Reducing Neonatal Sepsis by Managing Bioburden with Giant Omphalocele

Approximately 775 babies in the United States are born with an omphalocele each year.  An abdominal wall defect where herniation of abdominal organs such as the small intestine, part of the large intestine, liver and spleen make up a giant omphalocele.  The herniating organs are covered by a membranous sac, which can rupture during birth, increasing the risk for neonatal sepsis. Sepsis remains one of the leading causes of morbidity and mortality both among term and preterm infants. In the past year, three premature newborns (33 to 37 weeks) were admitted to a Mid-Western tertiary referral children's hospital with giant omphalocele. Two of the newborn omphalocele sacs were ruptured at birth requiring immediate surgery to contain organs.  Tissue Matrix graft was placed around organs to stimulate neo-epithelialization. The third newborn kept an intact membranous sac. All three newborns were treated using a fatty acid derivative in DACC (Dialkylcarbamoyl chloride) technology dressing as a contact layer over the omphalocele to irreversibly bind with bacteria, without releasing endotoxins, through hydrophobicity action. Negative Pressure Wound Therapy (NPWT) with white foam was changed three times per week to maintain moisture at the graft site and over membranous sac. The newborn with the intact sac grew partial neo-epithelial tissue on the sac prior to surgery for closure. One newborn with a graft showed no infection with the omphalocele but had respiratory complications and passed away.  The other newborn with a graft had surgery reducing the defect but required a second Tissue Matrix graft. DACC dressing was not used on the second graft under NPWT and a pseudomonas infection developed that required systemic antibiotics.  DACC technology dressing was reinitiated again under NPWT with no further infections occured. A complete closure was achieved.