Gastroschisis is a birth defect where a baby’s intestines develop outside of their body through a hole next to the belly button. This article explores its management and factors influencing a baby’s prognosis.
What is Gastroschisis?
Gastroschisis occurs when an opening forms in the abdominal wall of a developing baby, typically to the right of the belly button, allowing the intestines to protrude outside the body. This defect develops early in pregnancy, usually between the fourth and eighth weeks, when the abdominal wall muscles do not fully connect. The exposed intestines float in the amniotic fluid, which can lead to irritation, swelling, and damage.
The exact cause of gastroschisis is often unknown, but research suggests it may result from a combination of genetic and environmental factors. It is not typically inherited or associated with other birth defects. Studies indicate a higher prevalence in babies born to younger mothers, particularly those under 20, and some lifestyle factors like tobacco or alcohol use during pregnancy are potential risks. Gastroschisis is relatively rare, affecting approximately 1 in 2,000 to 2,400 babies in the United States.
Navigating Treatment and Immediate Care
Gastroschisis is often detected during routine prenatal ultrasounds, typically around 18 to 20 weeks of pregnancy. This early diagnosis allows medical teams to plan for delivery at a specialized medical center. After birth, immediate care focuses on protecting the exposed organs, as they are vulnerable to heat loss, fluid loss, and infection. The baby’s temperature is managed, and intestines may be covered with a special material.
Surgical repair returns the intestines to the abdominal cavity and closes the opening. If the hole is small and the intestines are not overly swollen, a primary closure can be performed soon after birth, where the organs are placed back inside and the abdominal wall is closed in a single procedure. In cases where the intestines are very swollen or the abdominal cavity is too small to accommodate them immediately, a staged repair is often used. This involves placing the exposed organs into a protective bag or “silo” that is gradually tightened over several days, slowly easing the intestines back into the abdomen. Once all organs are inside, the silo is removed, and the abdominal wall is closed.
Understanding Survival Rates and Risks
While gastroschisis is a serious condition, survival rates are very high in developed countries, often exceeding 90%. However, certain complications can pose significant risks. Bowel damage is a concern, as the intestines exposed to amniotic fluid can become irritated, swollen, or even experience reduced blood flow. This can lead to intestinal atresia (a narrowing or absence of part of the intestine) or necrosis (tissue death), potentially necessitating removal of damaged sections.
Infection and sepsis are substantial risks due to exposed intestines. Babies with gastroschisis often require prolonged intravenous nutrition (TPN) because their intestines need time to heal and adjust to functioning internally. This extended reliance on TPN can lead to its own set of complications, including liver issues. Additionally, babies with gastroschisis are often born prematurely, which can add further challenges to their health and recovery. The severity of these complications directly influences a baby’s prognosis, with extensive bowel damage or severe infections increasing the likelihood of adverse outcomes.
Life After Gastroschisis
After surgical repair, babies with gastroschisis typically face a prolonged recovery period in the hospital, often lasting several weeks to months. During this time, they gradually transition from intravenous nutrition to oral feedings as their digestive system begins to function. Many infants may experience initial feeding difficulties, including malabsorption or reflux, as their intestines adapt.
Ongoing medical follow-up with specialists like pediatric surgeons and gastroenterologists is usually necessary to monitor digestive health and overall development. While some children may require continued support for digestive issues, most children who survive gastroschisis go on to lead normal, healthy lives without long-term complications.