How is gastroschisis diagnosed?
Gastroschisis is usually detected at the routine 16-20 week screening ultrasound when intestines are seen floating in the amniotic fluid outside the baby’s abdomen.
Although it is important to carefully monitor your pregnancy with ultrasound studies, genetic tests are usually not needed. Sometimes gastroschisis can produce a bowel obstruction or blockage, which can slow the baby’s growth. Your baby’s growth will be monitored by ultrasound.
If your baby has been diagnosed with gastroschisis, it would be beneficial to schedule a consultation with your family and one of our top surgeons, as well as a CHOC neonatologist and your perinatologist, to prepare for the birth and subsequent care of your baby.
What will happen when my baby is born?
Your perinatologist, a specialist in fetal and maternal medicine, will discuss your delivery plans. Most babies with gastroschisis deliver around 37 weeks and can be delivered either vaginally or through cesarean section. Your baby should be born at a hospital with close access to a high-level neonatal intensive care unit (NICU). CHOC has the only Level 4 NICU in Orange County—the highest level available because of the complex conditions we treat—and we have the only Surgical NICU on the West Coast. Learn more about our NICU.
Your baby will be assessed by a neonatologist and a pediatric surgeon and will need surgery soon after birth. If the gastroschisis is too large to be closed immediately after birth, a covering called a silo is placed over the exposed abdominal organs. Then, the organs are gradually reduced through the silo into the opening and returned to the body in a gradual process that can take up to a week. If the defect is small and the condition of the intestines allows, the gastroschisis will be repaired immediately. Sometimes this can even be done at the bedside in the NICU, using a process called “sutureless closure,” which does not require stitches or general anesthesia.
Babies with gastroschisis can stay in the hospital from two weeks to several months. Because your baby’s intestines have been floating in amniotic fluid for months, they are often swollen and need time to start to function. It can often take several weeks before the intestines are ready to handle milk. Once they are ready, feedings start off in very small amounts, something called “trophic feeds.” Feedings are then gradually increased day by day. Babies are discharged from the hospital when they are taking all their feedings by mouth and are gaining weight, and once intestinal function has returned.
What is the long-term outcome for a baby with gastroschisis?
The prognosis for gastroschisis is good, although there is a range of severity that depends entirely on the condition of the intestine. It is also rare to have other medical conditions associated with gastroschisis, although sometimes bowel blockages (intestinal atresia) and gastroesophageal reflux disease (GERD) can occur.
Overall survival for a baby born with gastroschisis is more than 95 percent. Fortunately, most fetuses with gastroschisis do not have severe damage to the intestine before birth. The relatively normal intestine can be returned to the abdomen and the defect closed in one or two surgical operations shortly after birth. These babies will still be in the NICU for several weeks before the intestines work well enough to allow feeding and subsequent discharge home.