Gastroschisis vs. Omphalocele - A Comparison

Introduction

An abdominal wall defect is an opening in the abdominal area where various abdomen organs protrude outside. The two main types of abdominal wall defects are gastroschisis and omphalocele. They are birth defects where a baby is born with their internal organs exposed out of the body through a hole formed from the belly. During the early pregnancy stages, it is fairly common for internal organs to extend out from the belly to the umbilical cord. But by 11 weeks of pregnancy, the organs retreat inside the abdominal area. Gastroschisis and omphalocele occur when the organ fails to retreat into the abdomen. They can affect a newborn's digestion process. In both these cases, surgical intervention is done to put the exposed organs in their proper locations. These conditions have many differences. This article will explain gastroschisis and omphalocele, their similarities and differences, and how both these conditions are treated.

What Are the Features Seen in Gastroschisis and Omphalocele?

In both gastroschisis and omphalocele, the baby's intestine will be exposed through the hole formed in the belly area. Other body organs, like the stomach or liver, are sometimes pushed out through the hole.

A. Features of Gastroschisis

• The hole is formed next to the belly button area, allowing the intestine to move out.

• The hole usually lies on the right side of the belly button area and can be small or large.

• The exposed organs do not have any protective layer making them more prone to irritation from the amniotic fluid surrounding the fetus inside the womb. When the intestine gets irritated from the amniotic fluid, it becomes twisted or inflamed.

• Fetuses with gastroschisis rarely have other congenital disabilities, genetic conditions, or chromosomal abnormalities.

B. Features of Omphalocele

• The hole lies in the belly button area.

• The exposed organs are covered by a transparent membraneous layer, which protects the exposed organs from amniotic fluid.

• Omphalocele is often associated with multiple congenital disabilities like congenital heart defects.

• Underdevelopment of the lungs is also seen with omphalocele. This underdevelopment happens because the abdominal organs are the ones that usually provide a framework for the growth of the chest wall. When those organs deviate from their original position, the formation of the chest wall does not happen properly. This deviation leaves a smaller space for the lungs to develop. As a result, respiratory insufficiency occurs, and the fetus might need mechanical ventilation to help them breathe.

• However, very rarely do individuals with breathing problems during infancy experience recurrent asthma or lung infections later in life.

• Affected babies can also have gastrointestinal problems like gastroesophageal reflux and difficulty feeding.

• A fetus affected by omphalocele grows slowly before birth and can be born prematurely.

• Omphalocele is a feature in many genetic syndromes like the Beckwith-Weidemann syndrome.

• A fetus affected by omphalocele can also have a chromosomal abnormality called trisomy. Trisomy is when an extra copy of the chromosome occurs in each cell.

What Causes Gastroschisis and Omphalocele?

Abnormal changes in the chromosomes or genes lead to abdominal wall effects like gastroschisis and omphalocele. Other causes include medications or exposure to toxins present in the environment. If a person is pregnant and is concerned about any exposure harmful to the baby, it is important to talk to a doctor about it.

What Are the Risk Factors Seen in Gastroschisis and Omphalocele?

The Centres for Disease Control and Prevention (CDC) states that teenage mothers are more prone to having babies with gastroschisis than older mothers. Other risks for omphalocele include smoking and drinking alcohol every day during pregnancy, intake of anti-depression medications called selective serotonin reuptake inhibitors (SSRIs), and obesity during the pregnancy.

What Complications Are Seen in Gastroschisis and Omphalocele?

Newborns with omphalocele tend to have other congenital disabilities like congenital heart defects. Other congenital disabilities usually affect the treatment of these abdominal wall defects. When organs grow outside the body, the space inside the abdomen that usually contains these organs does not grow enough to support them. If the layer of the sac surrounding the organs breaks, the chances of infection become very high. Sometimes the exposed organs can grow at an abnormal rate, get twisted, or have reduced blood flow, affecting the organ's health.

How Are Gastroschisis and Omphalocele Diagnosed?

• The abnormal location of the organs is usually detected through ultrasound scans during the second or third trimesters of pregnancy. Ultrasound is the noninvasive imaging method where sound waves produce still and moving images inside the body.

• Once the gastroschisis and omphalocele are discovered, the doctor will order a fetal echocardiogram to check for heart effects. An echocardiogram is an ultrasound of the heart.

• Periodic blood tests and regular ultrasounds are also performed throughout the pregnancy.

• If gastroschisis and omphalocele are diagnosed, the doctor, pediatric surgeon, neonatologist (newborn specialist), and rest of the healthcare team will help the patient figure out a plan for a healthy pregnancy and delivery.

How Are Gastroschisis and Omphalocele Managed?

• Both gastroschisis and omphalocele require surgical intervention.

• Surgery is done by placing the exposed organs back into the belly of the baby.

• If only a small part of the intestine is exposed, along with a small hole, then surgery is done soon after birth.

• When more organs and intestines are visible with the large opening, more than one surgery might be required.

• When multiple surgeries occur, the surgeries are done in stages over a while.

• Besides the full size, a baby's age is also an important factor in determining the time of surgery.

• Premature babies' surgery will be delayed until they are stronger and bigger.

• Management also includes providing the baby with fluids and nutrients intravenously.

• Antibiotics are also given to prevent infections.

• Further care includes warming the baby's body temperature and monitoring them as required.

Conclusion

Omphalocele and gastroschisis are abdominal wall effects that are commonly seen. Both conditions are managed through surgical interventions, usually successful, with no long-term health issues. Babies born with his condition are usually smaller than an average baby, and it takes longer for them to develop. They also take more time to have a healthy digestive system and become successful in feeding. However, with appropriate care after surgery, these babies become healthy as their peers.