Management of the Infant With Gastroschisis: A Comprehensive Review of the Literature

Tracey Williams, MSN, RN, NNP, Rachel Butler, MSN, RN, NNP, Tara Sundem, MSN, RN, NNP


NAINR. 2003;3(2) 

In This Article

Abstract and Introduction

Gastroschisis is a congenital defect of the abdominal wall involving evisceration of abdominal contents. The incidence of gastroschisis is approximately 1.4 per 10,000 pregnancies and is rarely associated with other congenital anomalies. To provide appropriate care for these infants, the newborn/infant nurse must have a clear understanding of the embryology, etiology, and pathophysiology of the defect, and the ability to differentiate between gastroschisis and omphalocele. The purpose of this article is to provide the reader with a basic understanding of management strategies. Parents need to be provided with timely and accurate education and support as they cope with the stress of having an infant with gastroschisis. With appropriate care, these infants do well and have an essentially normal outcome.

Gastroschisis, formally thought to be a variant of omphalocele, was first described in the 1940s. It was not recognized as having a different embryologic origin for almost 20 years after the first reported case. Until the 1970s, survival of infants with gastroschisis was relatively poor.[1] With increasing technology, mortality has been reduced, and survival is an expected outcome. Infants with gastroschisis present the health care team with numerous challenges from delivery to postdischarge. This article reviews the embryology, incidence, diagnosis, clinical manifestations, associated anomalies, management, complications, and follow-up needs for newborns and infants with gastroschisis.

Gastroschisis is a defect in the abdominal wall causing evisceration of abdominal contents.[2] The defect usually occurs on the right side of the umbilical cord and is never enclosed in a peritoneal sac.[2,3] The vertical opening is approximately 2 to 5 cm in size, with the umbilicus normally developed and properly positioned.[4,5] The small and large intestines are usually the only organs protruding outside the abdominal wall (Fig 1). The spleen and liver may also be involved, but with a much lower incidence.[6] Malformations of other major organ systems are infrequently associated with gastroschisis; however, if malformations occur, they are commonly related to infarction or atresia of the herniated bowel.[7]

Intestines and stomach protruding from gastroschisis defect.


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