Choices A and C are correct. Postnatal nursing interventions for omphalocele are aimed at minimizing the complications to the neonate. Although the intestines remain in a peritoneal sac in an omphalocele, there is no skin covering the defect. Therefore, there is an insensible loss of heat and fluids. Complications such as dehydration, electrolyte imbalance, hypothermia, and infection ( necrotizing enterocolitis) may ensue. Because of the defect, infants with omphalocele have reduced chest capacity and respiratory reserve. The pre-operative nursing management of neonates with omphalocele involves airway stabilization, covering the defect with sterile gauze soaked in saline, inserting an orogastric tube for bowel decompression, and establishing peripheral intravenous access. Subsequent interventions include the administration of intravenous fluids and broad-spectrum antibiotics.

The defect should be covered with sterile gauze soaked in saline ( Choice A). This keeps the intestines moist and reduces insensible fluid loss. Additionally, such a protective covering will prevent infection. Infection prevention in omphalocele patients is a priority because exposed abdominal contents are prone to severe infection when there is no protective skin covering.
Due to insensible heat loss from the exposed viscera, hypothermia is a critical complication of an omphalocele. Affected infants struggle to maintain their body temperature. The affected infants should not be tightly swaddled because this would put pressure on the exposed intestines compromising the blood flow. Using a radiant warmer can help with thermoregulation in these infants without compromising the intestines (Choice C).

Choice B is incorrect. It is inappropriate to position an infant with an omphalocele in the prone position. Prone positioning would place the exposed intestines directly onto the surface, causing compression of the intestines and blood-flow compromise. Instead, supine positioning is preferred.

Choice D is incorrect. Trophic feeding refers to feeding small volumes of enteral feeds to stimulate the development of the infant's immature gastrointestinal tract. Trophic feedings would not be started in an infant with an omphalocele before the surgical repair. The intestines will need to be placed back in position before the feeds can be initiated. Initially, the feeding will be primarily parenteral, with very gradual transitioning to the enteral feeds.

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