The use of Actilite on neonatal exomphalos

Bernadette Reda - Neonatal Surgical Liaison Nurse, Birmingham Children's Hospital

Method

A baby girl with an antenatal diagnosis of exomphalos was born at 28+1 weeks gestation, with a birth weight of 910g. At 16 weeks gestation there had been premature rupture of membranes.

It was a small abdominal defect of less than 5cms and the choice of treatment would have been primary surgical repair, however, this pre-term infant, with significant respiratory compromise related to pulmonary hypoplasia and respiratory distress syndrome, required significant ventilatory support, including nitric oxide. The surgical centre was 17mls away and the journey was considered to be too hazardous to undertake. The decision was made to start conservative management of the exomphalos in the local unit. Actilite® honey impregnated dressings were started on day 3. The dressings were applied directly onto the sac, covered by simple sterile gauze and a crepe bandage to complete the dressing, in order to achieve 
the desired protection.

Initially, the dressing was changed on alternate days for 4 days, in order to closely monitor progress. The patient’s ventilation was improving slowly and the exomphalos was covered with a darkening eschar. We subsequently reduced the dressing changes to twice weekly for six and a half weeks, when the dressings were discontinued, as full epithelialisation was achieved (day 51 of life).

On day 37 of life it was noted that there were several pustules on the abdomen above the exomphalos. A swab was taken and a short course of intravenous flucloxacillin and gentamicin commenced. The swab results were negative and the rash resolve within days. The patient had remained well throughout.

Conclusion

Enteral feeds of expressed breast milk were started on day 4 of life and full enteral requirement achieved by day 17 of life. The progress of enteral feeds was interrupted by intermittent abdominal distension, which was investigated with a plain abdominal x-ray and an upper gastrointestinal contrast study. The findings were consistent with gaseous distension and enteral feeding was continued. Initially adequate weight gain was not achieved and this was treated with the addition of breast milk fortifier to the expressed breast milk and oral sodium chloride supplements.

The patient had a good clinical outcome and was discharged home on day 66 of life (37+3 weeks corrected gestational age).