What Causes Gastroschisis in Babies

What is Gastroschisis?

Gastroschisis is a birth defect where the foetal abdominal wall near the umbilical cord doesn't completely close during development in the womb, causing the intestine and sometimes other organs to protrude out through the hole in to the amniotic fluid. The organs could get damaged, swollen and irritated as a result of floating in the amniotic fluid. Based on the condition of the intestine it is further categorized in to two:

• Simple gastroschisis: In this type the intestines protrude out from the abdominal hole in to the amniotic fluid but do not have any other complications or damage to the intestines,

• Complex Gastroschisis: In this type of gastroschisis, the intestines protrude out through the abdominal hole and could also have atresia (blockage), necrosis (tissue death), swelling, twisting (volvulus), perforations (holes), and or stenosis (narrowing).

Gastroschisis Vs Omphalocele

In both these birth defects the baby is born with the organs protruding out through the abdominal hole, however in the case of omphalocele the organs are covered by a membrane while there is no membrane covering in case of Gastroschisis.

Related: Congenital Heart Defects

Gastroschisis Causes

The exact cause of Gastroschisis is unknown, but certain risk factors could influence this outcome.

• Very young maternal age

• Genetic changes in the baby

• Low BMI or underweight mother

• Maternal use of recreational drugs, alcohol or smoking

• Poor nutrition during pregnancy

• Use of certain medications of health condition of the mother

• Exposure to certain chemicals like nitrosamines

• Having Urinary Tract Infections (UTIs) right before or during pregnancy

Babies with Gastroschisis do not usually have other birth defects, it happens as an individual phenomenon in most cases.

Gastroschisis Symptoms

Although pregnant women with gastroschisis babies may not have any specific `symptoms, the doctor during ultrasound would notice the birth defect with the following symptoms:

• Intestines and sometimes even other organs seen outside the baby's abdomen

• Swollen Intestines

• Twisted Intestines

• Low body temperature of the baby

• Some babies may have complex gastroschisis where the intestine is damaged:

  • Perforated Intestine

  • Intestinal atresia / blockage

  • Intestinal necrosis or tissue death

  • Intestinal stenosis or narrowing

Gastroschisis Diagnosis and Tests:

In most cases the diagnosis happens in pregnancy during ultrasound scan where a doctor can see if the intestine or other organs are outside the abdomen

• Ultrasound: A non invasive imaging test that uses sound waves to look for what is happening inside the womb during pregnancy.

• Blood Tests: Pregnant women are tested to look for any anomalies during pregnancy, a high level of alpha-fetoprotein in the blood could indicate abdominal defect/s in the baby.

• MRI (Magnetic Resonance Imaging: Is a non invasive technique that uses magnetic field with computer generated radio waves to create detailed images of the inside of the womb and the baby, it gives a detailed view of the organs or the anomalies in detail.

• Physical Exam: Doctors would notice the abdominal issues at birth and would use tests like X-ray, blood tests and MRI on the baby to do a detailed assessment of the defect.

Gastroschisis Treatment

Surgery is the only way to treat Gastroschisis, timing will be decided by the doctor based on the severity and the condition of the baby. In many cases surgery is done soon after birth. The baby will also be treated with:

• IV fluids: Till the baby's intestines and abdomen heals, IV drip will be used to nourish the baby.

• Antibiotics: To prevent any infections, the baby is given antibiotics.

• Temperature control: As the baby's intestines are outside the body, they lose heat leading to drop in body temperature, which will be regulated.

Gastroschisis Surgery

Once the baby is born, based on the type of gastroschisis and severity the doctor will take a call on the timing of the surgery.

• Primary Surgery: In most cases the surgery is done right after birth, could be even the same day to put the intestines (other organs too in some cases back into the abdomen) and close the hole. Most babies have simple gastroschisis which can be fixed usually with one to two surgeries.

• Stages Surgery: Some babies have complex gastroschisis, issues like intestinal swelling, necrosis, narrowing, obstruction and others where multiple surgeries are required over time to correct the defects. Multiple factors like health of the baby, size of the abdomen play a crucial role in the timing of the surgery.

  
  

Until the surgery is done the intestine and other organs if any are placed in a plastic bag called silo to prevent infections, dehydration and damage. The bag also allows the intestines to heal and shrink in size if swollen so they can be pushed back slowly into the stomach by tightening the bag over time. The baby may need to stay in an NICU after birth, till the treatment is done. In some cases it could be months till the baby heals and is able to feed normally to be sent home.

Gastroschisis Complications

Gastroschisis in some cases could lead to multiple complications before or after birth:

• Premature Birth: Many babies with Gastroschisis are born prematurely due to fetal growth restrictions, doctors opt to deliver to reduce damage to the intestines and other complications associated with the defect that could risk the pregnancy.

• Infections: The baby could develop infections at the surgical sight or at the exposed intestines site post surgery. Antibiotics is used to treat but may develop further complications.

• Feeding Difficulties: As the intestine and abdomen heal, the baby may struggle to feed and will need assistance or a nasogastric tube (tube through nose to stomach) to help with feeding the baby

• Bowel Resection: Removing parts of the damaged intestine before putting the rest of it back into the abdomen. Sometimes it happens as a complication after gastroschisis correction surgery.

• Short Bowl Syndrome: When parts of the intestine is missing (doesn't develop fully) or removed as part of the treatment it could lead to it becoming too short for food to be absorbed and may need further treatment to aid nutritional absorption.

• Colostomy: Not usually a complication of gastroschisis but sometimes the colon gets damaged as well and will need surgery to correct, one end of the intestine is brought out through abdominal wall and connected to a bag for stool to pass as the colon needs to heal (temporary) or in severe cases is damaged beyond repair (permanent), this procedure is called colostomy.

• Narrowing of the intestine after surgery leading to a blockage that needs further treatment.

Gastroschisis Outlook

Most babies do very well after the surgery, without any other complications they develop and grow like any other normal baby. Some babies do develop gastrointestinal complications later in life that may need further treatment or surgeries to correct, talk to your doctor to know more. Overall the survival rate for babies with gastroschisis is over 90% and in babies with simple gastroschisis which is the more common type of the two with proper timely treatment and care, these babies thrive and could go on to live healthy lives.