G.I. Anomalies in Newborn and Pediatric Care




Necrotizing Entero-Colitis –NEC

  • Definition
  • Cause
  • Genetics
  • Associated problems – Prematurity
  • Epidemiology
  • Immediate care
  • Surgical Repair
  • Complications
  • Prognosis mortality in Georgia 38.5%.  15% of all deaths after the first week of life for infants weighting 1500 g or less at birth.





  • Definition- an abdominal wall defect to the side of the umbilical cord (umbilicus). The infant is born with intestines protruding through the defect and no protective sac is present.  MSAPF levels are greater in gastroschisis than in omphalocele
  • Cause- Abdominal wall defects occur as a result of failure of the mesoderm to replace the body stalk. Disruption of blood flow to the affected abdominal wall occurs. Seen more often in younger mothers or those who use cocaine, nicotine. Recurrance 3-5%
  • Antepartum- IUFD, growth retardation, preterm delivery & stillbirth.
  • Genetics- Gastroschisis is rarely associated with other birth defects. Gastroschisis is a life-threatening event requiring immediate intervention.
  • Associated Problems-  include; malrotation, atresia, volvulus, infarction
  • Epidemiology- 77 – 100% survive  Occurs in 1:10,000 births
  • Immediate Care- Delivery by C/S may be helpful. Immediately after delivery, the exposed organs are covered with warm, moist, sterile dressings. A tube is inserted into the stomach (nasogastric tube, also called NG tube) to keep the stomach empty and to prevent choking on or breathing in of stomach contents into the lungs.
  • Surgical Repair- Surgical repair of abdominal wall defects involves replacing the abdominal organs back into the abdomen through the abdominal wall defect, repairing the defect if possible, or creating a sterile pouch to protect the intestines while they are gradually pushed back into the abdomen over 1-2 weeks using gravity.
  • Complications- Necrotizing entero colitis which may be reduced by feeding with breast milk.
  • Prognosis – normalization within 3 months






ProcedureCase 52: Image 2

  • Definition- An omphalocele is an abdominal wall defect at through an opening in the abdominal muscles in the area of the umbilical cord. the base of the umbilical cord (umbilicus); the infant is born with a translucent membrane protruding through the defect which contains small intestine, liver, and large intestine.  The defect occurs in-utero The omphalocele may be small, with only a portion of the intestine protruding outside the abdominal cavity, or large, with most of the abdominal organs (including intestine, liver, and spleen) present outside the abdominal cavity. Further, the abdominal cavity itself may be small due to underdevelopment during pregnancy.  Rupture may occur in utero (> 10%)

  • Cause- As a fetus is growing in the mother's uterus before birth, different organ systems are developing and maturing. Between the sixth and 10th weeks of pregnancy, the intestines actually project into the umbilical cord as they are growing. By the 11th week of development, the intestines should return to the abdomen. When the fetus is growing and developing during pregnancy, there is a small opening in the abdominal muscles that the umbilical cord can pass through, connecting the mother to the fetus. As the fetus matures, the abdominal muscles should meet in the middle and grow together, closing off this opening. An omphalocele occurs when the abdominal organs do not return to the abdominal cavity as they should.  It is not known what causes omphalocele.


  • Genetics- When an omphalocele is isolated (no other birth defects are present), the risk for it to happen in a future pregnancy is 1 percent, or one in 100. There are some families that have been reported to have an omphalocele inherited as an autosomal dominant or X-linked recessive trait. In these cases, the chance for reoccurrence would be higher.
      1. Thirty percent have a chromosomal (genetic) abnormality, most commonly trisomy 13, trisomy 18, trisomy 21 (Down syndrome), Turner syndrome, or triploidy.



  • Associated problems- Many babies born with an omphalocele also have other abnormalities. The chance for reoccurrence depends upon the underlying disorder: Associated with increased maternal age


    • Some infants with omphalocele have a syndrome known as Beckwith-Wiedemann syndrome.
    • More than two-thirds of babies with omphalocele have abnormalities of other organs or body parts, most commonly the spine, digestive system, heart, urinary system, and limbs.


  • Epidemiology-  
    • A small omphalocele (involving protrusion of a small portion of the intestine only) occurs in one out of every 5,000 live births.
    • A large omphalocele (involving protrusion of the intestines, liver, and other organs) occurs in one out of every 10,000 live births.
      Omphalocele occurs relatively equally in boys and girls.


  • Immediate care Because some or all of the abdominal organs are outside the body, infection is a concern, especially if the protective membrane around the organs breaks. Also, an organ may lose its blood supply if it becomes pinched or twisted. A loss of blood flow can damage the affected organ. Omphalocele can often be detected on fetal ultrasound in the second and third trimesters of pregnancy. A fetal echocardiogram (ultrasound of the heart) may also be done to check for heart abnormalities before the baby is born.  After birth, the omphalocele can be noted by the physician during the physical examination. X-rays (diagnostic tests that use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) may also be done after birth to evaluate abnormalities of other organs or body parts.

  • Surgical Repair- Specific treatment for an omphalocele will be determined by: the baby's gestational age, overall health, and medical history extent of the condition the baby's tolerance for specific medications, procedures, or therapies.
    • For a small omphalocele (only a portion of the intestine protruding outside the abdominal cavity), shortly after birth, an operation is done to return the organs to the abdomen and close the opening in the abdominal wall.
    • For a large omphalocele (most of the abdominal organs, including intestine, liver, and spleen, are present outside the abdominal cavity), the repair is done in stages and may include the following:
      1. Initially, sterile, protective sheeting is placed over the abdominal organs.
      2. Because the abdomen may be small and underdeveloped, it may not be able to hold all of the organs at once. Therefore, the exposed organs are gradually moved back into the abdomen over several days or weeks. The abdominal wall is closed surgically once the organs have been returned to the abdominal cavity.
      3. Because the abdominal cavity may be small and underdeveloped and the organs may be swollen, a baby with an omphalocele may have breathing difficulties as the organs are returned to the abdomen. The baby may need help from mechanical ventilation while the swelling is decreasing and the size of the abdominal cavity is increasing.
  • Post-Operative Care- The infant is cared for post-operatively in a neonatal intensive care unit. The baby is placed in an isolette (incubator) to keep warm and prevent infection. Oxygen is given and mechanical ventilation is often required. Intravenous fluids, antibiotics, and pain medications will be given. A nasogastric tube will be in place to keep the stomach emptied of gastric secretions. Feedings are started by nasogastric tube as soon as bowel function resumes. Feedings are started very slowly and often infants are reluctant to feed. These babies may need feeding therapy and lots of encouragement.


  • Complications- Problems in the future often depend on:
    • the size of the omphalocele.
    • if there was a loss of blood flow to part of the intestine or other organs.
    • the extent of other abnormalities


  • Prognosis.

o        Babies who have damage to the intestines or other abdominal organs may have long-term problems with digestion, elimination, and infection.


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created November 16, 2005 by; Kim Hayes, Daniel Henriquez, Michael Jackson, Jody Kenneally, Doris Obando, Brooke Roebuck (NU Class of 2006)