All babies with gastroschisis need surgery soon after birth to put their intestines into their bellies and close the hole. Because of the special level of care they need, it's best for these babies to be born at a hospital that has a neonatal intensive care unit (NICU). Babies can be transferred to Seattle Children's NICU for care after surgery.
Surgery for Gastroschisis
When your baby is born, the surgeon will use one of several methods to take care of your baby's intestines. Sometimes babies can have surgery right away, other times it's best to wait. The timing of surgery will depend on your baby's condition. Your baby's surgeon and medical team will monitor this closely.
Because the intestines of babies with gastroschisis develop on the outside of the body, sometimes the space inside their bellies does not grow large enough for the intestines to fit inside right away. Most of the time, the surgeon can stretch the belly, fit all of the intestines inside, sew the hole closed, and make a new belly button. Sometimes the surgeon will place the intestines in a plastic bag to help protect them and keep them warm until they are put back through the hole into the belly.
In about 15% of infants with gastroschisis, the intestines will not fit inside the belly without causing too much pressure inside. This pressure could lead to problems with the heart, lungs and blood supply to the intestines.
To tell whether the intestines will fit inside the belly, we measure the pressure as we try to put the intestines inside. If the pressure is too high, we sew a bag on to the baby's abdominal wall, place the intestines inside, and slowly squeeze the baby's intestines into the belly over the course of five to 10 days. Then we take the bag off and sew the belly closed. By squeezing the intestines in slowly, we can avoid problems with the heart, lungs and blood supply to the intestines.
Whether your baby has surgery right away or not, at some point they will go to the NICU to be stabilized. Your baby will need an IV (intravenous) line, a tube that goes into a vein to give fluids. Some babies need to be on a breathing machine (ventilator) to help their lungs.
If your baby also is born with a blockage of the intestine (intestinal atresia), they will need more surgery to correct the problem. Your baby's doctor will discuss the timing of this surgery with you.
After Surgery for Gastroschisis
After surgery, it may take anywhere from one week to several months for your baby's intestines to start working well. Your baby will likely have to get feedings through a tube that goes into a large vein (central line) or a tube that passes through the nose or mouth into the stomach (nasogastric tube, NG tube; or orogastric tube, OG tube). We will give your baby pain medicine to make them comfortable.
As your baby's health improves, we will move them from the NICU to a regular hospital room, and eventually home.
The severity of gastroschisis can vary widely. So can the length of a hospital stay. Your baby will need to be in the hospital at least until all the organs are moved, the hole is closed and the baby is able to eat well. This will take weeks to months. The average length of stay in the hospital for gastroschisis is a little more than a month.