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Understanding Gastroschisis
• What is gastroschisis?
• How common is gastroschisis and what causes it?
• How is gastroschisis detected during pregnancy?
• How will my pregnancy be managed now that gastroschisis has been detected?
• How will the gastroschesis be treated after birth?
• What is the long-term outlook for babies with gastroschisis?
• What are the chances I could have another baby with gastroschisis?
• What can I expect from the specialists at Morgan Stanley
Children's Hospital?
WHAT IS GASTROSCHISIS?
Gastroschisis is a birth defect in the abdomen, and is often
referred to as a "ventral wall defect." Babies with gastroschisis
are born with portions of their small and large
intestines exposed outside the body through a small opening
generally found to the right of the belly button. The
protruding bowel has no protective covering, and so it is
exposed to amniotic fluid and can become swollen and
damaged. The image on the right depicts the intestines
freely floating as they would in the amniotic fluid and the
repair after surgery.
Gastroschisis generally occurs as an isolated birth defect,
so babies with this condition are not likely to have a chromosomal
abnormality or other birth defects. Around 10%
of babies with gastroschisis will also have a blockage in
their intestines.
HOW COMMON IS GASTROSCHISIS AND WHAT CAUSES IT?
Gastroschisis is seen in approximately 1 in 5000 births, and is more
common in mothers under 20 years old. Women who smoke during
pregnancy may also have a higher chance to have a baby with gastroschisis.
No specific cause is known for gastroschisis, but it results from the
incomplete formation of the abdominal wall in the first trimester of
pregnancy.
HOW IS GASTROSCHISIS DETECTED DURING PREGNANCY?
Gastroschisis is usually identified during pregnancy through prenatal
ultrasound in the second trimester. Careful ultrasound examination can
distinguish it from other types of ventral wall defects. Gastroschisis
can not be detected in the first few months of pregnancy because the
abdominal contents are within the umbilical cord as a normal part of
their development.
Gastroschisis may also be suspected due to results of a screening test,
known as the 'AFP test', performed in the second trimester. This test can
indicate if the baby is likely to have gastroschisis or other ventral wall
defects, as well as a birth defect of the spinal cord called spina bifida. If
the results are positive (meaning a higher chance for these birth defects
has been identified) a prenatal ultrasound is performed to closely examine
the baby's development.
HOW WILL MY PREGNANCY BE MANAGED NOW THAT GASTROSCHISIS HAS BEEN DETECTED?
Regardless of where the gastroschisis was first detected during your
pregnancy, you will still have another thorough ultrasound to examine
the anatomy and development of the baby through the Center's ultrasound
unit. Your prenatal care will be handled by an MFM specialist, an
Obstetrician with special training and expertise in high-risk pregnancy.
Once the diagnosis of gastroschisis is confirmed, you will have an
opportunity to meet with a variety of pediatric subspecialists who
routinely see patients with this diagnosis and who work together as a
team to best manage your pregnancy and prepare for the birth of your
baby. Your clinical care coordinator will make appointments for you to
meet the following subspecialists: -
A Pediatric Surgeon who will thoroughly discuss with you the
general surgical approach taken with gastroschisis, and what you might
expect for your baby after birth. The same pediatric surgeon you
meet during your pregnancy will likely be the one to operate on the
baby after birth.
- A Geneticist or a Genetic Counselor, who are experts in fetal
development and inheritance.
- A Neonatologist, a pediatrician specializing in newborns that need
extra attention in the Neonatal Intensive Care Unit (NICU). You will
have an opportunity to tour the Labor floor and the NICU with a
Neonatologist, learn what to expect in the days after you give birth,
and become familiar with the facilities and the philosophy of care.
Pregnancies with gastroschisis are very closely monitored during the
third trimester due to the increased chance that the baby could have
problems with growth, amniotic fluid volume (either too much or too
little), or distress. In general, special ultrasounds and prenatal testing
known as biophysical profiles (BPP) and non-stress tests (NST) are
performed on a weekly basis to monitor the baby's well-being. As your
delivery date approaches, your MFM and medical team will discuss with
you the route of delivery for your baby; having a baby with gastroschisis
does not mean that you have to have a cesarean section. Whether you
undergo an induction of labor or a planned cesarean section, you will
ideally have your baby when the whole medical team is ready and available.
Ultimately, you and your medical team will decide what is best.
HOW WILL THE GASTROSCHESIS BE TREATED AFTER BIRTH?
Once you give birth, your baby will be examined carefully to check the
gastroschisis and look for any other problems. A small tube is placed
in the baby's mouth to the stomach to prevent the intestines from filling
with air and fluid, and all nutrition is given to the baby intravenously
(through an IV). Your pediatric surgeon will cover the exposed intestines
in a sterile sheet known as a "silo," and the baby will go to the NICU.
The exposed intestines will be gradually and carefully put back into
the abdomen, making sure that the abdomen can expand enough to
accommodate the intestines. When the silo is sufficiently reduced
(usually over 5 to 10 days), the baby will have an operation where the
abdomen is closed.
Once the intestines are in the abdomen, they take a little while to work
well on their own. The baby will continue to receive all nutrition through
the IV until the intestines start to function. When this happens, the
baby will continue with the IV feeding, but can also take breast milk or
formula through a naso-gastric drip (called an NG tube). Over time,
feedings through the NG tube are increased, and when the baby is
ready, feeding by mouth is started. When the baby has gained enough
weight and is feeding well through the NG tube and by mouth, he or
she is probably ready to go home. This whole process can take a few
weeks, but before leaving the hospital you and your family will know
how to care for your baby once you have left the hospital. You will
continue to see your pediatric surgeon and other specialists as needed
for regular check-ups to monitor the progress your baby has made
since going home.
WHAT IS THE LONG-TERM OUTLOOK FOR BABIES WITH GASTROSCHISIS?
Overall, children with gastroschisis are able to live very full, active,
and productive lives. The length of stay in the hospital for babies after
birth is directly related to the damage to the exposed intestines. In the
minority of cases that have abdominal blockage, the affected portions
of the intestines need to be removed, and can possibly result in a short
gut. These children will need special feedings for much longer, sometimes
indefinitely. Children with gastroschisis also have a higher chance
of developing inguinal hernias (protrusions in the abdominal wall) later
in life that need to be surgically repaired. However, for most children
with gastroschisis there are no long-term health problems.
WHAT ARE THE CHANCES I COULD HAVE ANOTHER BABY WITH GASTROSCHISIS?
Gastroschisis does not appear to run in families, and the chances
to have another affected baby are less than 5%. Future pregnancies
should be monitored by prenatal ultrasound and AFP screening at 16
weeks gestation.
WHAT CAN I EXPECT FROM THE SPECIALISTS AT MORGAN STANLEY
CHILDREN'S HOSPITAL?
The well-being of you and your baby are extremely important to
everyone involved in your care. NewYork-Presbyterian Morgan Stanley
Children's Hospital/Columbia University Medical Center has consistently
been ranked one of the best pediatric hospitals in the country: our
pediatric surgeons have extensive experience with gastroschisis, and
our MFM team is among the largest and most experienced anywhere.
Our NICU is one of the most advanced in the United States, and has been
cited several times for its excellence and dedication to patient care.
The well-being of you and your baby are extremely important to
everyone involved in your care. Together we are all dedicated to giving
you the best pregnancy and healthiest outlook for your child.
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