i am 20 years old and pregnant with my first child. At 20 weeks my doctor discovered that my baby had gastoschisis. All has been well for the baby. i am now 36 weeks and possibly due any day. His bowel is now swollen to 1.5, and i wanted to now what the delivery risk are and what to expect for after delivery surgery for my baby. Also if you could explain what hes gonna go through when hes born with being in Intensive care and Surgery.
I'm sorry for the late reply. The surgical and medical management varies a bit from institution to institution. In general, you can expect that a neonatal team (with team members that might include pediatricians, neonatologists, neonatal nurse practitioners, neonatal nurses, and respiratory therapists) will be present at the time your baby is born. After initial stabilization (making sure your baby is breathing well and the heartbeat and blood circulation is well established), your baby will have an intravenous line placed for fluids and nutrition. A suction tube will also be placed through the mouth into the stomach to prevent excess air from going into the intestine and causing swelling of the intestine. The intestines themselves will be covered with either wet gauze dressing or a plastic bag (or both).
The timing of surgery depends upon how much of the intestines are out of the abdomen and the approach within the particular institution. Some surgeons prefer to "reduce" the gastroschisis immediately and close the abdomen as soon as possible. Other surgeons will place the intestines into a small plastic "silo" to gradually reduce the gastroschisis over a few days before closure. It is common for the baby to require respiratory support on a ventilator when the gastroschisis is reduced because the increase in abdominal pressure makes it more difficult for the baby to breathe.
After surgical closure, it may take some time before the intestines start to function normally. A suction tube into the stomach is left in place and the baby is not fed until it is evident that the baby is able to handle it's own secretions and that the intestines are passing things through appropriately. The baby will continue to receive IV nutrition through this time period.
Eventually as the intestinal function improves, the baby will be started on small volumes of feeds, sometimes through a small feeding tube into the stomach. If the feedings are tolerated, the volume of feeds is increased gradually until the baby is taking all of the feeds by mouth in a normal fashion.
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