It also makes a difference whether the defect is a gastroschisis (organs
not covered by peritoneum) or omphalocele (organs covered by peritoneum).
Patients with gastroschisis have a 20% incidence of NEC.  Patients with
omphalocele often have associated abnormalities, like trisomy 13, 18, or
21, prune belly syndrome, Beckwith-Wiedeman syndrome.

Both require surgery, which in gastroschisis must be performed semi-
emergently.  The decreased risk of infection is certainly a benefit from
breastmilk for these babies, who will be on TPN for a while (major
infection risk for everything) and be intubated for a while (major
infection risk for pneumonia.)  Also, the babies with gastroschisis have
bowel which is often in rough shape from being in contact with the urine-
laden amniotic fluid.  The easily digestible breastmilk will be of benefit
there.

Shannon T. McElearney, MD
PGY4, General Surgery
Univ. of Virginia
mom to 16 month old nursing man Jack

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