Gastroschisis

Treatment for gastroschisis involves surgery shortly after birth to move the intestines inside the baby’s body and close the opening in the abdominal wall. Gastroschisis is not generally associated with other abnormalities or genetic disorders.

How does gastroschisis affect my baby?

Babies with gastroschisis face risks that include:

• Irritated, swollen intestines caused by exposure to the amniotic fluid
• Blocked or reduced blood flow to the protruding organs or twisting of the intestines, in cases where the opening tightens up during fetal growth, causing major damage to these organs
• Blockage or narrowing in the bowel, known as intestinal atresia
• Lower than normal birth weight
• Problems with feeding, digestion, dehydration and absorption of nutrients after birth
• Preterm delivery and stillbirth

The outlook for each baby depends on the size of the opening, the abdominal organs protruding outside of the fetus, and the extent of damage to the baby’s intestines and other organs before birth.

Cause and Prevalence

Gastroschisis is believed to be caused by disruption of the blood supply to the abdominal wall during fetal development, preventing it from closing all the way.

The defect is estimated to occur in 1 in 5,000 live births. According to the Centers for Disease Control and Prevention (CDC), recent studies show the birth defect is becoming more common. The condition occurs more often among mothers in their late teens or early twenties.

Gastroschisis or Omphalocele?

Gastroschisis is one of two main types of abdominal wall defects. A similar but more serious condition is omphalocele, in which the abdominal organs protrude through the baby’s navel and are covered by a sac or membrane. Children with omphalocele often have other birth defects.

Accurate diagnosis is critical to proper prenatal care and treatment planning for your baby’s condition.

Testing and Diagnosis

Gastroschisis is usually detected during a routine prenatal blood test and ultrasound. High levels of a protein in the mother’s blood known as alpha-fetoprotein (AFP) can indicate certain fetal defects, including abdominal wall defects. An ultrasound scan can confirm the diagnosis with imaging of the organs outside the fetal body.

If gastroschisis is diagnosed during your pregnancy, you may be referred to a fetal center with specialized expertise in the care of complex and rare fetal conditions, including abdominal wall defects.

At Texas Children’s Fetal Center, we arrange for you to visit as quickly as possible to meet with a team of specialists experienced in diagnosing and treating gastroschisis, including maternal-fetal medicine (MFM) physicians, neonatologists, pediatric surgeons and fetal imaging experts. Our specialists will perform a comprehensive evaluation and additional testing to gain critical about your baby’s condition for proper treatment planning.

Testing may include:

• Anatomy ultrasound to confirm the diagnosis, distinguishing it from omphalocele, and gain more information about your baby’s defect
• Fetal MRI for a more detailed view to assess the severity of the condition
• Fetal echocardiogram to evaluate your baby’s heart and look for any heart defects

Following this thorough assessment, our specialists will meet with you about your results, answer any questions your family has, and provide treatment recommendations based on your baby’s gastroschisis. 

Treatment During Pregnancy and Delivery

You and your baby will be closely monitored throughout your pregnancy, with regular ultrasounds to assess fetal growth and any changes in your baby’s condition, including damage to the intestines caused by the amniotic fluid or impaired blood flow.

Because your baby’s intestines will be exposed at birth, delivery and postnatal care should be carefully planned and coordinated with a team of maternal-fetal medicine specialists, neonatologists, and pediatric surgeons experienced in the treatment of gastroschisis.

Delivery should take place at a center equipped to address both the mother’s needs in pregnancies complicated by birth defects and the immediate surgical and intensive care needs of babies with gastroschisis, avoiding the need to transport your newborn, delay treatment and risk injury to the exposed bowel.

Babies with gastroschisis can typically be delivered vaginally. Because of the increased risk of stillbirth, in some cases delivery may be scheduled between 35 and 37 weeks of gestation, with labor induced.

At delivery, the exposed abdominal organs will be placed in a special “bag” to keep them warm, moist, and protected. Your baby will be moved to a neonatal intensive care unit (NICU) for surgery. Our gastroschisis patients are expertly cared for in Texas Children’s level IV NICU, the largest and highest-ranked NICU in the South, providing the highest-level of care available for premature and critically ill babies. 

Surgical Repair After Birth

Surgery is performed shortly after birth to move the intestines and any other protruding organs into the baby’s body and close the opening in the abdominal wall. When completed in one surgery, this is known as a “primary repair.”

In some cases, a more gradual approach may be needed to move the organs into the baby’s body. Known as a “staged repair,” this approach may be necessary when:

• The baby’s condition is unstable
• There is a large volume of intestines or multiple organs outside the body
• The intestines are extremely swollen from prolonged exposure to the amniotic fluid
• The baby’s abdominal cavity isn’t large enough immediately after birth to hold the organs

In a staged repair, a long, plastic pouch called a “silo” is placed around the exposed intestines immediately after birth and attached to the baby’s abdomen. The other end of the pouch is hung above the abdomen and the organs are gradually pushed down through the defect and into the baby’s body. The process typically takes 5 to 10 days. When all of the organs are inside the baby and any intestinal swelling has reduced, the silo is removed and surgery is performed to close the opening in the abdomen.