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PubMed This is a summary of 21 peer-reviewed journal articles Updated
Neonatology

The NICU Journey and Surgical Repair of Gastroschisis

At a Glance

After birth, a baby with gastroschisis requires specialized NICU care to protect the exposed bowel and surgically return it to the abdomen. Treatment involves surgical repair, IV nutrition, and slowly introducing milk as the digestive system wakes up.

The moments following birth and the weeks in the Neonatal Intensive Care Unit (NICU) are focused on two goals: safely returning the intestines to the abdomen and teaching the “sleepy” bowel how to digest milk. While this journey requires patience, the medical team uses highly specialized techniques to care for your baby every step of the way.

Immediate Postnatal Care

Right after birth, the medical team’s first priority is to protect the exposed bowel and keep the baby warm and stable [1].

  • Setting Expectations in the Delivery Room: Because the bowel is exposed, the baby will be brought immediately to a warming table for assessment. You will likely not be able to hold them for skin-to-skin contact right away, which can be an emotional shock [2][3]. However, your team will help you connect through “hand hugs” (resting your hands gently on them) as soon as they are stable.
  • Bowel Protection: The intestines are placed in a sterile, clear plastic bag (often called a “bowel bag”) to prevent moisture loss and protect them from infection [4][1].
  • Decompression: A small tube is usually placed through the nose or mouth into the stomach to remove air and fluid [1].

Options for Surgical Repair

The timing and method of repair depend on how much space is in the baby’s abdomen and how the bowel looks at birth.

  • Primary Closure: If there is enough room and the baby is stable, the surgeon may return the bowel and close the opening immediately—sometimes even at the bedside without general anesthesia [5][6]. This traditional closure can sometimes leave a visible scar or an altered belly button appearance.
  • Staged Closure (Silo): If the bowel is too swollen to fit safely all at once, a silo (a clear, spring-loaded plastic pouch) is placed over the bowel [7]. Over several days, the surgeon gently squeezes the silo to guide the bowel back into the abdomen using gravity [8]. Your baby will be given pain medication and sedatives to ensure they are comfortable and not in pain during these bedside reductions.
  • Sutureless (Umbilical Cord Flap) Repair: This modern technique uses the baby’s own umbilical cord tissue to cover the opening rather than using traditional stitches [7][9]. It often results in a very natural-looking belly button and can sometimes be done without the need for a breathing machine (ventilator) [10][11].

The Feeding Journey: From IV to Milk

Because the intestines have been exposed to amniotic fluid, they are often “thickened” and “sleepy” at birth [12].

  1. TPN (Total Parenteral Nutrition): For the first week or more, the baby will receive all their calories through an IV [13].
  2. Pumping and Trophic Feeds: Because the baby will initially be fed through a tube, mothers who wish to provide breastmilk will need to start by exclusively pumping shortly after delivery. Once the bowel shows signs of “waking up”, doctors will use this milk for “trophic feeds”—tiny amounts to prime the digestive system [13][14].
  3. Human Milk Advantage: Using human milk (mother’s own or donor milk) is easier to digest and is associated with shorter hospital stays [15][16]. Direct breastfeeding can eventually be introduced once the baby is stronger and their bowel is functioning fully.
  4. Standardized Protocols: Many NICUs now use strict, step-by-step feeding plans proven to help babies get home sooner [17][18].

What to Expect

The average NICU stay for a baby with “simple” gastroschisis is often 1 to 3 months, though every baby follows their own timeline [19][20]. The most significant milestones are the successful closure of the abdomen and the baby’s ability to take all their feedings by mouth or tube without IV support [19][21].

Common questions in this guide

Will I be able to hold my baby immediately after birth with gastroschisis?
Because the bowel is exposed, your baby will be taken immediately to a warming table for assessment and protection. While you likely cannot do skin-to-skin contact right away, your care team will help you connect through gentle 'hand hugs' as soon as your baby is stable.
What is a staged closure or silo repair for gastroschisis?
A silo is a clear plastic pouch placed over the exposed bowel when it is too swollen to fit safely into the baby's abdomen all at once. Over several days, the surgeon gently squeezes the silo to guide the bowel back into the belly using gravity while your baby is kept comfortable.
What is a sutureless gastroschisis repair?
A sutureless repair is a modern surgical technique that uses the baby's own umbilical cord tissue to cover the abdominal opening instead of traditional stitches. This method often results in a natural-looking belly button and may reduce the need for a breathing machine.
How will my baby be fed after gastroschisis surgery?
Initially, your baby will receive all their nutrition through an IV, known as total parenteral nutrition (TPN). Once the bowel begins to wake up, doctors will introduce tiny amounts of breast milk or donor milk, called trophic feeds, to prime the digestive system.
How long will my baby stay in the NICU for gastroschisis?
The average NICU stay for a baby with simple gastroschisis is typically between one and three months. The timeline depends on when the abdomen is successfully closed and how quickly your baby can digest all their feedings without IV support.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Which repair method (primary, silo, or sutureless) do you anticipate using, and what factors will determine that decision at birth?
  2. 2.How soon after the repair can we start 'trophic feeds' (small amounts of milk to prime the gut)?
  3. 3.Does your NICU have a standardized feeding protocol specifically for gastroschisis babies?
  4. 4.Will my baby need a breathing tube or general anesthesia for the repair, or can it be done at the bedside?
  5. 5.What signs are you looking for to know that the bowel is 'awake' and ready for milk?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (21)
  1. 1

    Sutureless closure for the management of gastroschisis.

    Diyaolu M, Wood LS, Bruzoni M

    Translational gastroenterology and hepatology 2021; (6()):31 doi:10.21037/tgh-20-185.

    PMID: 34423152
  2. 2

    Gastroschisis: embriology, pathogenesis, risk factors, prognosis, and ultrasonographic markers for adverse neonatal outcomes.

    Muniz TD, Rolo LC, Araujo Júnior E

    Journal of ultrasound 2024; (27(2)):241-250 doi:10.1007/s40477-024-00887-8.

    PMID: 38553588
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    Improving care and survival of newborns with surgical conditions in Tanzania (TINY Tanzania): a focus on gastroschisis.

    Philipo GS, Bokhary ZM, Kapapa M, et al.

    Pediatric surgery international 2024; (40(1)):250 doi:10.1007/s00383-024-05828-4.

    PMID: 39237649
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    Closed gastroschisis with left defect: a rare variant.

    Singh JK, Yadav DK, Khanna K, Khanna V

    BMJ case reports 2018; (2018()) doi:10.1136/bcr-2017-223846.

    PMID: 29367227
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    Tu-be or not tu-be? Is routine endotracheal intubation necessary for successful bedside reduction and primary closure of gastroschisis?

    Miyata S, Joharifard S, Trudeau MO, et al.

    Journal of pediatric surgery 2022; (57(3)):350-355 doi:10.1016/j.jpedsurg.2021.06.011.

    PMID: 34304903
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    Outcomes of bedside sutureless umbilical closure without endotracheal intubation for gastroschisis repair in surgical infants.

    Pet GE, Stark RA, Meehan JJ, Javid PJ

    American journal of surgery 2017; (213(5)):958-962 doi:10.1016/j.amjsurg.2017.03.017.

    PMID: 28385380
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    Sutureless vs sutured abdominal wall closure for gastroschisis: Operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium.

    Fraser JD, Deans KJ, Fallat ME, et al.

    Journal of pediatric surgery 2020; (55(11)):2284-2288 doi:10.1016/j.jpedsurg.2020.02.017.

    PMID: 32151403
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    Does timing of gastroschisis repair matter? A comparison using the ACS NSQIP pediatric database.

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    Journal of pediatric surgery 2017; (52(11)):1751-1754 doi:10.1016/j.jpedsurg.2017.02.008.

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    Management of gastroschisis in an extremely low birth weight infant: report of a case.

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    PMID: 39379753
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    Evaluation of Clinical Outcomes of Sutureless vs Sutured Closure Techniques in Gastroschisis Repair.

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    JAMA surgery 2019; (154(1)):33-39 doi:10.1001/jamasurg.2018.3216.

    PMID: 30325977
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    Implementing a standardized gastroschisis protocol significantly increases the rate of primary sutureless closure without compromising closure success or early clinical outcomes.

    Joharifard S, Trudeau MO, Miyata S, et al.

    Journal of pediatric surgery 2022; (57(1)):12-17 doi:10.1016/j.jpedsurg.2021.09.022.

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    Gastroschisis Complicated by Colonic Atresia.

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    The American surgeon 2023; (89(6)):2762-2763 doi:10.1177/00031348211048848.

    PMID: 34730464
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    Nutritional management and postoperative prognosis of newborns submitted to primary surgical repair of gastroschisis.

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    Early Commencement of Enteral Feeds in Gastroschisis: A Systematic Review of Literature.

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    Enteral Feeding with Human Milk Decreases Time to Discharge in Infants following Gastroschisis Repair.

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    Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study.

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    Journal of pediatric surgery 2024; (59(5)):863-868 doi:10.1016/j.jpedsurg.2024.01.045.

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    The effect of standardized feeding protocol on early outcome following gastroschisis repair: A systematic review and meta-analysis.

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This page explains gastroschisis surgical repair and NICU care for educational purposes only. Your neonatologist and pediatric surgeon are the best sources for your baby's specific treatment plan.

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