Legal Briefs: An Infant with an Omphalocele Ends Up with Organ Transplants

Abstract

A 2,226-g female infant with a prenatal diagnosis of an omphalocele was born at 33 3/7 weeks’ gestation to a 43-year-old gravida 4, para 1, aborta 3 woman. The pregnancy was unremarkable except for the known abdominal defect containing a portion of the liver and preterm labor. Before delivery, the woman had received nifedipine for tocolysis, antibiotics as a result of preterm labor, and 1 dose of antenatal steroids. However, labor progressed and the infant was born via cesarean delivery. The infant emerged active and had Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. A loose nuchal cord was noted at delivery. The umbilical cord gases were normal. The physical examination showed a normal-appearing infant with a soft abdomen without distention and an omphalocele. The surgery team determined that a silo was not necessary because the defect was “small,” with only a portion of the liver as the contents in the sac, and a “large abdominal domain.” The neonatology team covered the omphalocele with xeroform and placed a Replogle tube and peripheral intravenous line. Echocardiography and ultrasonography of the head were performed, and no cardiac or brain abnormalities were found. Fifteen hours after birth, the infant was brought to the operating room (OR) for omphalocele excision with reduction and primary closure. During the 3½ hours in the OR, the surgeons noted that the abdominal cavity was actually too small to fit the large anterior lobe of the liver that was within the sac. Because of this complication, the surgical team digitally stretched the abdomen to provide more space to accommodate the entire liver. During the procedure, a small amount of bleeding occurred on the inferior border of the liver segment, which was compressed with gauze. When the bleeding stopped, the anterior lobe of the liver was …