Oomphalocele:  This is a form of myelomeningocele which is where the spinal
column doesn't close completely in utero.  During fetal development, the
structure of the spinal column normally starts out as two separate entities;
fusing as the spinal column around the 3rd-4th weeks of development; prior to
a woman missing her first period, thus many times unaware she is even
pregnant.  The intake of 4mcg folic acid (folate) taken daily
preconceptionally has reduced the incidence of myeolomeningocele (MM).  The
infant is usually delivered by cesarean section so as to prevent further
injury as a result of birth trauma.  Sometimes a sac encloses the spinal
column and sometimes it is exposed; as a result, requiring applications of
normal saline to keep the site moist and prevent further damage.  The infant
is highly vulnerable to massive infection due to this exposed area and
therefore immediately placed on broad-spectrum antibiotics.  Surgery is
performed as soon as possible after birth once the baby is stable and deemed
able to tolerate the procedure.  The location of the defect can take place
anywhere along the spinal column, from the brain stem to the tailbone.  The
size of the defect can also vary from anywheres between a few cms. to the
entire length of the spinal column.  I think the most common site is in the
lumbar region (lower back).
Enough of the pathophysiology of the defect.....these infants definitely can
benefit from breastmilk!  Moms who don't ever plan to breastfeed should be
encouraged to pump milk and provide it to this infant as a necessary medicine
while the baby is ill and recovering from surgery.  The benefit of prenatal
diagnosis for MM is that mom can be prepared for this condition prior to
birth so that a cesarean can be planned and also it provides us the best
opportune time to discuss the benefits of breastmilk for this infant.  When
an infant has a critical condition such as this one, the "stress" caused by
the condition often times shunts blood away from the infant's gut
(intestines), leading to difficulty with tolerating feedings.  Usually the
infant will be fed feedings via a continuous feeding tube at very small rates
(ie. 1-2cc/hr) and slowly increasing the amount of feeding as tolerated.
Remember, this infant is highly susceptible to infection; thus, the
immunoglobulins in breastmilk can provide added protection to this infant.
And, breastmilk as we know is much easier to digest and tolerate by these
infants, so that feedings can be increased at a faster rate than that of
formula.  If fed formula, many times the infant has problems digesting, so
high amounts of undigested or partially digested formula are aspirated via
the feeding tube.  These are called "high residuals".  When the infant has
high residuals, feedings cannot be advanced. By the way, feedings will
usually not be started until after surgery has taken place.  And, once the
surgery is performed and baby is stable and recovering, there is no reason
the baby can't go to the breast if this is what the mom desires.  But, you're
talking several weeks before breastfeeding can be initiated.  Sorry to go on
and on......hope this helps!
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services
Geneva, Il

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