Postnatal stabilisation and management of babies with exomphalos (SCANS guideline)

These guidelines have been developed by the Steering Group of the Surgical Conditions Affecting Neonates in Scotland (SCANS) Managed Clinical Network. These recommendations are applicable to all healthcare professionals caring for babies with exomphalos.

Throughout this document we use the term parent to mean all parents, carers and legal guardians and the term mother to mean all women and people who have given birth.

The guidelines are underpinned by the following key principles: 

1. Babies with exomphalos should be managed on a surgical neonatal intensive care unit (NICU) with joint care provided by neonatologists and paediatric surgeons (1). For the purposes of these guidelines, the surgical NICUs are located in Glasgow (Royal Hospital for Children), Edinburgh (Simpson’s Centre for Reproductive Health) and Aberdeen (Royal Aberdeen Maternity Hospital) – see Appendix 1 for contact details.
2. Network pathways and processes should be in place to ensure that

• • Where there is an antenatal diagnosis of exomphalos, the parents receive multi-disciplinary team (MDT) counselling involving fetal medicine, neonatology and paediatric surgery, ideally as a joint session.*
  • Where there is an antenatal diagnosis of exomphalos, birth is planned in a maternity hospital co-located with a surgical NICU.
  • Where the baby is born in a non-surgical centre, referral to the surgical NICU is performed in a timely manner, ideally within 2 hours of birth or sooner. Referral should be via the ScotSTAR emergency line 03333 990 222, which will initiate a conference call.
  • Repatriation from the surgical NICU to the local hospital is facilitated as soon as possible when clinically appropriate (2).

*Note MDT counselling may not be required if the parents opt to not continue the pregnancy.