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Abdominal Wall Defects (Gastroschisis)
What is an abdominal wall defect?
Gastroschisis is an abdominal wall defect (opening) at the base of the umbilical cord that allows intestine (bowel) and other abdominal contents to come outside the body before birth. Gastroschisis occurs about 1-2 times in 10,000 births. It is more common in babies who have mothers aged 20 or less.
Omphalocele is an abdominal wall defect (opening) of the umbilical ring (belly button) that allows intestines and other abdominal contents to grow outside the body into a translucent (see through) sac before birth. Omphalocele occurs about once in 3200-10,000 births. In 30-50% of these babies there are other health problems including heart and genetic problems.
How are abdominal wall defects diagnosed?
Gastroschisis and omphalocele are usually diagnosed by ultrasound during pregnancy. A blood test of the mother (alpha-fetoprotein level) may also suggest these problems. If these defects are noticed then genetic studies and heart tests are also recommended. Occasionally, a baby will be born without anyone knowing in advance.
How is the decision made that surgery is needed?
All babies that have an abdominal wall defect will require surgery to put the intestines into the abdomen and close the muscle and skin. Sometimes all of the intestines do not fit immediately and then the replacement may take place over days, weeks, or months. During this time the intestines will be within a silo (sterile wrapping) with the amount growing smaller each day as the baby grows and the abdomen is able to hold more and more of the intestine.
When will my child be able to go home?
A baby with gastroschisis or omphalocele will be cared for in the Neonatal Intensive Care Nursery (NICU). Parents are encouraged to visit and spend many hours with their baby. The nurses and physicians will explain all of the machines, tests and care the baby is receiving.
It may take a long period of time before the baby’s intestines work well enough for the baby to eat, grow and go home. The final surgery may not be completed for many months. Either way the mom and dad will be taught how to care for their baby in the nursery and at home. The baby will be sent home as soon as it is safe for the baby and family.
Mom should pump and save her breast milk which will be given to the baby as soon as the intestines will work to digest milk. The baby will be given fluids through an IV (tube in a vein) to help him/her grow until s/he can have breast milk. Often feeding will be given through a tube that goes through the baby’s nose into the stomach (NG tube) until the baby can suck, swallow and breathe safely.
What care is needed at home after surgery?
Sometimes babies go home receiving feedings through a tube or through a special IV. Other babies may go home needing their abdomen cared for by applying cream and wrapping their abdomen daily. These babies will not be submerged into the bath until their skin is pulled together during surgery. All babies will need car safety seats. Mom and dad will need CPR training and appointments will be made with the primary care physician and the pediatric surgeon before discharge.
When should I call the surgery team?
Occasionally babies can have a bowel obstruction (when food cannot pass through the intestine.) When this happens the baby begins to vomit “bilious” fluid (greenish/yellow bile), the abdomen may get hard and full, the baby may stop having bowel movements and not want to eat. Most importantly, the baby will behave differently and you will know he is sick! The surgeon must be called and the baby taken to see the surgeon is immediately!
What are the long term consequences?
All babies are different but most babies born with gastroschisis or omphalocele and no other birth defects have normal growth and development. These infants will need physical therapy to help develop their abdominal muscles and they should be followed by a nutritionist to ensure growth. If they have an additional health problems please ask the doctor or nurse how these problems will affect your child.
Please reproduce and distribute this sheet to your surgery families. This teaching sheet can also be downloaded at www.APSNA.org.
Copyright 2006, Beth Zimmermann,. Copied with permission by Jones and Bartlett Publishers, Sudbury, MA."