They checked the blood flow and looked for blockages and lesions.
No one could say what had caused the birth defect. Gastroschisis occurs in one in 2,500 births and is rising markedly, suggesting an environmental trigger for an underlying genetic problem.
At the end of the day, however, CHOP's doctors had a plan based on experience with hundreds of such cases.
Janaya would come for monthly checkups at first. Then, around her 32d week, when the baby's danger of life-threatening complications would grow, twice a week.
And, with the addition of the SDU, they would deliver the baby at CHOP.
The doctors explained that even with gastroschisis, a vaginal delivery would be better than a C-section, as it is for most babies.
Making sure the baby survived to birth would be the first hurdle.
Nationally, about 10 percent of gastroschisis babies die before they are born. But at CHOP, with close monitoring for signs of fetal distress, the risk to Janaya and John's child was lower.
Four decades ago, when IV nutrition was in its infancy, almost all gastroschisis babies died. Moreover, for many years the problem wasn't recognized until the baby was born, complicating care.
Today, with modern ultrasound technology, almost all cases are discovered months before birth.
The doctors at CHOP have developed protocols for taking care of these babies before and after birth. Plus, they treat 30 to 40 such patients a year, yielding a 95 percent survival rate, compared with a national rate of about 85 percent.
Once born, Janaya's baby would be immediately handed over to a team of neonatologists and surgeons, who would start the slow process of putting his intestines back into his body.
Even then, the doctors explained to John and Janaya, the baby would face a long course of care with risks of serious - sometimes fatal - setbacks.
The key would be how well the newborn's inflamed intestines recovered from months of exposure to amniotic fluid. Any severely damaged segments would need to be removed. If too much of the intestines were lost, the prognosis would be bleak.
For gastroschisis babies, blockages and infections are major concerns. Necrotizing enterocolitis, or NEC, happens when poor blood flow damages the intestines, leading to serious infections. It occurs in as many as one in five such babies after birth.
Because the baby's abdominal cavity would be too small to absorb the intestines all at once, it could take weeks. The intestines would be inched in through the same hole they had spilled out of. Then it was a relatively simple "surgical closure" to sew him up.
Janaya was glad to have a plan.
But something nagged at the back of her mind for the hour-long drive home to Phoenixville. She was sure all the doctors at CHOP were very good. She just wanted the best one.
She jumped online as soon as she got home.
The next day she called CHOP's surgeon-in-chief, N. Scott Adzick, a pioneer in fetal surgery. Could she persuade the renowned pediatric surgeon to take her son's case?
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