What are the characteristics and management of Gastroschisis?

Characteristics and Management of Gastroschisis

Gastroschisis is not usually associated with other anomalies or chromosomal disorders, is located to the right of the umbilical cord, and repair is typically followed by prolonged ileus. 1, 2

Key Characteristics of Gastroschisis

• Gastroschisis is a congenital abdominal wall defect characterized by herniation of intestines and occasionally other abdominal contents through an opening in the abdominal wall 2
• The defect is typically located to the right side of a normally inserted umbilical cord, which distinguishes it from omphalocele 2, 3
• Unlike omphalocele, no membrane covers the herniated abdominal contents in gastroschisis 2, 1
• Gastroschisis is rarely associated with other structural anomalies or chromosomal abnormalities, in contrast to omphalocele which frequently has such associations 1
• The prevalence of gastroschisis has been increasing worldwide, from approximately 0.1 per 10,000 births in the 1970s to over 5 per 10,000 in the early 2000s 2

Diagnosis and Associated Factors

• Gastroschisis is usually diagnosed prenatally through routine ultrasound examination 2, 4
• Risk factors strongly associated with gastroschisis include young maternal age, maternal smoking, and recreational drug use 2, 5
• Fetuses with gastroschisis are more likely to be born prematurely and with intrauterine growth restriction (IUGR), with approximately 48% showing growth retardation 2, 6
• Laboratory findings in amniotic fluid testing for gastroschisis differ from omphalocele, with specific patterns that help differentiate between the conditions 1

Surgical Management and Outcomes

• Gastroschisis requires early surgical intervention after birth 2
• Surgical repair is typically followed by prolonged postoperative ileus, which is a significant factor in neonatal morbidity 2
• Other complicating factors that affect outcomes include bowel atresia or necrosis 2
• Despite these challenges, advances in surgical and post-operative care have improved outcomes, with approximately 90% survival rate 2
• Prenatal diagnosis allows for planning the optimal timing, mode, and location of delivery 4
• Evidence supports elective delivery at 37 weeks' gestation in a tertiary pediatric center 4

Long-term Outcomes

• Although infants with gastroschisis often experience a difficult neonatal course, they typically have few long-term complications 4
• The prognosis is primarily determined by the degree of bowel injury, which can be difficult to assess antenatally 4
• Growth-restricted fetuses with gastroschisis, despite being more likely to require emergency cesarean delivery, may have shorter hospitalization times and fewer major complications compared to non-growth-restricted counterparts 6

Common Pitfalls in Management

• Failing to distinguish between gastroschisis and omphalocele can lead to inappropriate screening for associated anomalies 1
• Not recognizing the high likelihood of prolonged ileus after repair can result in inadequate preparation for extended parenteral nutrition 2
• Underestimating the impact of growth restriction, which is common in gastroschisis cases and may affect management decisions 6