Introduction
Gastroschisis is a congenital disability affecting roughly 1 in 5,000 live births. In this condition, a baby’s intestines, and sometimes other organs, are located outside the body due to a hole in the abdominal wall. While a diagnosis may be concerning, understanding the condition, its causes, and treatment is crucial. This guide offers information on diagnosis, treatment, and long-term prognosis. With increased awareness and medical advances, most infants with gastroschisis achieve everyday, healthy lives.
Prevalence and risk factors of gastroschisis
| Risk Factor | Details | Statistical Information (Based on CDC 1995-2012 Data) |
|---|---|---|
| Maternal Age | Women under 20 years old have a higher likelihood of having a baby with gastroschisis. | Highest increase in prevalence observed in non-Hispanic black mothers aged <20 years, with a 263% increase. |
| Lifestyle Factors | Smoking, alcohol, and illicit drug use during pregnancy may be linked to an increased risk. | The connection between lifestyle and gastroschisis is suggested by research but needs further investigation. |
| Genetics | The condition doesn’t typically run in families, and the recurrence risk is not higher in future pregnancies. | Gastroschisis is usually not associated with other chromosomal abnormalities. |
| Environmental Factors | Environmental and toxic substances have been suggested as potential contributors, although the definitive cause remains unknown. | The prevalence of gastroschisis has been increasing for decades, with researchers still exploring the exact cause. |
What exactly is gastroschisis and how does it happen?
Gastroschisis is a congenital disability resulting from the incomplete closure of the abdominal wall during early pregnancy, typically to the right of the umbilical cord. This opening allows intestines and other organs to protrude. The exposed organs in amniotic fluid can become irritated, swollen, and inflamed. This exposure and potential narrowing of the opening can affect blood flow and intestinal development, possibly leading to complications like intestinal blockage.
How is gastroschisis diagnosed during pregnancy?
Gastroschisis is often detected prenatally, allowing medical teams to prepare.
- Routine prenatal screening: High levels of alpha-fetoprotein (AFP) in maternal blood tests may be an initial indicator.
- Targeted ultrasound: A specialized ultrasound can confirm the diagnosis, showing intestines floating in amniotic fluid.
- Distinguishing from other defects: Ultrasound helps differentiate gastroschisis from other defects like omphalocele, where organs are contained in a sac.
- Ongoing monitoring: Specialists monitor the baby’s growth and intestinal health throughout pregnancy, watching for complications like intrauterine growth restriction (IUGR).
Treating gastroschisis: From birth to recovery
Treatment begins immediately after birth in a high-level neonatal intensive care unit (NICU) to prevent infection and organ damage.
Immediate postnatal management
Exposed organs are protected using a sterile bag or plastic wrap to maintain warmth and moisture and prevent fluid loss. IV fluids and nutrition are provided, and antibiotics are given in order to avoid infection.
Surgical repair options
Surgery depends on the defect size and the baby’s condition.
- Primary repair: For minor defects with minimal exposed intestine, organs may be placed back and the opening closed in a single operation soon after birth.
- Staged repair (silo placement): If the intestines are too swollen or the abdomen is small, a silo pouch is placed over the intestines and attached to the abdominal wall. Organs gradually return to the abdomen over several days, after which the abdominal wall is closed surgically.
Post-surgical care and recovery
Recovery continues in the NICU. Intestinal function takes time to normalize, so initial nutrition is typically provided intravenously. As function improves, feeding progresses to oral or tube feedings, with breast milk being beneficial. Hospital stays range from weeks to months based on progress and complications.
Actionable steps for expecting parents
For parents with a gastroschisis diagnosis:
- Educate yourself: Learn about gastroschisis from reliable sources.
- Assemble your care team: Seek a medical center with an experienced NICU and pediatric surgeons. The team may include maternal-fetal medicine specialists, neonatologists, and pediatric surgeons.
- Plan for delivery: Vaginal delivery is often possible, but delivering at a hospital with immediate access to a NICU and specialized care is recommended.
- Seek emotional support: Find support through groups or counseling.
- Connect with other families: Organizations like Avery’s Angels Gastroschisis Foundation offer support.
Long-term prognosis and challenges
The long-term outlook is generally positive with high survival rates. However, some children may have challenges.
- Growth and feeding: Issues like low growth, reflux, or poor nutrient absorption can occur but usually improve. Short bowel syndrome is rare in severe cases.
- Possible complications: Intestinal blockages or hernias may require future surgery.
- Psychological support: The surgical scar may affect self-consciousness, especially in adolescence, so emotional support is essential.
Summary: Moving forward with hope
Gastroschisis is a serious but manageable condition with modern medical care. While challenging, the path through diagnosis, surgery, and recovery typically leads to a healthy life for most children. A strong medical team, proactive planning, and family support are vital for success.
This guide provides an overview of gastroschisis and the recovery process. Further learning, asking questions of your medical team, and reaching out to support networks are encouraged.
FAQs
What is the survival rate for gastroschisis?
Survival rates are approximately 95% in industrialized nations with proper medical care.
What is the difference between gastroschisis and omphalocele?
In gastroschisis, organs are exposed without a covering membrane, while in omphalocele, organs are contained within a membrane.
Can gastroschisis be treated during pregnancy?
No, but prenatal diagnosis and monitoring allow for surgical preparation immediately after birth.
How long does a baby with gastroschisis stay in the hospital?
Hospital stays vary from several weeks to months, depending on severity and recovery.
Will a baby with gastroschisis have other congenital disabilities?
Gastroschisis is not typically associated with chromosomal abnormalities or other major structural defects, though intestinal blockages can occur.
