Gastroschisis Betty Lew Winter 2016

Gastroschisis: What is it? Neonate’s stomach and bowel are formed outside of the body Opening usually right side of umbilical cord < 2 in. in size Bowel is unprotected so it could be swollen and irritated Occurs approximately 4th week of pregnancy Rare birth defect, cause unknown

Risks Gastrointestinal abnormality: Malrotation - bowel not in correct position Atresia - passage blocked Volvulus - twisting of bowels may cut off blood supply Infarction - blood supply to an area is cut off and damaged Increased chance of stillbirth (~10%) & growth restriction (75%)

Diagnosis Ultrasound Loops of bowel floating freely should be seen, possibly liver as well Discuss method of delivery with physician Select medical center to properly treat newborn May suggest C-section ~36 weeks once lungs are mature

Diagnosis Alpha-Fetoprotein Screening AKA “triple screen” or “quad screen” Blood test performed at 15-18th week to detect birth defect Abnormally high AFP may suggest gastroschisis Test not completely accurate

Surgical Procedures “Primary surgery” - neonate has small amount of bowel outside of body that may only need one repair “Staged repair” - neonate has large amount of bowel outside of body that requires several repairs Repair occurs 3-10 days or longer Plastic pouch (“silo”) placed around bowel & attached to belly Silo tightened daily, gently pushing some bowel inside When all bowel is inside, silo’s removed and belly is surgically closed

Signs of Improvement Bowel sounds Spontaneous passing of stool Decreased drainage coming from tube of neonate’s stomach

Management Postoperative Ventilate until neonate able to breathe spontaneously (~3 days) Keep pressure off diaphragm NGT/OGT used to suction applied to keep stomach empty Central IV line for nourishment - vitamins, minerals, calories & fat

Management Postoperative Arterial line: IV fluid & medications Monitor blood pressure Remove blood for lab work Antibiotics and pain medication