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Wednesday, September 4, 2013

Gastroschisis, an abdominal wall defect

A new study published this week in Obstetrics and Gynecology reports on the rise in the incidence of a birth defect called gastroschisis, an abdominal wall defect. The study was large, reviewing over 4700 cases of gastroschisis occurring in 15 states from 1995-2005. While the condition is still relatively uncommon, the number of cases nearly doubled in the ten year period (from 2.32 to 4.42 per 10,000 live births). The highest rates (11.45 per 10,000) proved to be in non-Hispanic white teen mothers. Women younger than age 20 were over seven times more likely to have a baby with gastroschisis compared with women aged 25-29. Why? We don’t yet know.

In gastroschisis, the baby has an opening in the abdominal wall, usually on the right side near the belly button. During pregnancy, part or all of the baby’s intestines come out through the opening. Sometimes the baby’s stomach and liver also may be outside the body.

The intestines and other organs float in the amniotic fluid that surrounds the baby in the uterus. The amniotic fluid can irritate the baby’s intestines, sometimes causing them to swell, twist or get shorter. As a result, some babies have lasting intestinal problems. Babies with gastroschisis usually don’t have any other birth defects.

If a baby has a small abdominal wall defect (only part of the intestine is outside the body), he will probably have surgery within 12 to 24 hours of birth. The surgeon will place the intestine back inside the abdomen and close the opening.

If a baby has a larger defect, however, the surgery may take place in stages. In some cases, the baby’s intestines may be swollen or the abdomen may not have grown enough to hold them. The surgeon may place the intestines in a tall plastic container called a “silo.” The silo is positioned over the opening in the abdomen. Over several days or weeks, the surgeon will gradually tighten the silo. This helps to push the intestines and other organs back inside the abdomen. Once all the organs are inside, the surgeon will remove the silo and close the opening.

While life starts for these little ones with what seems an intense ordeal, most babies with gastroschisis recover and develop normally. Some have feeding problems that last at least through early childhood but most eventually outgrow these problems.

More research is needed into the cause of gastroschisis. The March of Dimes has and is funding a number of grants on research involving abdominal wall defects and we will continue to look into the causes so that hopefully one day these defects can be prevented.


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