WILL HAPPEN AT BIRTH?
If everything goes as planned,
you will deliver at a tertiary care center with direct access
to a neonatal intensive care unit. The neonatologists will be
present at delivery, so that they can immediately assess your
baby and start treatment, if necessary. At the same time, the
pediatric surgeons will be alerted, so that surgical correction
can be performed as soon as possible. In most cases, however,
you will be able to see (and hold) your baby after delivery.
Your baby will be "stabilized"
in the intensive care unit. An intravenous line will be placed
in an arm or a leg, so that fluids can be given. Because of the
exposed intestines, your baby is likely to lose a lot of fluid
by evaporation, and is likely to cool off more rapidly as well.
Your baby will therefore be placed under a warmer, and the loops
of bowel will be carefully wrapped to protect them from the outside.
If you baby shows signs of distress, it is possible that he will
be intubated, so that we can help him breathe better.
Once it is clear that there are
no other major problems, your baby will be ready to undergo surgical
repair of the defect. How this is done will depend on how much
intestines and other organs are exposed, and how big your baby
is. In many cases, all the intestines can safely be placed back
in the abdomen (so-called "primary repair"), and the
abdominal wall can be closed. Of course, this is done
in the operating room with your baby under anesthesia. Often,
however, there is so much out that this cannot be safely replaced
all at once. In that case, we try at least to protect the intestines
until they are ready to be put back in the abdomen. For this,
we place a "silo"
(a clear plastic or silicone pouch) over the intestines, so that
they are now shielded from trauma, infection and dehydration.
This can be done at the bedside, in the intensive care unit,
or in the operating room.
Once the swelling has gone down
and the abdomen has become used to the presence of more bowel,
the silo can
be removed and the abdomen closed over the intestines. This typically
takes a few days to a week.
WHAT HAPPENS NEXT?
As mentioned before, the intestines
have suffered somewhat during pregnancy, and they will need some
time to recover. On average, it may take 2 to 3 weeks before
the intestinal tract functions properly again. During that time,
your baby will be fed through the veins only, by "total parenteral nutrition," or TPN. He will get all the calories necessary
to grow, until he can be fed by mouth again. Once gut function
returns, it will likely take a while before your baby can tolerate
full feeds, and that nutrition through the veins can be stopped.
Your baby is likely to stay in the hospital for at least 1 month.
Sometimes, this can be much longer, depending on the degree of
prematurity and the condition of the bowel.
COMPLICATIONS AND LONG-TERM OUTCOME
The overall outcome of gastroschisis
is excellent: some infants may have minor intestinal problems
in the first few months, but will recover from that and lead
a completely normal life. Although the belly button may not look
perfectly normal, there should be minimal scarring.
In some rare cases, however,
there may be some complications. While gastroschisis is usually
not associated with other anomalies, there may be intestinal
defects in 5 to 10%. These represent in utero "accidents,"
where a piece of intestine becomes necrotic and disappears. As
a result, there may be a missing portion of intestine (intestinal
which will have to be fixed. Often, this is not discovered until
a few weeks after birth. An additional operation will then be
necessary. Very rarely, a large portion of intestine suffers
and dies off. In those rare instances, bowel function may suffer.