Nursing Diagnosis 

1. Imbalanced nutrition: less than body requirements related to poor absorption and perforated intestine as evidence by  _____ % weight loss since birth. 

2. Delayed growth and development related to congenital anomaly as evidence by low weight percentile. 

3. Risk for infection related to perforated intestine as evidence by fever and pain 

4. Risk for self-concept disturbance related to scars and future medical needs as evidence by verbal statement or body language. 

You Are Not Alone! 
Listed below are a few websites that can help guide parents of children diagnosed with Gastroschisis to a healthy network of support.

Avery's Angels 
This is a very popular and well known organization in the Gastroschisis world. It provides resources, programs, support meetings, fundraisers and events for those affected by Gastroschisis. You can volunteer, sign up as a member or even work for the organization as a paid employee! There are many ways to get involved, and Avery's Angels is working toward raising awareness for everyone affected by Gastroschisis.

http://averysangels.org

Gastroschisis: Help Resources and Member Contributed Stories
This website offers the chance to parents of children with Gastroschisis and even grown children who had gastroschisis an opportunity to be apart of something. You can sign up to be a member and share your stories as if it were a blog. However, the great thing about this website is by signing up to be a member you have access to many helpful Gastroschisis resources and support networks.

http://www.gastroschisis.co.uk

News Moms Need: What moms and moms-to-be need to know
This blog is open to all new moms or those who are expecting a new baby. You can discuss any topic and connect with other moms that are going through similar medical experiences as you are. It is an open forum where moms can feel safe and share the struggles, worries, fear and many other emotions that they may be experiencing.

http://newsmomsneed.marchofdimes.org/?p=14333

Facebook! 
Surprisingly, there are many support groups that you can join on Facebook! It is a great resource because it allows you to share photos and videos as well as written posts. You can connect fast with others from all over the world! There are endless amounts of Facebook pages that you can explore or you can start your own Facebook for Gastroschisis and share you journey with others.

Facebook.com (search gastroschisis)

Helpful Apps For Moms

With the ever growing advances in technology it is becoming easier and easier for many people to learn and connect with almost anything. New moms can take advantage of the vast amount of applications that are easily downloaded to any smart phone. Highlighted below are a few apps that would be especially helpful for moms with babies that have been diagnosed with Gastroschisis. 

  Baby center is a simple app that can help a pregnant mother keep track of her      developing child. It provides week by week tips and trackers through resources like videos, new mommy essentials, product reviews, calendars, community forums and much more. It is the ultimate guide to pregnancy and offers a lot of great information throughout the course of your pregnancy. 

      Baby bump is a similar app to Baby Center but provides more of a community based forum where moms with Gastroschisis babies can connect and talk with other moms going through similar situations. It is very important to be able to connect with others and provide feedback and advice for those who are going through the same hardships. 

PubMed is a very informational app that can provide mothers with education on the the diagnosis of Gastroschisis. It includes the treatment, recovery, prognosis, pathophysiology, medications and much more helpful information.

This another app that can be very helpful in providing valuable information about Gastroschisis. Including the diagnosis, treatment, diet, recovery and much more! 

http://whatisgastroschisis.weebly.com/apps.html

Support and Information For Parents of Children Diagnosed With Gastroschisis

1. Avery's Angels Gastroschisis Foundation: http://averysangels.org/averys-story

This foundation is an amazing recourse for parents and families that have babies with Gastroschisis. It was founded by a family who themselves had a child with Gastroschisis. Unfortunately, their son Avery did not make it. However, they explained how wonderful it was to have a solid support system that was always there for them in their time of need and wanted others to experience the same help. Avery's Angels is a foundation built to help educate and support those who are experiencing the trials of having a child with Gastroschisis. They offer programs to raise awareness for Gastroschisis, while raising funds both nationally and internationally for families affected by this disorder.  

2. Gastroschisis Help Resources and Member Contributed:

    Stories:http://www.gastroschisis.co.uk

This help center is great for everyone that has dealt with the effects Gastroschisis can have on families and those diagnosed. It is an open blog in which you may become a member. Those who visit this site can write and talk about anything relating to Gastroschisis. You can talk with other people who have experienced situations similar to yours regarding Gastroschisis. It has often been used by children who have survived treatment and repair of Gastroschisis, who may be experiencing complications since. It is a very good resource for those who have many questions and want to connect with others who are going through or have gone through similar complications. 

3. Band Back Together: http://www.bandbacktogether.com/gastroschisis-resources/

This website is a one stop shop if you're looking for a variety of resources that may help with a Gastroschisis diagnosis. A few of the resources listed include: 

• Baby loss resources
• Birth defects resources
• NICU resources 
• Life After the NICU
• Specialty needs parenting resources 
• Pregnancy resources 

4. CDC: http://www.cdc.gov/ncbddd/birthdefects/gastroschisis.html

The CDC provides the most up-to-date information and treatments for those with Gastroschisis. It includes the signs and symptoms, assessment, diagnosis, occurrence, risk factors, treatment and emotional support. I would recommend this for the most accurate scientific information regarding this disorder.

Resources 

http://www.cdc.gov/media/releases/2016/p0121-birth-defect.html

http://www.bandbacktogether.com/gastroschisis-resources/

http://www.gastroschisis.co.uk

http://averysangels.org/averys-story

Treatment 
There are many new treatment options that are being explored for the repair of Gastroschisis. The most traditional method that is being used today however is broken down like this:

• Your baby will receive general anesthesia, which allows your baby to remain pain free throughout the procedure. 
• The surgeon will then examine your baby's intestines (bowel) closely for signs and symptoms of damage or other birth defects. If the surgeon does find damaged parts, he will remove that section of the bowel and stitch the healthy edges together. 
• The organs that are outside of your baby's belly will be slowly inserted back through the opening in the abdomen. 
• If possible, the surgeon will repair the opening in the abdomen. 

This method can be performed right after the birth of your baby, however if the bowels are too big or damage from prolonged exposure to amniotic fluid the surgeon will not perform surgery for repair. If this is the case, your baby's intestines will be placed in what is called a Gastroschisis silo. This is where the exposed bowel is placed into a protective barrier, and over the course of a week or so the surgeon will guide the intestines back into the abdomen to prevent overloading the abdomen at once. 

One study found that the use of a Gastroschisis silo is the most simple, quick and effective way to place the bowel back into the abdomen. It allows for natural accommodation of the bowel into the abdominal cavity with little edema and vascular compromise and was the studies first choice in treatment of Gastroschisis (Fischer, Moores, Andrews, 1995). 

Signs/Symptoms of Complications From Gastroschisis Repair 

• Bilious or green vomiting 
• Bloated stomach
• No interest in feeding 
• Edema 
• Vascular compromise 

Fischer, J. D., Chun, K., Moores, D. C., & Andrews, H. (1995). Gastroschisis: A simple technique for staged silo closure. Journal of Pediatric Surgery, 30(8), 1169-1171. Retrieved February 28, 2016.

Harrison, M. R. (2015, March). Gastroschisis. Retrieved February 28, 2016, from http://www.pedsurg.ucsf.edu/conditions--procedures/gastroschisis.aspx

Signs and Symptoms of Gastroschisis 
There are no apparent signs and symptoms of Gastroschisis in utero or directly related to the mother, the only way of knowing its presence is by ultrasound. In an ultrasound you will see a large lump outside of the babies abdomen, usually appearing close to the umbilical cord (Chung, 2012).This is where you will see signs/symptoms including, small abdominal cavity, herniated intestines, swollen intestines and that opening in the abdominal wall previously mentioned. After birth, there are many symptoms and complications that can arise for a baby with Gastroschisis. Symptoms related to Gastroschisis can come from the twisting, squeezing, pinching and damage done to the organs as they passed through the narrow opening of the abdomen. Upon delivery of the baby, the doctor will assess the organs and make sure there is absence of major damage. In addition, about 1 in 10 babies with Gastroschisis will experience another bowel problem called intestinal atresia. This is occurs when part of the infant's intestine has not formed completely and becomes blocked. After treatment of Gastroschisis, babies can experience trouble digesting food, often forcing them to maintain a special diet while their body continues to heal (Chung, 2012).

Chung DH. Pediatric surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery.19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 67.

Diagnosis
Gastroschisis is fairly easy to detect early on in a woman's pregnancy. It is usually detected in the second trimester using antenatal sonography, a high frequency scan that allows us to see the baby's movement. The diagnosis of Gastroschisis can be made before 20 weeks gestation however, and even as early as 12 weeks! In early pregnancy, we can see the bowel loops freely floating in the amniotic fluid with the thickness and diameter of the bowel at a normal measurement. Later on in pregnancy more complications with the bowel can be detected. These include bowel obstruction, peritonitis, bowel perforation, and fetal growth restriction. Another method used to diagnose involves testing for  an elevated amniotic fluid alpha-feta protein level (AFP). This is caused because the herniated bowel is floating in amniotic fluid, which raises the maternal serum and AFP levels in a mother. Using AFP levels to diagnose a baby with Gastroschisis occurs between 77-100% of the time (Khan, 2015).

Khan, A. N. (2015, September 9). Gastroschisis. Retrieved February 10, 2016, from http://emedicine.medscape.com/article/403800-overview

Gastroschisis is becoming more common as the incedince in the United States and abroad rises. The CDC claims that about 1,871 babies are born each year with Gastroschisis. So what factors contribute to this birth defect? Unfortunately, the exact cause of Gastroschisis is unknown to a certain extent. Common links that have been attributed include changes in the babies genes, mother's lifestyle choices such as smoking and drinking, things she may come in contact with in her environment, certain medicines and possibly what she eats and drinks (CDC, 2016). As the CDC continues to study and research these exact links they have also found that younger teenage mothers were at a higher risk than older mothers. It was also found that white females among this young group were more likely to have a baby with Gastroschisis than black teenage mothers. Of these babies born with Gastroschisis, one study reported that 95% will survive hospitalization and treatment. Factors that lead to poor outcomes for these babies were found to include; cardiac disease, gastrointestinal, respiratory and infectious disease complications. Among the highest in these categories for causing mortality included, intestinal atresia, cardiac anomalies, lung hypoplasia and sepsis (Lao, Larison, Garrison, Waldhausen, Goldin, 2010). Another study found a possible cause regarding the pathophysiology and process of Gastroschisis. One hypothesis is that the high level of estrogen during early pregnancy causes thrombosis of fetal vessels; palmitic acid, which is a byproduct of thrombosis, affects cell signaling and prevents the fusion of body wall folds. This occurrence of thrombohilia explains the early onset of Gastroschisis and its high incidence in young mothers (Raveenthiran, 2012). 

Lao, O. B., Larison, C., Garrison, M. M., Waldhausen, J. H. T., & Goldin, A. B. (2010). Outcomes in Neonates with Gastroschisis in U.S. Children’s Hospitals.American Journal of Perinatology, 27(1), 97–101. http://doi.org/10.1055/s-0029-1241729

Raveenthiran, V. (2012). Etiology of Gastroschisis. Journal of Neonatal Surgery, 1(4), 53.

Epidemiology: Gastroschisis is an interesting disorder to track the prevalence and causes of. According to the Journal of Medical Genetics, their study found that Gastroschisis is strongly correlated with a very low maternal age. The prevalence of Gastroschisis among this population in the past was 1 in 50,000 births and has since increased by 10 and 20 fold. As this increase in prevalence is strongly correlated with low maternal aged mothers, this study found that the genetic reason behind this is still an unknown factor. In conclusion this study found that it is difficult to predict and determine epidemiologic data, this is because there are differing views between published data as a result of differences in each studies definition of Gastroschisis. Most of the time Gastroschisis is rare and isolated making it fairly easy to detect prenatally. This allows time for proper treatment with low morbidity an mortality rates. Prenatal diagnosis of this disorder is vital to proper postnatal care. With early diagnosis we can ensure adequate planning of delivery, making sure that the proper staff is ready and available. However this study found that because Gastroschisis hits disproportionately, the vulnerable and very young populations are at most risk. Along with this data they also found that Gastroschisis is more common in Caucasians than in African Americans and Orientals, making it clear there needs to be more studies done that examine the role that genes play in the incidence of Gastroschisis. 

Castilla EE, Mastroiacovo P, Orioli IM. 2008. Gastroschisis: International epidemiology and public health perspectives. Am J Med Genet Part C Semin Med Genet 148C: 162-179.

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Gastroschisis

Description: Gastroschisis is a birth defect of the abdominal (Belly) wall. A hole in the baby's belly just next to the belly button allows the intestines space to escape through. The size of the hole determines how much of the babies organs are exposed, these may include the intestines, stomach and liver. This disorder usually occurs early on in pregnancy after the muscles that make up the baby's abdominal wall do not form correctly. Because the bowel is exposed to amniotic fluid for a prolonged period of time, it can become very irritated causing it to shorten, swell or twist.