St. Vincent Kids’ Health blog features a series on high-risk pregnancies. If you are pregnant and a fetal condition has been detected that requires advanced maternal-fetal care, talk to our perinatal nurse navigator 317-415-7448.
Gastroschisis is a birth defect that is on the rise, especially among babies born to young black mothers. This congenital birth defect happens in the baby’s abdomen and causes the intestines to hang outside of the body near the belly button while the baby is in the womb. Last year The Centers for Disease Control and Prevention sounded the alarm about the growing prevalence of gastroschisis and the importance of managing high-risk pregnancies. https://www.cdc.gov/mmwr/volumes/65/wr/mm6502a2.htm
In nearly 20 years, the prevalence of gastroschisis has more than doubled in the U.S. Overall, this fetal condition can happen if the mom is young or older; babies born to teenage black mothers are at much greater risk.
“Public health research is urgently needed to figure out the cause and why certain women are at higher risk of having a baby born with gastroschisis," said Coleen Boyle, director of the CDC’s National Center on Birth Defects and Developmental Disabilities.
St. Vincent Neonatologists are part of a High-Risk Pregnancy Perinatal Team at the delivery and carefully handle the abdominal organs while stabilizing the newborn in the NICU. In the womb these organs were surrounded by amniotic fluid, which may have caused the affected parts to become thick, swollen and inflamed. Gastroschisis is also related to other gut problems including intestinal blockage, malrotation, twisting or infarction if the blood supply is cut off to part of the bowel. The severity of the condition and the recovery time will vary based on the size of the defect and any associated GI problems.
caption: Gastroschisis, a rare fetal condition that can develop early in the pregnancy. (Source: CDC.gov) To learn more about this fetal condition see https://www.stvincent.org/services/perinatal-care/fetal-conditions?tab=49ca5344f06243128b0b9bf7e37c3b93
At the 20-week prenatal appointment a complete anatomy ultrasound is obtained. The baby’s anatomy is developed enough to detect possible abdominal wall defects. If there is an abnormal ultrasound or elevated alpha fetoprotein (AFP) blood test, a maternal fetal medicine (MFM) specialist at the St. Vincent Perinatal Center will be consulted to diagnose and manage the high-risk pregnancy. A pediatric surgeon and neonatologist at St. Vincent Women’s will meet with the family to show them the NICU and discuss the newborn treatment plan.
These pregnancies are monitored very closely:
Labor is usually induced between the 35th and 37th week of pregnancy. A vaginal delivery is preferred. Gastroschisis does not require a cesarean delivery except for routine obstetrical indications.
A baby with gastroschisis will need to have the intestines and organs put back into the abdominal cavity and to repair the hole. If there is a small amount of bowel that can easily be reduced, the infant may have a primary closure shortly after delivery.
The bowel is often swollen and may not immediately fit into the abdominal cavity. For this reason, the exposed bowel is placed into a silo with warm saline. Gradually the swelling goes down and the bowel moves back into the body. The abdominal wall defect is repaired at a later time once all the bowel and all organs are in place.
These babies often need help with breathing. A special tube is placed to assist with breathing until several days after the abdominal closure. A nasal gastric tube is placed to keep the stomach empty and keep the pressure down on the intestines as it heals. Eating is done through a central IV line that provides nourishment (vitamins, minerals, calories and fat). This line will be in place for a prolonged period of time until bowels begin to respond; baby begins to stool; and drainage from the stomach tube decreases.
Feedings will need to be started slowly and monitored closely for tolerance. Many babies with gastroschisis will have slow movement through the intestines, which will cause problems of reflux. The baby will need to tolerate full feedings for optimal growth prior to going home. The time to full feedings with good weight gain usually is the primary determinant of length of stay in the hospital.
Recovering from uncomplicated gastroschisis often means a lengthy stay (4-6 weeks) in the NICU. During this time, it is very important for mom and the family to bond with their new baby. There will also be a lot of time teaching the baby how to eat and take a bottle. Speech therapists often work with the mother and child on therapies that stimulate eating and swallowing.
The most common side effect is acid reflux but it can be managed with medication from your your pediatrician. A pediatric surgeon to close the abdominal hole and a pediatric gastroenterologist may be consulted for ongoing care and treatment.
For more information see all services at Peyton Manning Children’s Hospital