Children's Hospital Colorado

Gastroschisis

Gastroschisis, which is Greek for "belly cleft," is an opening in a baby's abdominal wall through which some of the baby's bowels (intestines) may protrude. For parents, the prospect of having a child with gastroschisis can be very scary. But the good news is that most babies born with this defect have positive outcomes. At Children’s Hospital Colorado’s Colorado Fetal Care Center, we work with families to diagnose gastroschisis early so we can ensure the best outcomes as well as develop a treatment plan after birth.

What is gastroschisis?

Gastroschisis is a congenital defect, meaning that it is present at birth. This defect creates a hole in the abdominal wall, which allows some of the baby's intestines to fall outside of the abdominal cavity. Gastroschisis is almost always located immediately to the right of the insertion of the umbilical cord. The hole is usually about 1 to 2 inches in diameter (2 to 5 centimeters), but can be bigger in rare cases, exposing other organs such as the stomach and liver.

What causes gastroschisis?

In most babies, the cause of gastroschisis is unknown. However, recent research has indicated that certain factors can increase the likelihood of having a baby with the condition. One trend that all doctors tend to agree on is that the risk of having a baby born with gastroschisis is higher for mothers who are 20 years old or younger. Other possible risk factors include smoking tobacco, drinking alcohol or using recreational drugs during pregnancy.

Although not a very significant factor, some research suggests that gastroschisis can occur again within the same family — estimating that gastroschisis can happen in future pregnancies about 4 percent of the time.

Symptoms of gastroschisis

Typically, gastroschisis can be detected during pregnancy by an ultrasound, which is an imaging device that allows doctors to see the baby while still inside the mother’s womb. After birth, gastroschisis is very easily diagnosed as intestines and other organs will be plainly visible through the hole in the abdomen.

Complications associated with gastroschisis

Gastroschisis, unlike other abdominal wall defects, is not associated with chromosomal abnormalities (chromosomes create the "blueprint" for the baby). Gastroschisis-associated abnormalities are usually confined to the gastrointestinal tract and are most often associated with blockages in the intestines.

Even when other abnormalities are present, they are not usually life-threatening. There is, however, an increased risk for intrauterine growth restriction (IUGR) and stillbirth in 10 percent of cases. IUGR is poor growth of the baby while in the womb.

If the intestines are outside the abdomen while the baby is inside the womb, they will be exposed to amniotic fluid and may not work well after birth. This means that infants can experience problems with feeding, digestion and absorption of nutrients.

How is gastroschisis diagnosed?

We are able to diagnose most cases of gastroschisis during routine ultrasounds. In addition, screening in the second trimester (for maternal serum alpha–fetoprotein, or MSAFP) may detect fetal gastroschisis. The diagnosis of abdominal wall defects during the first trimester is difficult because it is normal for the bowel to protrude or push into the base of the umbilical cord. The most reliable ultrasounds occur after 14 weeks of pregnancy, when the bowel should be entirely enclosed in the abdomen. If gastroschisis is not diagnosed before birth, it will be evident upon delivery.

How will gastroschisis affect my pregnancy?

Intrauterine growth restriction (IUGR) may affect up to 77 percent of fetuses with gastroschisis. IUGR is a condition in which a baby grows less than the average size while inside the womb. Excess amniotic fluid (called polyhydramnios) or too little amniotic fluid (oligohydramnios) are also commonly seen with gastroschisis. In cases of polyhydramnios, the uterus may stretch more than usual, increasing the risk of preterm labor.

We will perform additional ultrasounds to assess your baby's growth as well as the amount of amniotic fluid surrounding it. In addition, we will begin fetal testing to check your baby's heart rate twice per week between weeks 30 and 32 of pregnancy.

Often, we recommend delivery around 37 weeks of pregnancy (approximately 3 weeks early) to avoid the risk of stillbirth. We usually recommend that you deliver in our state-of-the-art fetal center so we can better coordinate the obstetric, neonatal and pediatric surgical teams. A C-section is not necessary in most cases, but our team will discuss delivery options with you beforehand.

Gastroschisis surgery and treatment options

Gastroschisis is not currently treatable while your baby is in the womb. We treat gastroschisis with surgery after birth to place the intestines back in your baby's abdomen.

Soon after your baby is born, surgeons place the organs inside the abdomen and close the opening in the abdominal wall. In some cases, there are a larger amount of intestines outside the abdominal wall, and the intestines need to be placed back inside the abdomen at a slower pace. This process may take place over 3 to 5 days.

The extent of gastroschisis surgery required depends on how much of the intestines or additional organs lie outside their body at birth and if there is an associated closing or blockage in the intestine. Additional surgeries may be required if there is a blockage of the intestines.

During the process of gastroschisis surgery, your baby may need additional treatment such as:

  • Intravenous (IV) nutrition
  • Antibiotics to prevent infection
  • Careful body temperature monitoring

Intravenous nutritional support is particularly important as it often takes weeks for the gastrointestinal tract to work well enough for feedings to fully support your baby.

Throughout treatment, our staff helps prepare families to care for their baby at home. We also connect loved ones with support groups and other resources to help them maintain their emotional and physical health during this recovery process.

What is the long-term outcome for babies with gastroschisis?

Gastroschisis outcomes have improved greatly in recent years, thanks largely to innovative surgical techniques. Research suggests that the survival rate for babies with gastroschisis is 90 percent. Babies with gastroschisis benefit greatly from being born in a facility with experts who specialize in children’s surgery. Babies recovering from gastroschisis surgery may also have trouble eating, digesting and absorbing nutrients, so it essential to consult a pediatric nutrition expert to ensure the long-term health of your baby.

Today’s procedures enable the vast majority of babies diagnosed with gastroschisis to live long and healthy lives. Their degree of need for ongoing care varies depending on the severity of the condition and associated symptoms.

Why choose the Colorado Fetal Care Center for your child’s gastroschisis care?

The most important part of gastroschisis treatment is having your baby in the hands of capable surgeons soon after birth. Our pediatric surgeons have extra training and experience in performing surgery on children and infants and have the most experience in the Rocky Mountain region in treating these kinds of birth defects. When it comes to your child’s care, that pediatric expertise matters.

If your baby is diagnosed before birth, our Colorado Fetal Care Center team will help coordinate your baby’s care every step of your journey. From diagnosis and delivery, to surgery and ongoing care, your baby will be expertly treated and cared for in our nationally-recognized Neonatal Intensive Care Unit. In addition to your baby receiving care from a full team of specialists, we also help you and your family feel as prepared as possible to return home and care for your child as they grow.


Related departments

PRODWEBSERVER1