Medanta Gurugram treats a newborn with rare congenital condition Gastroschisis

New Delhi: A team of specialists at Medanta Hospital in Gurugram has successfully treated a newborn girl with Gastroschisis, a rare congenital condition where the intestines protrude outside the body. This potentially life-threatening defect requires immediate surgical intervention post-birth to correct. 

Sakshi Shukla, from Punjab, discovered the condition during a Level-2 scan at 18-20 weeks of pregnancy. This diagnosis led her to Medanta, where she settled for the remainder of her high-risk pregnancy to ensure specialized care. The Medanta team was led by Dr. Shandip Kumar Sinha, Director of Pediatric Surgery, Dr. Preeti Rastogi, Director of Obstetrics and Gynecology, and Dr. T J Antony, Director of Neonatology. 

Dr. Preeti Rastogi emphasized, “When the patient came to us at 26 weeks, we first ruled out any associated developmental problems as associated soft tissue and developmental anomalies can throw up challenges. We recommended close follow-ups to ensure the foetus was not at risk of intrauterine growth restriction (IUGR) or premature delivery.”

“In Gastroschisis, it is crucial that the baby is born at term because prematurity adds additional risks and complications to an already difficult situation. At 37 weeks, since our patient was beginning to show early signs of severe oligohydramnios (decreased amniotic fluid) and there was decreased foetal movement, we took her up for elective caesarean section. Although IUGR had set in, the baby weighed 2.3kg at birth and had fully developed organs, making the surgery safer,” she added.

Dr. Antony stated, “The neonatal team was present at birth to ensure she started breathing effectively and normally. Simultaneously, the surgical team worked to ensure the intestines did not dry out and covered them properly in a polythene wrap to keep them moist, and protected from germs and contaminants. They also ensured there were no blockages or malrotation. Then we wheeled the baby into the neonatal intensive care unit (NICU), where she was stabilised, her initial workup was done, and after two hours she was ready for surgery.”

Dr. Sinha explained, “Operating on a newborn within the first few hours of life is complex due to the body’s transitional changes. Creating the necessary space without making it too tight was critical to maintaining viability. In this child, after emptying the meconium (the first stool of an infant) and mobilising the delicate skin flap, we were able to create space for the intestine to be placed inside abdominal cavity. We made sure that the closure was not associated with compartment syndrome. The entire surgery took 1 hour 30 minutes and there were no post operative complications.”

Post-surgery, the baby was ventilated for 48 hours and began gastric feeds on the fifth day. Until then, she received total parenteral nutrition intravenously. Dr. Antony noted the gradual increase in feedings was well-tolerated, with no infections, allowing the baby to gain weight steadily. After 12 days, she was discharged home with her mother.

Shukla noted that the detailed explanations and supportive environment helped her navigate this challenging period with confidence and assurance. The success of this case highlights the critical role of tertiary care hospitals in providing the necessary resources and expertise to manage rare and complex conditions like Gastroschisis.

Gastroschisis affects approximately 4.3 per 10,000 live births and poses a significant survival challenge, with an overall survival rate in India at 45%, compared to 90% in Western countries. Previously, conditions like gastroschisis were often discovered at birth, reducing survival chances, but now they are detected during Level 2 scans, allowing parents to seek appropriate care in advance.