Gastroschisis is when a baby’s anterior abdominal wall is not completely sealed. As a result, the baby is born with their intestines and/or other organs such as the liver protruding through a hole (usually 2cm-4cm diameter) nearing the perimeter of the belly button, usually occurring on the right side.
Surgery is immediately required after birth. Depending on the severity of the condition, all contents can be placed back in their normal positions in a single surgery, or in dire circumstances, multiple stages performed over time must be done in order to complete this task. It is important to understand that it is possible that complications due to Gastroschisis can lead to infant fatalities.
This article focuses on explaining all aspects of Gastroschisis, the condition itself and it’s statistics, cause, impacts, treatments, and serious effects that it can have on your newborn baby.
10 How Common Is Gastroschisis?
According to the CDC, about 1,871 babies are born in the United States with Gastroschisis. According to the National Gastroschisis Foundation Avery's Angels, the survival rate for children that are born with Gastroschisis averages in between 83-97%.
9 Am I At Risk?
Surprisingly, current research from the CDC states that younger women (especially teenagers) are susceptible to having a baby with Gastroschisis than older women.
Further research using cohort studies completed in California have recently determined that women who consumed OTC medication such as aspirin or ibuprofen throughout pregnancy were more susceptible to having babies with Gastroschisis.
In addition, those who consumed alcohol or smoked, or used illicit illegal drugs (including methamphetamine and cocaine) were more likely to have babies suffering from this condition.
It was also found that the condition included higher percentages of women with a low socioeconomic status and that Caucasian women were more likely than African American women to be susceptible to this birth defect.
8 When Can Gastroschisis Be Detected?
Gastroschisis can be detected in the early stages of pregnancy, through a blood test called an Alpha Fetoprotein Test, or as early as 14 weeks through an ultrasound. It is physically recognizable immediately after birth.
7 How Will My Pregnancy Be Affected?
You will be monitored very closely by your OB in addition with a Maternal Fetal Medicine Specialist that specializes in high-risk pregnancies.
You will experience more ultrasounds and other types of testing that reassure your health professional that your baby is not in distress. Your doctor will monitor your baby’s heart rate, growth progress, as he is susceptible to Intrauterine Growth Restriction (IUGR) and bowel dilation. Your amniotic fluid volume is tremendously important as your baby’s intestines are living in its contents. Your doctor will also have you keep track of your baby’s movements by using kick counts.
Expect to have multiple ultrasounds, a Non-Stress Test (NST) and Biophysical Profile (BPP) routinely administered throughout your pregnancy. Amniocentesis (checking for chromosomal abnormalities), Maternal Serum Screening, and MRI will also be done. Click here to acquire information about them.
If your Doctor suspects that the hole is closing in the abdominal wall of your baby, this can result in perilous, everlasting damage and you may be induced for an early delivery.
6 Cesarean Section Or Vaginal Birth?
Many babies that are born with Gastroschisis arrive early averaging 36-37 weeks. Recent research has determined that a Cesarean section is not absolutely necessary to reduce morbidity. A vaginal birth is easily possible as the outcomes from both methods are similar.
5 How Gastroschisis Is Treated
There are two surgeries that are typically used to treat Gastroschisis, and it depends on the amount of your baby’s intestines that must be surgically placed back in their abdomen, and how large the diameter of the gap is.
A pediatric surgeon will perform either surgery immediately after birth, and your baby will be given antibiotics to treat or prevent infection. A nasogastric intubation or an (NG) tube will be inserted through the nose and into his stomach to keep it empty. An IV line will also be given to administer medicine and nutrients.
He will be transported to be assessed and to do this, his lower body will be placed in a sterile bag feet first until the level of his armpits. This is also important for your baby to retain his heat and a normal body temperature, and not to suffer from hypothermia.
The first surgery is called a primary closure and is the preferred method of treatment. The baby’s abdominal area must be large enough to contain all of the organs that need to be placed back inside. A primary closure allows the intestines to be put back into the abdomen within a single surgery ending with the abdominal wall stitched and sealed closed.
The second and more common type of surgery is a Staged Silo Closure. In many cases, most babies are born with their abdominal areas too small to contain all intestinal organs. As a result, multiple stages of surgeries are needed to complete this process. In a Staged Silo Closure, a sterile silicone bag holds the intestines vertically and above the baby. Over the course of days or up until a week, it naturally gravitates or is squeezed to allow the intestines to be placed back inside the abdomen and sewed closed.
4 How Long Will My Baby Be In The Hospital?
Unfortunately, expect a prolonged stay. Babies born with Gastroschisis stayed in the NICU for an average of 41 days according to the Avery's Angels website. The factors that determine the length of stay are
- The overall health of the digestive tract and it’s ability to function properly
- Your baby’s ability to consume all food by mouth, and
- Your baby’s developmental weight gain.
The reason why primary closure surgery is the preferred treatment is that your baby’s stay is expected to not be as extended. It skips the prolonged steps that Staged Silo Closure requires, therefore being recognized as more “time efficient”.
3 What Are The Possible Serious Complications?
The problem that occurs with Gastroschisis is that the intestines are constantly immersed in amniotic fluid. By the few last remaining weeks of pregnancy, amniotic fluid consists of primarily urine, resulting the intestines to be covered with a thick film.
What is concerning for the baby are that this occurrence weakens the ability of the intestine to remain in its correct location in the abdomen, and it’s failure as an organ to function properly.
Gastroschisis is a dangerous birth defect that should be taken seriously. Although the survival rate is typically high for babies born with Gastroschisis, (83-97%) there are complications that could potentially result in infant fatality. This is why it is so important to seek prenatal care, so your doctor and specialist will create and implement the best treatment that will benefit your baby’s life.
Here are some severe complications that can develop post delivery/surgery.
Atresia: When a section of your baby’s intestine is incomplete. Instead of being open to allow food and bowels to pass freely, it is closed off in one or more sections of the small or large intestine.
Intestinal stenosis: Similar to Atresia, the section is partially obstructed but is too narrow for nutrition, bowels, and movement to flow through freely.
Short Bowel Syndrome: After surgery, there is not enough intestines left that are capable of absorbing an adequate amount of nutrition to supplement growth
Sepsis: When the body’s major organs and tissues are damaged due to the body’s reaction to an infection.
Hypothermia: After birth, it is easy for the baby to lose heat due to the intestines being exposed. Maintaining a normal body temperature is essential.
Hypoglycemia: A condition when sugars in the blood are too low, causing seizures and comas
Necrotizing Enterocolitis (NEC): An extremely dangerous disease suffered by many premature babies. The tissues of the intestines become damaged or die, causing the walls to become inflamed or through a hole that has been generated, (perforation). Wastes then permeate from the intestines into the bloodstream, causing a vicious life-threatening infection.
Complications due to Total Parenteral Nutrition use: TPN is when your baby receives nutrition through IV use. A newborn has a weakened immune system and at risk for:
- Staph Infection: Bacterial infection of the skin
- Fungal Infections: It is possible for a baby to contract this through surgeries, open cuts even in the NICU. It is extremely dangerous if the infection enters the bloodstream
Stillborn: Babies that are born with the birth defect Gastroschisis are at 10% more risk of being stillborn.
2 Your Baby’s Long-term Future Development
One of the most common effects that Gastroschisis could have on your baby in the long run she will experience a slow growth rate, and more than likely will be smaller compared to her peers.
Your child may suffer from GER Gastroesophageal Reflux and/or GERD Gastroesophageal Reflux Disease that may cause symptoms associated with heartburn, gas and vomiting.
Because your child will have multiple tubes inserted in their mouths after they are born, some children suffer from feeding and speech delays and difficulties. Others are delayed in their motor and mobility skills. Check the laws and the state you live in because some states are required to provide free Speech and/or Occupational therapy for those who are eligible.
It is common for a child to find that they may acquire abdominal hernias, where after surgery, the skin bulges out of place through a weakened muscle in the abdomen. Children and teenagers can be deeply affected by these scars and suffer teasing or even bullying from their peers. It is advised to receive counseling to improve their self-esteem, as they grow older and more conscious of their bodies.
Lastly, Gastroschisis patients are subject to Intestinal Malrotation. Two complications can occur,
- Obstruction: A condition in which the intestines twist and cause obstruction or blockages of food and bowel. This is painful and may require additional surgery to unblock the passages.
- Volvulus: Where the intestines entangle itself, cutting off blood supply and circulation
1 Get Support
Always reach out and do not be afraid to seek support. You and your family do not have to face this experience alone. Remember that no matter how bad things are, that there is hope. Ask your Doctor or health practitioner for some local references to resources that are available throughout your community. Here are some non-profit organizations and National support groups that will provide you with information and guidance for your journey.