
cannot breastfeed.  However, accurate monitoring of volume of intake will
need to be recorded, so use of the BabyWeigh Scale is a necessity.  Again,
sorry for my confusion!  I ended up stuck in the back rather than the front!
I must be getting old!
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services
Geneva, Il

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