The use of a bowel bag to protect eviscerated abdominal contents in patients with omphalocoele and gastroschisis has been shown to decrease fluid and heat loss from the lesion and to decrease tissue trauma.

In the delivery room an infant with an abdominal wall defect should be dried, assessed, and resuscitated as per NRP guidelines. IM vitamin K may be administered in the delivery room prior to putting the infant in the bag feet first. Pull the bag up over the defect (usually to the nipple line) and pull the drawstring to secure the bag snugly around the infant’s chest. Make sure the entire defect is covered.

The infant with an abdominal wall defect should be placed on his/her side with a blanket roll behind the back for support to prevent kinking of the superior mesenteric artery. A blanket roll can be used outside the bowel bag to support the abdominal contents if needed.

While awaiting surgery, a Replogle tube should be placed to decompress the stomach, and the intestines should remain visible through the bowel bag to be assessed for any signs of acute compromise. The bowel bag should not be removed if the infant stools or urinates in the bag. Urine and meconium are sterile and no attempts need to be made to quantify output in the brief time interval preceding surgical intervention.

If an infant with an abdominal wall defect is outborn and the defect has been wrapped in gauze, the transport team should remove the gauze if it comes off easily. Any adherent gauze should be left in place and the infant placed in a bowel bag. There is no need to moisten the bag with sterile saline.

References:

Chahine AA, Ricketts RR.Resuscitation of the surgical neonate. Clinics in Perinatology 1999; 15: 702-706.

Strodtbeck F. Abdominal wall defects. Neonatal Network 1998; 17: 51-53.