Pediatric Genitourinary/Gastrointestinal Disorders

Pediatric Kidneys

• Kidneys are large and not well-protected from trauma.

• Shorter urethra in girls increases the risk of infection.

• Slower glomerular filtration rate → kidneys are less efficient at regulating fluid, electrolyte, and acid/base balance.

• Smaller bladder capacity:

  • Infants: 20 cc to 50 cc

  • Adults: 700 cc

• Urine Output:

  • Infants: 2 mL/kg/hr

  • Older Children: 0.5 to 1 mL/kg/hr

• The renal system reaches maturity at 2 years of age.

Urine Collection in Pediatric Patients

• Always discuss and obtain permission for the procedure with a caregiver before catheterization.

• Involve Child Life Services (CLS) for older children before invasive urine collection techniques.

• Urine Bag:

  • Appropriate for infants and toddlers.

  • May be sterile or clear for urinalysis (UA).

• Straight Catheterization:

  • Used for urinalysis (UA).

  • In most cases of retention or obstruction, this technique is the same as in adult patients but may be difficult due to smaller anatomy and patient cooperation.

Urinary Tract Infection (UTI)

• An infection of the urinary tract, most commonly the bladder, caused by bacterial transmission via the urethra.

• Females are at an increased risk due to their shorter urethra length and the proximity of the urethra to the vagina and anus.

• Infant Symptoms:

  • Irritability

  • Fever

  • Poor feeding

  • Vomiting

  • Jaundice

• Children Symptoms:

  • Fever

  • Vomiting

  • Dysuria

  • Incontinence

  • Urinary hesitancy and urgency

  • Hematuria

  • Abdominal pain

  • Flank pain

  • Foul-smelling urine

• If left untreated → pyelonephritis, urosepsis, renal scarring, and hydronephrosis.

• Diagnostic Tests: Urinalysis (UA) with reflux to culture.

  • UA: Positive for blood, nitrates, leukocyte esterase, white blood cells, or bacteria.

  • Culture: Will reveal the infecting organism.

UTI: Nursing Care

Most patients will manage this at home; care surrounds education for prevention and treatment:

• Ensure adequate hydration.

• Avoid:

  • Urinary retention

  • Frequent bathroom breaks (*note for school-aged child).

• Females:

  • No bubble baths or soap application to the vulva.

  • Wipe front to back.

  • Cotton underwear.

  • Change pads/tampons frequently during menstruation.

  • Void after intercourse.

• Complete full course of antibiotics and return to PCP for re-check.

• Pain Management:

  • Acetaminophen.

  • Ibuprofen.

  • Small children may void in a warm bath or with a heating pad.

• Hospital Admission Criteria & Care:

  • Criteria: Infant <2 months—s/sx: urosepsis, immunocompromised patient, inability to tolerate oral medications.

  • Care: Administer antibiotic therapy, hydrate via oral or IV fluids, pain management, and antipyretic PRN.

What are Some Structural Urinary Disorders?

• Hypospadias/Epispadias

• Vesicoureteral Reflux

Hypospadias/Epispadias

Hypospadias:

• A congenital anomaly of the male urethra, foreskin, and penis leading to the abnormal ventral placement of the urethral opening.

Epispadias:

• A defect in which the urethral opening is on the dorsal surface of the penis.

Abnormal displacement has the potential to cause developmental or functional issues:

• Deflection of the urinary stream.

• Inability to urinate standing.

• Erectile dysfunction causing intercourse difficulties.

• Problems with fertility due to improper deposition of sperm.

Circumcision is contraindicated before surgical repair.

Hypospadias/Epispadias: Nursing Care

Surgical repair occurs 6 to 12 months of age and is usually outpatient.

Post-Operative Care—Caregiver Support and Education Surrounding:

• Pain Medication Administration:

  • Analgesics (acetaminophen, ibuprofen)

  • Antispasmodics (oxybutynin).

• Antibiotics are given post-op to prevent infection while the catheter is in place.

• Surgical site care: Dressing stays in place for 3 days; soak it off; may apply Vaseline to outer diapers once the dressing comes off.

• Double-diapering and catheter care.

• When to call the provider or go to the ED: Fever, excessive bleeding, inconsolable pain, change in urine output.

Vesicoureteral Reflux (VUR)

Retrograde passage of urine from the bladder into the upper urinary tract → renal scarring.

Potential for renal insufficiency or failure later in life.

Primary:

• Congenital abnormality → Inadequate closure of the uretrovesical junction → Failure of the anti-reflux mechanism.

Secondary:

• Result of high pressure in the bladder → failure of the uretrovesical junction to close.

• May be caused by neurogenic bladder, obstruction, or dysfunction of the bladder.

Diagnostic Test:

• Voiding Cystourethrogram (VCUG).

Grading:

• Severity is graded on a I to V scale.

• Grades III to V are associated with recurrent UTIs, hydronephrosis, and renal injury.

Vesicoureteral Reflux (VUR): Nursing Care

Daily administration of prophylactic antibiotics until VUR is resolved, either spontaneously or surgically.

Educate the child and caregiver about:

• Proper toileting

• Perineal hygiene

• The need for regular urine testing and Voiding Cystourethrogram (VCUGs).

Post-Operative Care:

• IVFs—1.5 maintenance rate to promote urinary output.

• Strict I & Os.

• Foley and stents may be in place—urine will be bloody for 2 to 3 days post-op.

• Administer analgesics and antispasmodics.

• Ambulate and advance diet as tolerated.

What are Some Acquired Urinary Disorders?

• Nephrotic Syndrome

• Post-Streptococcal Glomerulonephritis

• Hemolytic Uremic Syndrome (HUS)

Nephrotic Syndrome

• Increased permeability across the glomerular filtration barrier → plasma protein through the basement membrane → loss of protein in the urine and decreased protein and albumin in the serum.

• Hypoalbuminemia → a change in osmotic pressure → fluid shifts into interstitial tissue → shift in volume prompts kidneys to conserve water and sodium → edema.

• Primary:

  • This syndrome occurs in the absence of disease.

  • It includes idiopathic nephrotic syndrome, which is the most common form (90% of patients).

• Secondary:

  • This syndrome is associated with disease or is secondary to another process that causes glomerular injury (e.g., SLE, Henoch-Schonlein Purpura, Sickle Cell Disease, Infective Endocarditis).

• Signs & Symptoms:

  • Nephrotic-range proteinuria—urinary protein excretion greater than 50 mg/kg per day.

  • Hypoalbuminemia—serum albumin concentration less than 3 g/dL (30 g/L).

  • Edema (generalized—anasarca).

  • Hyperlipidemia.

Nephrotic Syndrome: Nursing Care

Promote Diuresis:

• Administer corticosteroids (prednisone) and diuretics (furosemide) as ordered.

• Daily weights.

• Monitor urine output and proteinuria.

• Regular assessment of vital signs and edema.

• Administer albumin as ordered for severe hypoalbuminemia.

Prevent Infection:

• Give prophylactic antibiotics as ordered.

• Vaccine administration—pneumococcal and varicella.

• Avoid live vaccines during steroid treatment.

Nutrition:

• May require fluid and salt restriction.

• Encourage foods high in protein and potassium (if low from diuretics).

Child & Caregiver Support and Education:

• Surrounding the course of treatment and preventing relapse by adhering to the treatment plan.

• Teach how to check for proteinuria via urine dipstick.

• Offer supportive resources to children distressed with appearance.

Post-Streptococcal Glomerulonephritis

An immune complex disease that occurs after an infection.

Infection → immunologic response → glomerular inflammation and injury → can lead to uremia and renal failure.

Signs & Symptoms:

• Recent infection (viral URI, strep)

• Fatigue

• Proteinuria

• Hematuria

• Decreased glomerular filtration rate

• Retention of sodium and water → edema & hypertension

Nursing Care:

• Antibiotic therapy if strep infection is present.

• Monitor and manage hypertension with antihypertensives (e.g., labetalol) and diuretics.

• Sodium and water restriction.

• Strict I & Os.

• Cluster care to allow for rest.

• May require dialysis for life-threatening fluid overload refractory to treatment, uremia, elevated K+ resistant to treatment.

Hemolytic Uremic Syndrome (HUS)

Three defining features of HUS:

• Hemolytic Anemia

• Thrombocytopenia

• Acute Renal Failure

Acquired HUS:

• Shiga toxin-producing E. coli (STEC): 90% of pediatric cases of HUS.

  • Ex: Undercooked beef, feces, certain animals, unpasteurized dairy.

  • Signs & Symptoms: Begins 5 to 10 days after diarrhea onset.

    • Abdominal pain

    • Vomiting

    • Diarrhea (bloody)

    • Hematuria

• Streptococcus pneumoniae: 5% to 15% of pediatric cases of HUS.

  • Develops following a pneumococcal infection; the pneumococcal vaccine is protective against many strains.
    Initial disease in patients is more severe (higher mortality rate) than in patients with STEC.

  • Signs & Symptoms:

    • Pneumonia

    • Usually with empyema (collection of pus outside the lungs) or effusion

    • Dyspnea

    • Respiratory distress

    • Fever

    • Cough

• Patients may progress to severe AKI or renal failure; 50% of patients will need dialysis.

• Neurologic Signs & Symptoms (can be seen in about 20% of patients):

  • Altered mental status

  • Seizures

  • Coma

  • Stroke

HUS: Nursing Care

Care is Supportive:

Anemia:

• Slow infusion of PRBCs (for Hgb <6) over 3 to 4 hours to prevent fluid overload.

Thrombocytopenia:

• PLT transfusion if significant bleeding is present.

Maintain Appropriate Fluid Balance:

• This is tricky as patients with HUS may have increased (oliguria or anuria) or decreased (vomiting, diarrhea) intravascular volume.

  • If decreased intravascular volume—administer fluids to restore euvolemic state.

  • If increased intravascular volume—administer diuretics and antihypertensives as ordered.

Monitor Kidney Function, Prevent Further Injury:

• Labs—CBC, CRT, BUN, electrolytes

• Avoid administration of nephrotoxic medications.

Manage HTN:

• Restore euvolemia, administer diuretics or antihypertensives as ordered.

Patient May Require:

• Education should be given surrounding the risk of transmission (STEC is shed for 7 days; longer in younger patients for 3 weeks).

Gastrointestinal Disorders in Children

Upper GI Tract:

• The lower esophageal sphincter is fully developed at 1 month of age.

• Stomach capacity is 200 mL, with gastric emptying faster than in adults.

• Adults: 2,000 mL to 3,000 mL capacity.

Lower GI Tract:

• The small intestine is 250 cm vs 600 cm in adults.

• Healthy infants have a faster intestinal transit time than adults.

• The liver is ½ the size of the abdominal cavity, and the edge may be palpable on examination 2 cm to 4 cm below the right costal margin.

• Immature neuromuscular function often causes stooling after eating as a result of gastrocolic reflux.

• By 2 years of age, voluntary control of bowel movements occurs.

• Meconium is the first stool and appears black in color, sticky.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux:

• Passage of gastric contents into the esophagus (regurgitation or ‘spitting up’).

• Frequent in infants <12 months (30x/day).

• Physiologic in all ages until it causes symptoms of esophageal injury or complications → referred to as GERD.

Gastroesophageal Reflux Disease (GERD):

• Signs & Symptoms:

  • May be vague and include—poor weight gain (FTT—failure to thrive), feeding refusal, irritability, respiratory symptoms (cough, wheezing), neck or back arching, heme + stools.

  • Underlying causes must be ruled out before diagnosis (e.g., food allergies, malrotation, neurologic impairment).

• Conditions Associated with GERD:

  • Obesity

  • Cystic Fibrosis (CF)

  • Neurologic Impairment

  • Prematurity

  • Hiatal hernia

  • Achalasia

GERD: Nursing Care

Administering Feedings:

• Elevate the head or the head of the bed.

• Keep the infant upright for at least 30 minutes after feedings.

• Offer smaller, more frequent feedings; avoid overfeeding.

• Thicken feeds (e.g., oat cereal).

Other Modalities:

• GERD should resolve spontaneously as the infant grows.

• However, with moderate to severe cases, the infant may require medication.

  • PPI: Omeprazole

  • H2 Receptor Antagonist: Famotidine

• Nissen fundoplication is reserved for infants with severe GERD, refractory to the treatment above.

Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF)

• Congenital anomaly caused by a defect in the lateral section of the foregut into the esophagus and trachea (the trachea and esophagus do not separate normally during development).

• Clinical presentation of TEF depends on the presence of EA.

• EA: Proximal and distal ends of the esophagus do not communicate (blind pouch).

• Signs & Symptoms (present after birth):

  • Drooling

  • Choking

  • Coughing

  • Cyanosis

  • Respiratory distress

  • Inability to feed (aspiration)

  • NGT coiled in the esophagus (cannot pass)

  • Abdominal distension

• 50% of cases have associated anomalies (VACTERAL association or CHARGE syndrome).

• Diagnostic Tests:

  • Chest X-ray

  • UGI series

EA/TEF: Nursing Care

EA Post-Operative Care:

• Routine post-op care

• Administer parenteral nutrition, IV antibiotics

• Administer PO feeds when ordered

• Caregiver support and education:

  • Signs and symptoms to watch for and when to call the provider

  • PPI administration

  • Possibility of need for future esophageal dilations

TEF Post-Operative Care:

• NPO, NGT/OGT to low continuous suction

• Administration of parenteral nutrition, IVFs

• PRN suction and oxygen

• Comfort measures

• Caregiver education

Cleft Lip & Palate

The most common congenital craniofacial abnormality (30% associated with genetic syndromes).

Infants are at higher risk of developing this if the mother:

• Smokes

• Takes certain medications

• Is considered advanced in age

Presentation:

• Many infants present with both cleft lip and palate (50%).

• May present with cleft lip alone or cleft palate alone.

• May be left-sided, right-sided, or bilateral.

Examination:

• Cleft lip: visualized on examination.

• Cleft palate: visualized on examination and palpated with a gloved finger.

Repair Time:

• Cleft lip: 3 months.

• Cleft palate: 6 months.

Cleft Lip & Palate: Nursing Care

Promote Nutrition:

• If cleft palate is present, the infant may not be able to generate enough pressure to suck milk from the bottle or breast.

  • Adaptive equipment may be used to assist in feedings (squeezable bottle or modified nipple).

• If cleft lip (alone) is present, the infant can feed from the bottle or breast.

• Increased risk for aspiration with a cleft palate, so prevent this by covering the palate with a prosthodontic device.

Encourage Infant-Parent Bonding:

• Parents may experience distress surrounding the infant's appearance and hospitalization.

• Support parents in providing feedings and other care to the infant.

• Provide education for anticipated surgeries.

Post-Operative Care:

• Pain management with medication and comfort measures (holding, rocking, singing) — anticipate their needs.

• Prevent damage to the suture line of the lip and/or palate.

• The infant should lie supine, and may require a mitten or welcome-sleeve restraints.

• Do not allow the infant to suck on pacifiers, plastic syringes, or straws in older children undergoing repair.

• No oral suctioning (or keep it to a minimum).

Acute Viral Gastroenteritis

Intestinal Infection:

• Destruction of enterocytes → shift of fluid into intestinal lumen → loss of fluid and salt in stool (diarrhea).

• Intestinal injury decreases digestion and absorption.

• Occurs in infants and children year-round.

• Transmitted most often by the fecal-oral route by symptomatic and asymptomatic carriers.

• Examples of infectious pathogens: rotavirus, norovirus, and enteric adenovirus.

• Symptomatic onset depends on the virus (incubation period differs).

Primary Signs & Symptoms:

• Diarrhea

• Vomiting

Other Signs & Symptoms:

• Fever

• Abdominal pain

• Myalgia

• Anorexia

Patients with moderate to severe cases of this disease may experience:

• Weight loss

• Electrolyte imbalance

• Tachycardia

• Hypotension

• Sunken fontanelle

• Dry mucous membranes

• Reduced skin turgor

• Low urine output

• Listlessness

• Lethargy

Acute Viral Gastroenteritis: Nursing Care

Treatment is Supportive:

• Fluid repletion and replacement of ongoing fluid losses.

• Mild to moderate: Oral Rehydration Therapy (ORT).

• Moderate to severe: IV hydration.

• Antiemetic medications (Zofran).

Diet:

• Complex carbs are preferred.

• Avoid fatty or sugary foods (BRAT diet not necessary).

Monitoring:

• Daily weights.

• Electrolytes.

• PO intake (strict I & Os).

Caregiver Education:

• Diarrhea may last several days after discharge home.

• Handwashing.

• Signs and symptoms of when to call the provider or return to the ED.

Rotavirus Vaccine.

Infantile Hypertrophic Pyloric Stenosis

• Hypertrophy of the pylorus → obstruction of gastric outlet → forceful, often projectile vomiting.

• Occurs in early infancy between 3 to 6 weeks.

• Vomiting occurs immediately following feeding.

• Infants are irritable and hungry, wanting to be fed again soon after emesis.

• Signs & Symptoms:

  • Failure to gain weight or weight loss

  • Dehydration (dry mucous membranes, no tears)

  • Hyperchloremic metabolic alkalosis

  • Palpation of ‘olive-sized’ mass in RUQ.

• Diagnostic Tests:

  • Abdominal ultrasound will demonstrate hypertrophied pylorus.

Infantile Hypertrophic Pyloric Stenosis: Nursing Care

Treatment is surgical: Laparoscopic Pyloromyotomy

Pre-Operative Care:

• Administer IVFs to correct dehydration and electrolyte disturbances.

• Bolus of NS (x1 or x2, depending on the degree of dehydration and hypochloremia).

• MIVFs at 1.5 to 2x maintenance rate.

• NPO before surgery.

• Provide education and support to caregivers regarding surgery.

Post-Operative Care:

• Resume oral feeds and continue IVFs until tolerating PO.

• Strict I & Os.

• Monitor surgical site.

Intussusception

The most common cause of intestinal obstruction in children 6 months to 3 years of age.

• Bowel telescopes into a distal portion of itself. If left untreated → edema, vascular compromise, and bowel obstruction.

Classified by location:

• Ileocolic (90%)

• Ileo-ileal

• Jejuno-ileal

• Colo-colic

• May be preceded by a viral illness (URI, AOM).

• Most cases are idiopathic (75%), while some may have a lead point (25%).

Signs & Symptoms:

• Sudden, crampy, intermittent abdominal pain

• Severe abdominal pain

• Child may draw knees to chest

• Vomiting

• Diarrhea

• Lethargy

• Currant-jelly stools** (mucus + blood)

• Sausage-shaped mass on abdominal palpation (RUQ)

Intussusception: Nursing Care

Stable Child Without Signs & Symptoms of Perforation:

• Administer IVFs.

• Transport to radiology for air (pneumatic) or contrast (hydrostatic) enema.

• Educate caregivers about the procedure and the likelihood of recurrence (50% recur within the first 72 hours following nonoperative reduction).

Ill-Appearing Child, Signs & Symptoms of Bowel Perforation, or Unsuccessful Nonoperative Intervention:

• Emergent surgical intervention (diagnostic laparoscopy and/or exploratory laparotomy).

• Administer IVFs and antibiotics.

• NGT decompression.

• Post-Operative Care:

  • Important to assess for signs and symptoms of recurrence (occurs in up to 20% of patients).

• Caregiver support and education (high likelihood of recurrence).

Hirschsprung Disease

• Neural crest fails to migrate completely during intestinal development → aganglionic segment of the colon → lack of propulsion of intestinal contents (functional obstruction).

• The aganglionic segment may be short (rectosigmoid), long (extends proximal to the sigmoid colon), or total colonic aganglionosis.

• Outcomes are worse with long-segment disease.

• Associated with chromosomal anomalies (e.g., Trisomy 21).

• Hallmark sign = delay or failure to pass meconium within the first 48 hours of life.

• Signs & Symptoms:

  • Abdominal distension

  • Poor feeding

  • Constipation

  • Bilious emesis

  • "Squirt" or "blast" sign (explosive stool after rectal exam)

Hirschsprung-Associated Enterocolitis (HAEC):

• Bacterial overgrowth in the bowel due to stool stasis, leading to bacterial translocation through the mucosa.

• Can occur pre- or post-operatively (most common post-op complication).

• May lead to intestinal perforation, peritonitis, septic shock, and death.

• Signs & Symptoms of HAEC:

  • Fever

  • Vomiting

  • Lethargy

  • Explosive and foul-smelling diarrhea

Hirschsprung Disease: Nursing Care

• Surgical correction requires resection of the affected segment of the rectum and colon, bringing the normal ganglionic bowel down to an anastomosis with the distal rectum, close to the anus.

• It may be a laparoscopic pull-through or an open (laparotomy) pull-through; multiple surgeries may be required.

Pre-Operative Care:

• NPO and gastric decompression with NGT

• IVFs and IV antibiotics

• Rectal irrigations

• Monitor for signs and symptoms of HAEC

• Caregiver support and education

Post-Operative Care:

• Pain management

• NGT decompression until the return of bowel function (ROBF)

• Monitor for signs and symptoms of HAEC (notify provider, IV antibiotics, and irrigation will need to be started)

• Surgical site care and ostomy assessment/site care if present

• Caregiver support and education

Anorectal Malformation (Imperforate Anus)

Anal tract fails to develop:

• A normal opening is absent → the colon empties into the perineum or towards the vagina (female patients) or into the urinary system (male patients).

• Atresia may be present: the rectum is a blind ending with no connection or external opening.

50% to 60% of patients have an associated anomaly (VACTERL), so all newborns with this malformation need a complete VACTERL workup:

• Vertebral—tethered cord, scoliosis, myelomeningocele

• Anal—atresia

• Cardiac—ASD, PDA, tetralogy of Fallot

• GI—tracheoesophageal fistula

• Renal anomalies—vesicoureteral reflux

• Limb—abnormalities

Anorectal Malformation (Imperforate Anus): Nursing Care

If a fistula is present:

• Prepare and transport for diagnostic tests (ECG, chest X-ray, renal ultrasound, etc.).

• Perform rectal dilation as ordered.

• Provide caregiver support and education.

• The infant will need eventual surgical repair (at 3 months), instructions on performing dilations at home, and knowledge of the signs and symptoms of inadequate dilation.

• Provide typical newborn care.

Infants without a fistula require surgery following birth (also those with a urinary fistula or cloaca):

1. First surgery—colostomy to divert stool and gas.

2. Second surgery—posterior sagittal anorectoplasty.

3. Final surgery—colostomy reversal.

Pre-Op:

• Administer antibiotics.

• Maintain a limited clear or breastmilk diet 24 hours before surgery.

• Continue dilations.

Post-Op:

• Routine post-op care (pain management, advance diet as tolerated, monitor surgical site).

• Ostomy care (for the first and second surgeries).

• Apply bacitracin to the surgical site.

• Nothing per rectum (for the final surgery).

Gastroschisis & Omphalocele

Gastroschisis:

• Herniation of the abdominal wall contents through a ventral abdominal wall defect, to the right of the umbilicus, with umbilical cord insertion to the left of the defect.

• Not enclosed within a sac → exposure to amniotic fluid → thickening of herniated organs, and peel may be present.

• Increased risk in infants of young mothers (<20) and maternal obesity.

Omphalocele:

• Full-thickness, midline abdominal wall defect that allows evisceration of the abdominal contents into an external peritoneal sac.

• The umbilical cord inserts into the omphalocele membrane, not the abdominal wall.

• Pulmonary hypoplasia may be present.

• Associated with advanced maternal age and infants with chromosomal anomalies (trisomy 13, 18, and 21; Beckwith-Wiedemann Syndrome).

• Defects are usually larger than gastroschisis.

Gastroschisis & Omphalocele: Nursing Care

Gastroschisis:

• Cover the exposed viscera with a bowel bag to maintain temperature and prevent fluid losses.

• Observe the bowel for decreased perfusion (dusky, cool appearance).

• Position to the left if there is concern for vascular compromise.

• Insert an OGT and place it to suction.

• Position the infant on the right side to reduce tension on the mesentery.

• Resuscitate with IVF bolus, then administer MIVFs at a regular rate.

• Administer antibiotics and maintain strict I&Os.

• Prepare for silo replacement (staged closure) or operative intervention (primary repair).

• Post-Operative Care:

  • Pain management.

  • OGT until return of bowel function (ROBF).

  • Advance feedings once bowel function returns.

  • Strict I&Os.

  • Monitor for signs and symptoms of abdominal compartment syndrome.

Omphalocele:

• Cover the sac with sterile gauze or a bowel bag up to the infant’s chest.

• Observe the bowel for decreased perfusion (dusky, cool appearance).

• High risk for intestinal atresia.

• Insert an OGT and place it to suction.

• Administer IVFs and antibiotics; maintain strict I&Os.

• ‘Paint and wait’ technique is used if the defect is too large for a primary repair or if the infant is too unstable for surgery.

  • Application of bacitracin ointment to the sac allows eschar formation, then epithelialization over time → eventual ventral hernia that can be repaired later in life.

• Prepare for silo placement (staged closure) or operative intervention (primary repair).

• Post-Operative Care:

  • Pain management.

  • OGT suction until ROBF.

  • Advance feedings once bowel function returns.

  • Strict I&Os.

  • Monitor for signs and symptoms of abdominal compartment syndrome.