Key points about gastroschisis in babies
- gastroschisis happens when your baby’s abdominal wall does not fully close during early pregnancy
- the bowel grows outside the abdomen without a protective sac
- treatment begins soon after birth and may involve surgery
- most pēpi (babies) with gastroschisis have a good outcome
What is gastroschisis?
Gastroschisis is a rare condition that develops during early pregnancy. It happens when your baby’s abdominal (tummy) wall does not fully close. This leaves an opening, usually to the right of their tummy button. The opening allows the bowel, and sometimes surrounding organs, to grow outside the abdomen.
This illustration shows gastroschisis, where some of the bowel has grown outside the tummy through an opening in the tummy wall.
Source: KidsHealth
transcribeTranscript
The illustration shows a newborn baby lying on their back. Some of the bowel is outside the baby’s tummy through an opening in the tummy wall. The bowel is not covered by a protective sac.
A label points to the bowel outside the tummy.
Text at the top left reads: Gastroschisis. Some of the bowel has grown outside the tummy through an opening in the tummy wall.
At the top right is the KidsHealth logo with the website: kidshealth.org.nz.
Unlike omphalocele, there is no protective membrane or sac covering the organs. This means the bowel is exposed to amniotic fluid, which is the fluid surrounding your baby in the womb. The bowel may become irritated, swollen or damaged. The healthcare team will carefully assess your baby’s bowel after birth.
Omphalocele (Exomphalos) In Babies
Causes of gastroschisis
Gastroschisis is rare. The exact cause of gastroschisis is not known. It often occurs on its own and is not usually associated with other conditions.
Most pēpi with gastroschisis have a good outcome.
Your healthcare team will plan your baby’s birth
Several health professionals will care for you and your baby. These may include:
- a neonatologist - a doctor specialising in the care of newborn pēpi
- a paediatric surgeon - a doctor who specialises in surgery for pēpi and tamariki (children)
- an obstetrician - a doctor who specialises in care during pregnancy and birth
- neonatal nurses - nurses who specialise in caring for newborn pēpi
Your healthcare team will talk with you about your baby’s condition. They’ll cover possible complications and treatment options.
Your baby will need to be born at a hospital with:
- a neonatal intensive care unit (NICU)
- paediatric surgical services
If your baby is born in a region without a neonatal intensive care unit and paediatric surgical services, you will be transferred after birth.
Your healthcare team will help plan where your baby will be born.
You may have an opportunity to visit the NICU and meet some of the team before your baby is born.
Vaginal birth is usually possible
Pēpi with gastroschisis are more likely to be born before 37 weeks of pregnancy.
It’s usually possible to give birth vaginally. A caesarean is usually only recommended if there are other health reasons for one. Your healthcare team will discuss this with you.
Managing gastroschisis
Specialist care after birth
When your baby is born, the neonatal team will assess their wellbeing. Your baby may need support with their breathing.
The team will wrap the exposed bowel in transparent plastic. This helps prevent fluid and heat loss. It also allows the team to monitor the colour of the bowel and check that it is not kinked.
The healthcare team will pass a tube through your baby’s nose or mouth and into their stomach. This keeps their stomach empty of air and fluid.
Your baby will then move to the NICU, where the healthcare team will monitor them closely.
The team will place intravenous lines (IV Lines) to allow your baby to receive fluids directly into their bloodstream. Your baby may still be able to have small amounts of colostrum after birth.
Your baby’s healthcare team will explain any treatment your baby needs. They will answer your questions.
Treatment begins soon after birth
Treatment usually begins soon after birth. The aim is to place your baby’s bowel inside their abdomen and close the opening in the abdominal wall.
The type of treatment will depend on:
- how much bowel is outside your baby’s abdomen
- whether there is enough room inside the abdomen
- the condition of the bowel
- your baby’s overall health
Your baby may have surgery or treatment using a silo. A silo is a clear plastic pouch which holds and protects the bowel.
Repair in 1 surgery
The surgeon may be able to place the bowel inside your baby’s abdomen and close the opening in 1 surgery.
Your baby will have a general anaesthetic, so they will be fully asleep during the surgery. The surgeon and anaesthetist will explain the procedure. They will discuss any concerns you have and ask you to sign a consent form.
Treatment using a silo
If there is not enough room inside your baby’s abdomen, the healthcare team may place the bowel inside a silo.
The silo holds and protects the bowel. Over several days, the bowel gradually moves into your baby’s abdomen. This can take about 1 week. The surgeon will then close the opening in the abdominal wall.
Some babies need treatment for damaged bowel
The surgeon will carefully assess your baby’s bowel. If part of the bowel is damaged, your baby may need to have that section removed.
Some pēpi need a temporary stoma. This is where the surgeon brings the ends of the bowel through an opening in the abdomen. Poo passes through the stoma into a small bag attached to the outside of your baby’s abdomen.
Your baby will need another operation later to close the stoma and join the ends of the bowel.
Care after treatment
Your baby will continue to receive close care in the NICU. You will be able to see your baby once they are settled.
Your baby may need a ventilator, or breathing machine, until they are ready to breathe on their own.
Your baby will receive pain relief through an intravenous infusion. They may also have a small tube called a catheter placed into their bladder to drain urine for a while.
Feeding your baby
Your baby will receive nutrition through an intravenous line while their bowel recovers. This is called total parenteral nutrition (TPN).
When your baby is ready, they will start having small amounts of breastmilk or formula. At first, milk may go through a tube passed through their nose or mouth and into their stomach.
As the amount of milk increases, the healthcare team will reduce the TPN. Once your baby is ready to feed by mouth, you will receive help and support with breastfeeding or bottle feeding.
The length of your baby’s hospital stay will vary
The bowel can be slow to start working after treatment. Some pēpi need to stay in hospital for several weeks or months.
Some pēpi have problems with:
- vomiting
- gastro-oesophageal reflux
- runny poo (diarrhoea)
- constipation
Your baby will be able to go home when they are feeding well, gaining weight and passing poo.
Getting support
It’s understandable to feel anxious or worried. The hospital environment and the number of people involved in your baby’s care can feel overwhelming.
Your baby’s healthcare team and NICU social worker will provide guidance and support. Ask them any questions you have, including how you can care for and bond with your baby.
Your baby will have follow-up appointments
After your baby goes home, they will have outpatient appointments to monitor their growth and progress.
You can ask questions and discuss any concerns at these appointments.
Possible complications after treatment
After abdominal surgery, scar tissue called adhesions can sometimes develop. Adhesions or a kink in the bowel can cause a bowel obstruction. This means the bowel becomes partly or completely blocked.
Your baby’s healthcare team will monitor for possible complications during follow-up.
When to get medical help
After your baby leaves the NICU, see a health professional urgently if:
- your baby vomits green fluid
- your baby has a swollen abdomen
- your baby is not interested in feeding
- your baby seems unwell
- you are worried for any reason
These symptoms may be signs of a blockage in the bowel.
More information and resources
Source: Wāhi Rua | NZ Maternal Fetal Medicine Network
Te reo Māori version
Source: Wāhi Rua | NZ Maternal Fetal Medicine Network
Acknowledgements
Adapted from the leaflet: 'Gastroschisis. Neonatal Services. Matatiki, Child & Youth Health, Waitaha Canterbury'.
