A nurse is caring for a newborn with gastroschisis. Which nursing intervention should be the highest priority immediately after birth?

The highest priority is to protect the exposed bowel from drying, contamination, and heat loss by covering it with warm, moist sterile saline dressings and plastic wrap. Other options are incorrect as supine positioning may cause pressure, oral feeding is contraindicated, and antibiotics are secondary to physical protection.

Understanding Gastroschisis and Immediate Priorities

Gastroschisis is a congenital anomaly where the abdominal wall fails to close during fetal development, resulting in the bowel and other abdominal contents herniating outside the body. A hallmark sign, as noted in the literature, is the absence of a protective membrane covering the exposed viscera ^[1][3]. This means the bowel floats freely in amniotic fluid in utero and is completely exposed to the external environment after birth. The immediate postnatal period is critical because the exposed bowel is at extreme risk for two major complications: fluid and heat loss leading to hypothermia and dehydration, and infection due to the lack of a protective barrier ^[1].

The highest priority intervention is to cover the exposed bowel with warm, moist sterile saline dressings and plastic wrap. This action directly addresses the life-threatening risks of insensible water loss and evaporative heat loss from the exposed viscera. The saline dressing keeps the bowel moist, preventing tissue desiccation and necrosis, while the plastic wrap creates an occlusive barrier that traps heat and moisture. This is the first step in the clinical management algorithm before any surgical repair, such as the Spatulated Umbilical Cord Technique (SUCT) or primary fascial closure, is considered ^[2]. Placing the infant supine is incorrect because it can cause kinking of the mesenteric vessels at the defect site, compromising blood flow to the herniated bowel. Immediate oral feeding is contraindicated as the bowel is often not functional immediately, and surgery is required; the infant will be kept NPO and placed on intravenous fluids. While prophylactic antibiotics are administered to prevent infection, they are a secondary priority after the immediate physical protection of the bowel from environmental exposure and fluid loss. In resource-limited settings, task-sharing initiatives emphasize that the first responder's immediate action of protecting the bowel with a clean, occlusive dressing is the most crucial step in reducing mortality before transfer to a surgical center ^[4].