Gastroschisis

ExitCare ImageSometimes a baby is born with the belly contents outside the body. This is called gastroschisis. This means there is a problem with the baby's abdominal (belly) development. Other defects may be present which may require surgery. This problem is usually located near the umbilical cord area. Many of these babies are born earlier than expected (prematurely). Less than half of these pregnancies go to term. This problem is usually fixed with surgery. Usually more than one surgery is needed. Fixing the problem may be done in several steps. Sometimes, these babies have other problems with their digestive system. There may be problems with infection and handling the abdominal contents along the way. This is not considered to be a hereditary. This means it is not passed on from parent to child. Let your caregiver know if others in your family have had this condition.

OTHER PROBLEMS BABIES WITH GASTROSCHISIS HAVE MAY INCLUDE:

  • Prematurity is common.

  • Babies are often smaller than would be expected. This is called intrauterine (this means in the uterus or womb) growth retardation. It is abbreviated IUGR. The growth retardation means the baby's growing is slowed.

  • There may be other bowel defects. Openings within the bowels may be small and narrow or can even be closed. This must be corrected with surgery (an operation).

  • There may be less than the normal number of intestines. This may not be a problem that has to be cared for.

  • The baby may have breathing problems because contents from the gut may be squeezed out, causing the baby to get some of the material in their lungs (aspiration pneumonia).

  • Because the bowel is outside the abdomen, it may become twisted, which cuts off the blood supply and can lead to the death of the bowel (from going too long without blood supply).

  • Because the intestines are outside the body, there are increased chances of infection, and there are also more problems with controlling the temperatures of the baby, with or without infection.

  • In boy babies the testicles(gonads) may not descend into their normal position in the scrotum (the sac).

TREATMENT

Surgical repair (operation)

The surgical repair of the abdominal wall involves placing the organs located outside the abdomen back into the abdomen through the defect which is present. The defect is repaired at the initial surgery if possible. If the contents of the abdomen will not fit back into the abdomen through the hole in the abdominal wall, a sterile pouch is created which can hold the abdominal contents until everything can gradually be pushed back inside. The surgery is usually done hours after birth to prevent infection, temperature problems and fluid loss from the uncovered bowel.

Possible options during surgery (surgeon's choices)

  • Sometimes the skin can be stretched over the contents of the abdomen. Following this, the walls (muscles and other layers) of the abdomen can be repaired at a later date.

  • A patch of special material can be sewn to the skin edges to cover the contents of the abdomen. This will then be removed at a later surgery.

  • A sack can be built out of special material. This sack is sewn to the skin with the normally contained contents of the abdomen inside the sack. Over a period of time the abdomen grows and more of its contents fit inside. Once large enough, the sack can be removed with a second surgery and the wall of the abdomen can be repaired.

PROGNOSIS

  • It generally takes a few weeks until the baby can take food by mouth. The type of food taken will be guided by your caregiver. If your baby had a large amount of intestine which has not survived, special dietary needs may be present. Most often these intestines heal and adapt. Sometimes this takes months to years.

  • In babies where the remaining length of the intestines is not sufficient, they might need to have part of their nutrition provided by an artificial catheter.

  • In the first weeks after surgery the baby is at an increased risk for an inflammation of the bowel called Necrotizing Enterocolitis. This is a dangerous condition which your caregiver will discuss with you if it becomes necessary.

  • Your caregiver will instruct you in how to care for your baby's patch or pouch at home if one was created.