Gastroschisis

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Gastroschisis

• Anne Aspin
• 2005

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Gastroschisis

• Defect lies to right of umbilicus
• Central abdominal wall defect
• No sac

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Embryology

• 6TH Week intestine grows rapidly
• Rotates and inverts by 10th week
• Liver, bladder, stomach
• Caused by vascular accident.

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Incidence

• Omphalocele 1 4000
• Gastroschisis 16000 10,000
• Increasing over last 30 years
• Common in young mums, lt20yrs.

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Associated anomalies

• Gastro-intestinal tract, atresia,stenosis
• Duplication cysts.

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Delivery

• Maintain clear airway
• Large naso-gastric tube, at least size 8.
• Wrap the defect in cling film, or plastic bag.
• IVI.

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Cling film

• Clear so you can see defect
• Protection
• Prevent drying out.
• Encloses in own serous fluid.

8
On the neonatal unit

• IVI at unit protocol, at least 60-75 ml / kg
• HAS at 10 ml/kg cont infusion
• Ng tube asp half hourly, replacement fluid
• Prepare for theatre / transfer.

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Post operation

• TPN,
• Ng aspirated hourly, 2hrly, 4hrly, spigot
• EBM cont feeds / bolus feeds (2 week )
• Build up slowly
• Reflux
• Central line infection
• NEC

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Feeding problems

• Gastro-oesophageal reflux
• Vomiting
• Poor weight gain
• Colic
• Fractious, fussy, crying
• Irregular bowel actions

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So what can we do

• Nappy change prior to feeds
• Nurse with mattress raised
• Sit in a chair after feeds by day
• Tummy massage
• Warm bubbly baths, music, swing chairs

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Medications

• Thick,n easy
• Thix o d
• Ranitidine
• Omeprazole
• Erythromycin
• Domperidone

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Long term management

• Adhesive bowel obstruction
• Short bowel syndrome
• Motility disorders
• Bowel transplantation
• Normal lives mostly.