What is Gastroschisis?
Gastroschisis is a congenital condition characterized by a defect in the abdominal wall through which the intestines and sometimes other organs protrude outside the fetus’s body. This condition is typically identified through prenatal ultrasound, and it requires surgical intervention soon after birth to place the organs back inside the abdomen and close the defect.
How Common is Gastroschisis?
Gastroschisis is a relatively rare condition, occurring in about 1 in every 2,000 to 5,000 live births. The incidence has been noted to be increasing over the past few decades, particularly among younger mothers under the age of 20. The exact cause of this trend remains unclear.
What Causes Gastroschisis?
The etiology of gastroschisis is not fully understood, but it is believed to result from a combination of genetic and environmental factors. Unlike other congenital defects, gastroschisis is not typically associated with chromosomal abnormalities. Risk factors include maternal age, smoking, drug use, and certain medications taken during pregnancy.
How is Gastroschisis Diagnosed?
Gastroschisis is often diagnosed during a routine prenatal ultrasound, usually around 18-20 weeks of gestation. The ultrasound will show the intestines floating freely in the amniotic fluid outside the fetal abdomen. In some cases, additional imaging tests like fetal MRI might be conducted for a more detailed assessment.
Primary Repair: The organs are placed back into the abdomen, and the abdominal wall defect is closed in a single surgery. This is preferred when feasible as it reduces the risk of complications.
Staged Repair: When the defect is large or if the infant's condition does not allow for immediate closure, a
silo bag is used to cover the exposed organs. The organs are gradually moved back into the abdomen over several days, followed by closure of the defect.
What is the Prognosis for Infants with Gastroschisis?
The prognosis for infants with gastroschisis has improved significantly with advances in prenatal diagnosis and neonatal care. The survival rate is now over 90%, although outcomes can vary based on the severity of the defect and associated complications. Early detection and appropriate surgical management are critical for optimizing outcomes.
Can Gastroschisis be Prevented?
Since the exact causes of gastroschisis are not well understood, specific prevention strategies are limited. However, reducing known risk factors such as avoiding smoking, illicit drug use, and certain medications during pregnancy can potentially lower the risk. Regular prenatal care and early ultrasound screening are essential for early detection and management.
What is the Role of Neonatal Intensive Care Unit (NICU)?
Infants born with gastroschisis require immediate neonatal intensive care. The NICU provides specialized support including respiratory care, nutritional support via intravenous feeding, and close monitoring for any complications. The multidisciplinary care team in the NICU plays a crucial role in the immediate post-operative period and throughout the infant's recovery.
Conclusion
Gastroschisis is a serious but treatable neonatal disorder. Advances in prenatal diagnosis, surgical techniques, and neonatal intensive care have greatly improved the prognosis for affected infants. Early diagnosis and a multidisciplinary approach to treatment are key to managing this condition effectively.
