The case of the inside-out baby.

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Sept. 28 2006 6:24 PM

The Case of the Inside-Out Baby

What happens when organs fall out of a fetus?

Note: Some links in this article go to Web sites containing graphic and possibly disturbing images of the medical conditions described.

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The newborn daughter of Joseph "Reverend Run" Simmons, formerly of the rap group Run-DMC, died shortly after her birth last week. On Tuesday, the Web site TMZ.com reported that "the baby girl was born with organs outside the body." Hold on a minute … TMZ says the baby girl was born with what?

You heard me. It's not that rare for babies to be born with some organs outside of their bodies—and the condition isn't necessarily life-threatening. One out of every few thousand newborns has the condition, which can take several forms. In the most common varieties—called gastroschisis and omphalocele—the baby's bowels or other viscera protrude from a hole in its abdomen. The mortality rates for these conditions are about 15 percent and 40 percent, respectively.

Daniel Engber Daniel Engber

Daniel Engber is a columnist for Slate

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A baby with gastroschisis develops in the womb with its guts spilling out of an opening of about 1 inch or 2 inches in diameter, located just to the right of the umbilical cord. In most cases, it's just big enough to leak a few loops of small intestine. Sometimes large portions of the intestine and stomach can also slide out into the amniotic fluid. Once the viscera are exposed, they become inflamed and can lose their function. (Some researchers blame the damage on urine in the amniotic fluid.) Malnutrition, dehydration, and secondary intestinal defects pose major risks for the baby.

Doctors treat gastroschisis by trying to push the baby's organs back into its body. This doesn't have to be done immediately after birth, and in some cases the job gets easier the longer you wait. At first, the protruding intestines may be so rigid and inflamed that they don't quite fit inside the abdomen. The doctors can make a "silo" around the intestines with sheets of a silicone material called Silastic. Then they lay the baby on its back and wait as the innards soften up and gravity coaxes them back into place. After a while they remove the silo and sew up the abdominal cavity.

Omphalocele looks similar to gastroschisis, except the protruding organs aren't free-floating in the amniotic fluid. Instead they're encased in a thin membrane. An omphalocele forms when the umbilical cord doesn't fuse properly to the baby's abdomen: The abdominal wall fails to develop, and the baby's organs slide out into a ball at the base of the cord. A mild case involves only a portion of the small intestine; a "giant omphalocele" can include the liver, spleen, and ovaries or testes.

An omphalocele is much more dangerous than gastroschisis for several reasons. First, it often comes with a host of other birth defects, like chromosomal anomalies, and heart and neural-tube deformities. Babies with giant omphaloceles also tend to have undersized abdomens and lungs. The tiny lungs can cause severe respiratory problems and death.

It's unclear whether Reverend Run's baby suffered from either of these conditions. (Run's brother—producer Russell Simmons—told the New York Daily News he didn't believe the reports of her grisly birth.) Doctors usually diagnose gastroschisis and omphalocele by ultrasound at about 20 weeks. In general, the conditions are treated after birth.

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