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Understanding Gastroschisis

What is a gastroschisis?


A gastroschisis is an opening in the abdominal wall with the intestines coming out usually to the right of the belly button (the umbilicus). This may cause the intestines to be irritated and not function well after delivery. In addition, the infant may have a small belly cavity because the intestines were not inside during development.

What causes a gastroschisis?


The exact cause of a gastroschisis is unknown. It is not usually caused by a genetic condition and is generally not associated with other birth defects. A gastroschisis occurs in approximately one in 5,000 live births. The diagnosis of a gastroschisis is usually made by ultrasound, often in the second trimester.

Treating gastroschisis after birth


The treatment for a gastroschisis involves returning the intestines to the abdominal cavity and closing the belly wall.

After birth, the lower portion of your baby’s body is placed in a clear bag to protect the intestines and keep them warm and moist. When your baby is stable, the doctors will perform an operation to either return the intestines to the belly or to place a temporary bag, called a silo, over the intestines. This decision on the type of repair depends on how swollen the intestines are after birth, as well as the size of the opening and the abdominal cavity.

When a silo is used, the intestines are slowly moved back into the abdomen every day. When the silo is no longer needed, your baby is taken back to the operating room for closure. Babies often need breathing help from a ventilator during silo reductions and for several days after surgery.

Why choose Children’s Mercy?


Babies with gastroschisis require immediate surgical attention to protect their intestines. In the Fetal Health Center at Children’s Mercy, our surgical and neonatal specialists are immediately available to attend to your baby while you stay close by.

After surgery, we have experienced GI and dietary specialists who work together to maximize your child’s ability to eat and get enough nutrition to ensure that they will grow appropriately— even after they are dismissed home from the hospital. In rare circumstances where the intestinal length may be too short, Children’s Mercy has the only intestinal rehabilitation team in the region.

Before and after surgery, your baby will have a naso/oro gastric (NG/OG) tube. This tube goes through the nose or mouth and into the stomach. It is used to remove air and stomach fluids until the intestines begin to function. At first, the fluid from the gastric tube will be dark green, but it will turn clear as bowel function returns. Your baby will receive nutrition through IV fluids until the body is ready to digest food.

It will take the intestines several weeks to recover after a gastroschisis repair. Signs of returning function include "spit" colored fluid in decreasing amounts from the NG/OG tube and the start of your baby pooping.

When feedings are started, your baby will receive a small amount of milk through a feeding tube while still receiving IV nutrition. Tube feedings will slowly be increased and later changed to feedings by mouth. Mothers planning to breastfeed are encouraged to pump breast milk that will be frozen and stored until your baby is able to eat. Starting and increasing feedings is a slow and gradual process. Some infants who have a gastroschisis repair will have occasional setbacks requiring bowel rest or additional surgery.

The length of stay in the NICU for an infant with a gastroschisis varies. Your baby will be able to go home when they can tolerate full feedings and are gaining weight. After discharge, a pediatrician will monitor your baby. Your baby will come back to Children’s Mercy for follow up appointments with the pediatric surgeon or any other necessary specialists.

Stories

Gastroschisis: Warren's Story

Just 18 weeks into her pregnancy, Mariah Schumacher learned her baby boy had a defect in his abdominal wall requiring surgery to repair. Thanks to the Elizbeth J. Ferrell Fetal Health Center at Children’s Mercy, Mariah was able to give birth in the same hospital where her infant’s surgery was performed.

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