Understanding Gastroschisis
Gastroschisis Overview
Gastroschisis is a birth defect in which the abdominal wall does not close completely, allowing intestine (bowel) and other abdominal contents to slip through a small defect (opening) near the belly button, and stay outside the belly, while the baby grows.
Gastroschisis occurs 1-2 times per 10,000 births. It is not known what causes gastroschisis, but it is more common in younger mothers. Unlike other abdominal wall defects, such as omphalocele, gastroschisis is rarely associated with chromosomal abnormalities or other structural abnormalities, except for intestinal atresia (blockage).
Diagnosis
Gastroschisis is diagnosed by routine ultrasound during the second trimester of pregnancy.
Pregnancy and Delivery
After your initial ultrasound, you will be referred by your obstetrician or perinatologist to the pediatric surgeon, neonatologist, and nurse coordinator for consultation. The team will then develop a care plan for your baby at delivery and thereafter.
You will continue to have ultrasounds throughout your pregnancy to follow your baby’s growth and amniotic fluid volume.
There is no harm to your baby with a vaginal delivery. A C-section is indicated only when there are unusual obstetrical indications.
The doctors at the hospital you chose for the birth of your child will contact the Children’s Hospital Oakland Neonatal Intensive Care Unit (NICU) regarding the expected delivery time and notify our transport team in order to prepare for the transfer of your baby. Prior to transfer to Children’s Hospital Oakland, the delivery room team will assess your baby’s breathing, place an IV and a gastric tube (a tube that runs from the nose or mouth into the stomach) to decompress the intestine. They will place a protective covering over the exposed abdominal contents during transport. The Children’s Hospital Oakland team will then transfer your baby directly to the NICU, where both neonatologists and pediatric surgeons will assess your baby.
Treatment
The treatment for gastroschisis is surgery to place the bowel back in the abdomen and close the abdominal wall defect. There are different ways to surgically repair gastroschisis, based on how much of the abdominal contents are outside of the abdomen, and if there are any complications with the intestine.
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Primary Repair: If the surgeon feels that the intestines can be placed back into the abdomen without too much pressure on the bowel they will close the abdomen.
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Staged Repair: If the surgeon determines that placing the intestine into the abdomen will create too much pressure and compromise the bowel and breathing, the intestines will be treated with a plastic pouch, often called a “silo” bag. The bag not only protects the intestine but also allows gravity to gradually help the intestine into the abdomen. The surgeons will add gentle pressure every day to further aid in this process. Surgical closure of the abdomen will then be scheduled when ready, within a week.
Surgery and Follow-up Care
The baby will continue to be cared for by the pediatric surgery and neonatology teams in the NICU after surgery. The baby will most likely feed via special intravenous (IV) nutrition until the bowel starts to work properly after surgery, which can take up to four weeks. The intravenous nutrition will supply your baby with all nutritional requirements until he/she is able to tolerate food by mouth or via a gastric tube. We wait to give the baby breast milk or formula until the bowels begin to work. Signs that the bowels are working include bowel sounds, spontaneous passage of stool, and a decrease in the amount of drainage coming from the tube in the baby’s stomach.
Pumping and freezing breast milk is encouraged, as breast milk is especially beneficial for babies with special medical needs. The NICU staff will help you with pumping breast milk and its storage.
The length of hospital stay is different for every baby. After discharge from the hospital your baby will be monitored closely by his or her pediatrician to ensure appropriate growth and development. Your baby will also be seen every few months by the pediatric surgeon.
All babies are different, but babies with gastroschisis and no other birth defects typically have normal growth and development.