omphalocele baby

[elizabells]

Hey guys, gotta question...

We have a baby that's about 21 days post-op from total serial reduction of a GIANT (literally the size of the kiddo's head, and he was a good-sized term baby) omphalocele. He had a nine-day silo reduction and closure, all went well, the kid is feeding like a champ and almost ready to go home. However, the kid is wicked fussy (we think he's hungrier than what he's being fed) and screeeeeams a lot, and the only thing that calms him is being walked around and bounced. This is my first omphalocele kid, and I'm sort of leery of holding him too tight. Am I going to hurt him if I hold him like a regular baby? His incision is good, there have been NO problems with his gut. When the other kids are screaming, I just hold them prone against my upper chest and bounce a little.

[prmenrs, RN]

Consolability should be part of your acuity criteria. If it isn't, there's something wrong w/the staffing formula! Work together w/your unit to make staffing appropriate to the babies emotional needs. No baby should be allowed to just cry w/o someone available to help him/her.

You can try some of the other tips we mentioned, but staffing still needs to be adequate.

JMO.

[LilPeanut, MSN, RN, NP]

In our unit, consolability is definitely taken into account. If you have a fussy baby, you get a PCA. Several times I've been a PCA and my job for the entire shift is to keep the fussy baby happy, and the nurse handles the other 2-3 stable kids. And parental involvement is also taken into account. If mom lives at the bedside and the baby is fussy, it's not as much of a problem than with the guys whose parents never seem to be around.

[Tomskatt]

Just curious if you all see a trend? I have noticed that most of our gastroschesis and omphalacele kids come from young mom's. An unofficial poll in my present unit was that most (not all) gastros come from teenage potsmoking mothers. Has anyone else seen this? Please don't take offense, I am just interested to see what is happening in other parts of the country.

[LilPeanut, MSN, RN, NP]

In ours, gastros are often assisted repro babies....so older moms with excellent prenatal care.....

[elizabells, BSN, RN]

The baby in question was to a G4P2022 mom in late 20s. I never smelled tobacco on her, and 2/2 her job I'm 99% certain she doesn't do drugs.

And just to update - the kid did brilliantly, went home in 30 days, never had a problem feeding for one second. We figured the crying was probably due to hunger. He was a beast.

[prmenrs, RN]

That's good news!

[BittyBabyGrower, MSN, RN]

Most of ours are hispanic or have one hispanic parents.

I hate to let them cry, but lately when we have had a census of 50 or more (we usually only have 30 some) they are a bit neglected. We do what we can, but with sometimes 3 other kids with that one, it doesn't happen. Luckily we can put them in strollers and cart them room to room to entertain them LOL

[Gompers, BSN, RN]

Just curious if you all see a trend? I have noticed that most of our gastroschesis and omphalacele kids come from young mom's. An unofficial poll in my present unit was that most (not all) gastros come from teenage potsmoking mothers. Has anyone else seen this? Please don't take offense, I am just interested to see what is happening in other parts of the country.

Most of our gastros are born to young moms, most of whom are from Mexico. I think there is something in the nutrition there - probably lack of folic acid - that really sets that population up for birth defects. I'm just reporting what we've seen very often on our unit. I'd say 75% of our gastros are from this population (and about the same % of myelos) and you can't really ignore that.

We have noticed a trend with IVF babies, but it's not GI abnormalities - it's chromosomal ones. These kids seem more likely to have some funky syndrome, especially if there are twins or more resulting from the IVF. Again, just reporting what we see as a possible trend.

[lovemyjob]

I have noticed that our gastros have been primarily from hispanic families (not sure if they are mexican.) There are actually a lot of teratogens that manifest them selves as gastroschesis. I would tell you which ones they are but I left my book at work. I saw it in the book Core CUrriculum for mother baby nursing (studying for low risk cert.) I wonder if the environmental regulations in some third world countries is not as strict as ours and they are exposed to much more than Americans. I also find that the ones I see are where the moms are fairly new to the US.

[tracy6fan]

We've seen a marked increase in belly defect babies here, 6 gastros in a 2 or 3 week period during the spring. The genetisists are finding a link between belly defects and meth use, which is also pretty rampant here.