Gastroschisis is a birth defect of the abdominal wall that occurs in 1 out of 5,000 births. A small hole in the abdominal wall, usually less than 2 inches long, extends through the skin, usually to the right of the umbilical cord, according to Children's Hospital of Philadelphia (CHOP). The small intestine and part of the large intestine extrude through the hole and float in the amniotic fluid before birth. This makes the defect easy to diagnose if an ultrasound is done after 14 weeks.
Step 1
Discuss gastroschisis with your pediatrician in order to establish s diagnosis as early as possible. The first step in treating is early diagnosis and monitoring before birth. Gastroschisis may be suspected if alpha fetoprotein levels (AFP) are elevated; this is a common screening test done on maternal blood to check for possible fetal abnormalities. Babies with gastroschisis are often small for dates, and 20 to 40 percent have problems with the bowel beyond gastroschisis, such as malrotation or blocked or twisted areas, according to the Children's Hospital of Wisconsin (CHW). Stillbirth occurs in 10 percent of cases.
Step 2
Deliver by cesarean section. Cesarean delivery reduces trauma to the exposed bowel. A cesarean section may be scheduled around 36 weeks, according to Cincinnati Children's Hospital Medical Center.
Step 3
Close surgically immediately if possible. If the amount of bowel extruding through the abdomen is small, immediate surgical repair is done; this is possible in around two thirds of all gastroschisis cases, according to Cincinnati Children's.
Step 4
Reduce and replace intestines. After the baby is born, he or she is moved to the neonatal intensive care unit. Gastroschisis repair is usually done in stages, because the bowel, which has been exposed to amniotic fluid, is usually edematous and much larger than it normally would be. The initial treatment after birth is aimed at reducing the size of the intestine so it can fit back inside the abdomen without causing respiratory distress or damage to nearby organs.
Silastic sheeting, called silo, is placed around the exposed bowel. As the intestine becomes less swollen and inflamed, more of it slips back into the abdominal cavity by gravity. Once the silo is on the level of the abdomen, and most of the intestine has fallen back into the abdominal cavity, surgical closure can be done. This generally takes 3 to 10 days to accomplish, according to Cincinnati Children's; most infants are mechanically ventilated during this time.
Step 5
Return bowel to intestine and surgically close. Bowel will be carefully examined to make sure no necrotic, or dead, bowel is being returned to the abdomen. Necrotic bowel needs to be removed; healthy ends of bowel can be sewn together, according to the University of Maryland Medical Center. This doesn't cause long term problems unless large amounts of bowel are removed.
Step 6
Feed intravenously immediately, and gradually work up to oral feedings. Because of trauma, intestines don't start to work immediately after surgical replacement. The baby is given nutrition intravenously, to allow the intestines to rest and recover. Nasogastric (NG) feedings are started when the baby is ready to tolerate them, and the amount is gradually increased, while the baby still receives IV nutrition. If NG feedings are well tolerated, oral feeding is begun, and increased as tolerated, according to CHOP.
Step 7
Observe for complications. Feeding difficulties, infection, breathing problems and the need for further surgery can all complicate recovery. Short gut syndrome may result if large sections of intestine are removed, resulting in the need for long term supplemental nutrition, according to CHW.
Tips and Warnings
- Don't be afraid of the way your baby looks right after delivery. The exposed intestines will shrink each day.
