Omphalocele & Gastroschisis
With Dr. Dr. Fung Lim · hosted by Dr. Todd Ponsky · StayCurrentMD
Cued at 5:32 · stops at 6:17 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.
Omphalocele is right through the middle of the umbilicus and has a membranous cover.
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
A very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.
Alpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Biophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.
If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently.
Gastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.
Nearly 60% of gastroschisis infants are premature.
More than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.
Pseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Acetaminophen is identified as a risk factor for gastroschisis.
Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.
Mothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Minimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold.
These babies can have significant acidosis and pulmonary hypertension.
Primary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly.
Staged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.
Some patients develop intestinal perforation after only two to four days of enteral feeding.
The majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.
In the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time.
For small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
For omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.
At Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin.
For large omphalocele defects, besides intestine, a good amount of the liver is on the outside in the majority of cases.
For gastroschisis, only ultrasound is normally obtained to confirm the diagnosis without additional imaging.
For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.
Fetal growth is tracked monthly in these cases because there is concern for significant growth restriction.
Gastroschisis affects approximately one in every 2200 live births.
After sequential reduction with plastic clips in omphalocele, the patient is taken to the operating room for delayed primary closure of the fascia and skin.