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The 2 most common congenital abdominal wall defects are gastroschisis and omphalocele. Both are usually diagnosed prenatally with fetal ultrasonography, and affected patients are treated at a center with access to high-risk obstetric services, neonatology, and pediatric surgery. The main distinguishing features between the 2 are that gastroschisis has no sac and the defect is to the right of the umbilicus, whereas an omphalocele typically has a sac and the defect is at the umbilicus. In addition, patients with an omphalocele have a high prevalence of associated anomalies, whereas those with gastroschisis have a higher likelihood of abnormalities related to the gastrointestinal tract, with the most common being intestinal atresia. As such, the prognosis in patients with omphalocele is primarily affected by the severity and number of other anomalies and the prognosis for gastroschisis is correlated with the amount and function of the bowel. Because of these distinctions, these defects have different management strategies and outcomes. The goal of surgical treatment for both conditions consists of reduction of the abdominal viscera and closure of the abdominal wall defect; primary closure or a variety of staged approaches can be used without injury to the intra-abdominal contents through direct injury or increased intra-abdominal pressure, or abdominal compartment syndrome. Overall, the long-term outcome is generally good. The ability to stratify patients, particularly those with gastroschisis, based on risk factors for higher morbidity would potentially improve counseling and outcomes.

On initial examination, a male newborn has the finding shown in Fig 1. Figure 1. Initial presentation. ### Prenatal and Birth Histories ### Presentation (Day 1) The infant was placed nil per OS (NPO) and a large-bore nasogastric tube was placed to low-intermittent suction to decompress the stomach. Total parenteral nutrition was initiated for nutritional support. His glucose levels were monitored and found to be normal. The pediatric surgical team was consulted. Vital signs were as follows: ### Physical Examination (Day 1)

A late preterm newborn presents with exposed bowel and abnormal upper limbs. ### Prenatal and Birth Histories ### Presentation The female newborn cried immediately after birth. The exposed bowel was placed immediately in a plastic bowel bag and the infant was positioned on her right side. A nasogastric tube was placed and attached to continuous suction. The neonatology team provided positive pressure ventilation because of poor respiratory effort. Supplemental oxygen was titrated to maintain her pulse oximetry as per Neonatal Resuscitation Program guidelines. She was transferred to the NICU on continuous positive airway pressure (CPAP). ### Vital Signs ### Physical Examination (Newborn Day)