Introduction: Antenatally ruptured giant omphaloceles (RGO) represent a rare and highly complex pathology. The literature is sparse on the optimal management of these neonates. We present our experience of a neonate with a RGO and review the literature regarding the topic. Case: A male neonate was born at 34 weeks, weighing 2.3kg, with a RGO. Extracoelomic contents included the entire small and large bowel, stomach and the liver. A biologic mesh (Myriad Ultra) was placed on day 17 as a fascial bridge, and a negative pressure dressing (NPD) was applied using Mepitel, Acticoat and Kerlix as an interface. The NPD was changed every 72 hours in the NICU, with gradual granulation of the mesh. Our patient died at 10 weeks of age due to respiratory failure secondary to severe pulmonary hypertension. Systematic Review: A systematic review was performed according to PRISMA guidelines. Six articles describing the management of RGO in 9 neonates were reviewed. Five neonates were managed with synthetic mesh bridges, with a wide variety of reconstructive techniques subsequently utilised. These included serial mesh plication and excision, delayed skin grafting, component separation surgery, and escharization of the residual native sac. Four neonates were managed with the placement of a bioprosthetic mesh and negative pressure wound therapy. Outcomes were highly variable, and morbidity was high in patients managed with synthetic meshes. Conclusion: The management of neonates with RGO is incredibly complex. We suggest that the optimal strategy for these patients is the early placement of a bioprosthetic mesh in combination with negative pressure wound therapy.