CHILD HEALTH NURSING

1. NEURAL TUBE DEFECTS
Mr. M. Binanda Singh
RINPS

2. NEURAL TUBE
• The neural tube is the
embryonic structure
that eventually
develops into the baby's
brain and spinal cord
and the tissues that
enclose them.

3. What are neural tube defects (NTDs)?
Between the 17th and 30th day after
conception (or 4 to 6 weeks after the first day
of a woman's last menstrual period), the
neural tube forms in the embryo (developing
baby) and then closes.
The neural tube later becomes the babys
spinal cord, spine, brain, and skull.

5. Contd…….
 A neural tube defect (NTD) occurs when the
neural tube fails to close properly, leaving the
developing brain or spinal cord exposed to the
amniotic fluid.
 The two most common neural tube defects
are Anencephaly and Spina bifida.

6. Anencephaly

7. SPINA BIFIDA

8. INTRODUCTION
• Spina bifida is part of a group of birth defects
called neural tube defects.

9. DEFINITION
• It is a malformation of spine,
in which posterior portion of
lamina of vertebra fail to
close with or without
defective development of
spinal cord.

10. INCIDENCE
• Most common developmental defect of
central nervous system, occurring in about 1
or 2 per 1000 live births.
• May occur in any area of spine but most
commonly occurs in the lumbosacral area.
**Why commonly in the lumbosacral area?**

11. ETIOLOGY
• Genetic- (15 times more probability of
inheriting the defect)
• Maternal age- ( twice more common in
pregnant mother over 35 year or below 20
year)
• Environment
• Diet lack in folic acid

12. Classification
Spina bifida
Spina bifida cystica
Meningocele Myelomeningocele
Spina bifida
Occulta

13. Spina bifida Occulta
• A defect which results from
failure of formation of bony arch
around the spinal cord, but
spinal cord and meninges are
normal.
• It is not visible externally and is
asymptomatic.
• Occurs in 5% cases of
spina-bifida.

15. Clinical features
• Most of the patients are
asymptomatic.
• A dimple in the skin or growth of
hair over malformed vertebra.
• As the child grows, he may
develop foot weakness or
disturbances of bladder and
bowel sphincter.

17. Spina bifida cystica

18. • An external cystic defect can be seen at the back.
• The sac is composed only of meninges and is filled
with CSF.
• Spinal cord and nerves are normal.
• Patient may have weakness of legs or lack of
sphincter control.
Meningocele

20. Myelomeningocele
• Also known as open spina bifida,
Myelomeningocele is the most severe form.
• Spinal canal remains open along several
vertebrae in the lower or middle back.
• Both the membranes and the spinal cord
protrude forming a sac on the baby's back.
• In some cases, skin covers the sac.
However, tissues and nerves are exposed,
making the baby prone to life-threatening
infections.

21. • Manifestations of myelomeningocele depend on the
location and extent of defect.
• The higher the deformity the more neurological
deficits will be present.
• Approx. 90% of infants with severe spina bifida
develop hydrocephalus due to associated
Arnold-chiari syndrome. (a condition in which brain tissue
extends into your spinal canal.)
Myelomeningocele

23. • Loss of motor control and sensation occurs
according to the level of the lesion.
1. A low thoracic lesion may cause total flaccid
paralysis.
2. A sacral lesions leads to weakness of lower
limbs.
Myelomeningocele

26. Clinical features
• UTI are more common.
• Congenital skeletal anomalies may be present
due to denervation (any loss of nerve supply
regardless of the cause) e.g club foot,
dysplasia of hip, kyphosis and scoliosis.

27. Club foot

28. dysplasia of hip

29. dysplasia of hip

30. kyphosis and scoliosis

31. • These deformities are not only a cosmetic
problem, they may lead to back pain,
respiratory distress, difficulty movement,
recurrent skin breakdown.
Clinical features

32. DIAGNOSTIC EVALUATION
• Prenatal diagnosis : USG
Fetal MRI
Amniocentesis
• After birth:
 Neonatal examination
 CT scan, MRI
 Neurological assessment
 Laboratory tests

33. Amniocentesis
• Amniocentesis can also detect neural tube
defects, such as spina bifida, by measuring levels
of alpha-fetoprotein in the amniotic fluid.
• High levels of AFP may suggest the developing
baby has a neural tube defect such as spina bifida
or anencephaly.
• Test should be done between 14th to 16th week of
gestation who are at risk.

34. TREATMENT
• Spina bifida treatment depends on the
severity of the condition.

35. SURGERY

36. Spina bifida occulta
• Often doesn't require treatment at all, but
other types of spina bifida do.

37. Spina bifida cystica
• Required Laminectomy and closure of the
defect or removal of the sac is done in 24-48
hours of birth.
• T-closure of skin graft is done.

38. NURSING MANAGEMENT
Aim:
• Prevention of infection.
• Preventing injury to the sac.
• Prevention of skin breakdown.
• Preventing urinary tract infection.
• Preventing leg and hip deformities.
• Adequate nutrition.

39. REFERENCE
• Marlow Dorothy, “Text book of pediatric
nursing”, 6th ed., W.B. Saunders Company, 1988
• Marilyn J. Hockenberry “Wong’s essentials of
pediatric nursing”, 7thEd., Mosby Publication 2005
• Pediatric nursing as per INC syllabus 4th edition by
Parul dutta.
• Nelson essential of pediatrics First south asian
ediation, Elsevier By Karen Marcdante, Robert m
kiegman
• Essential pediatric nursing book by rimple Sharma
jaypee publishers.

40. THANK YOU