Better Care for Babies With Gastroschisis

Listen to this News

Gastroschisis is a birth defect with a hole in the abdominal wall near the belly button. This results in the baby's intestines and other organs like the stomach and liver to develop outside the body.

It was a fatal condition but with advancements in surgeries, 95% of babies born with gastroschisis now survived over the past 60 years. The main goal in managing gastroschisis is to reduce the risks in both the unborn and newborn baby ().

‘Over 95% of babies survived #gastroschisis after successful surgeries. #digestiveproblem #surgery #medindia’

The primary concern was to protect the intestines and other organs outside the body and ensure the digestive system works properly after the surgery.

Gastroschisis: Causes, Risks, and Prevention

Traditionally, gastroschisis is defined as a paraumbilical abdominal wall defect without a covering sac for the exposed organs. This review proposes an expanded definition, emphasizing a congenital secreto-motility disorder affecting the colorectal and hindgut, which can worsen the abdominal wall defect. The condition's classification includes simple and complex forms and highlights rare types such as "variant gastroschisis," which encompasses atypical presentations. The differentiation from omphalocele is emphasized, as gastroschisis typically presents with gastrointestinal complications rather than genetic anomalies often associated with omphalocele.

Although environmental factors primarily influence gastroschisis, the exact pathogenesis remains unclear. Proposed theories suggest a combination of abdominal wall defects and increased intraabdominal pressure leads to herniation. This review provides insights into intrauterine events and hindgut anomalies that can affect development, offering evidence from experimental models and prenatal monitoring to advance understanding of the condition's origins.

Risk factors for gastroschisis include maternal age under 20, substance use, stress, and micronutrient deficiencies, with the highest prevalence observed in lower socioeconomic backgrounds. Regional disparities in healthcare access contribute to higher gastroschisis rates and poorer outcomes. Preventative strategies include improving maternal nutrition, increasing awareness of risk factors, and promoting healthcare access, particularly for at-risk populations.

Diagnosing and Managing Gastroschisis Before and After Birth

Early diagnosis via ultrasound enables detailed prenatal monitoring and the option for delivery at specialized centers. The optimal timing for delivery is around 37-38 weeks, ideally via vaginal delivery to avoid complications linked to cesarean sections. Upon birth, careful handling of exposed bowel and temperature regulation is critical to prevent further injury. The use of preformed silastic silo and a multidisciplinary approach to perinatal management have significantly improved neonatal outcomes.

The primary aim of gastroschisis surgery is to reduce and close the defect without risking bowel ischemia due to high intra-abdominal pressure. The review describes bedside reduction and sutureless closure techniques, particularly effective for simple gastroschisis. For complex cases, gradual reduction using a silastic silo is favored. Postoperative care focuses on preventing infection, minimizing antibiotic exposure, and supporting gastrointestinal function, often through enteral feeding as soon as possible to reduce the reliance on total parenteral nutrition (TPN).

Complications for Gastroschisis Patients

Survival rates are high, with complications primarily arising in complex cases. Long-term complications can include gastrointestinal dysfunction, TPN dependence, and growth delays. The review encourages early feeding with breast milk to reduce risks of complications like necrotizing enterocolitis and suggests targeted interventions for cases with severe intestinal resection or short bowel syndrome.

Through a comprehensive approach encompassing preventative, surgical, and postnatal care, outcomes for gastroschisis patients have improved markedly. This review underscores the need for continued innovation in minimally invasive techniques and patient-centered care strategies to optimize results. Future research may reveal additional insights into prevention, prenatal diagnostics, and neonatal management of gastroschisis.

Reference:

1. Innovative Approaches to the Surgical Challenges in the Management of Gastroschisis: A Narrative Review of the Literature - (https:www.xiahepublishing.com/2994-8754/JTG-2023-00092)

Source: Eurekalert