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2. DEFINITION
Spina bifida (Latin: "split spine") is a
developmental congenital disorder caused by the
incomplete closing of the embryonic neural tube.
The closure of the neural tube occurs around the
23rd and 27th day after fertilization.
Some vertebrae overlying the spinal cord are not
fully formed and remain unfused and open.

3. CAUSES
• Maternal diabetes
• Family history
• Obesity
• Medications such as some anticonvulsants ex.
Valproic acid have an increased risk of having
children with spina bifida
• Folic acid deficiency

6. SPINA BIFIDA OCCULTA
• Occulta is Latin for "hidden". This is the
mildest form of spina bifida.
• In occulta, the outer part of some of the
vertebrae is not completely closed.
• The splits in the vertebrae are so small that the
spinal cord does not protrude. The skin at the
site of the lesion may be normal, or it may
have some hair growing from it, there may be
a dimple in the skin .

7. MENINGOCELE
• The least common form of spina bifida in
which cyst or fluid filled sac pokes through an
open part of the spine .
• The sac contain membranes that protect spinal
cord ie CSF and meninges.

8. MYELOMENINGOCELE
• This type of spina bifida often results in the
most severe complications.
• In which cyst or fluid filled sac pokes through
an open part of the spine .
• The sac contain spinal cord, CSF and
meninges.

9. CLINICAL MANIFESTATIONS
Physical Signs:
• Bladder and bowel control problems, including
incontinence, urinary tract infections, and poor
renal function.
• Pressure sores and skin irritations
• Paralysis

10. CONT…..
• Scoliosis
• Back pain
• Partial or complete lack of sensation
• Weakness of the hips, legs, or feet of a
newborn
• Other symptoms may include: Dimpling of the
sacral area
• Below-average intelligence.

11. EXECUTIVE FUNCTION
• Specific areas of difficulty in some individuals
include planning, organizing, initiating, and
working memory. Problem-solving,
abstraction, and visual planning may also be
impaired.

12. DIAGNOSTIC EVALUATION
 Neonatal examination
Pregnancy screening:
• Neural tube defects can usually be detected
during pregnancy by testing the mothers blood
(AFP screening) or a detailed fetal ultrasound.
• Increased levels of maternal serum alpha-
fetoprotein is seen in neural tube defects.
• Ultrasonography, X ray , CT Scan, MRI

13. TREATMENT
• PRENATAL SURGERY
The surgeon opens the uterus and repair the spinal
cord of the fetus, usually during week 19 to 25 of
pregnancy.
• POSTNATAL SURGERY
Laminectomy and closure of defect within 24 to 48
hours of birth. The spinal cord and its nerve roots
are put back inside the spine and covered with
meninges.

14. PREVENTION
• Dietary supplementation with folic acid in
pregnancy has been shown to be helpful in
reducing the incidence of spina bifida. Sources
of folic acid include whole grains, cereals,
dried beans, leaf vegetables and fruits.
• It is recommended that any woman
considering becoming pregnant should take 0.4
mg of folic acid a day.

15. NURSING MANAGEMENT
Pre-Op
• Position the child in prone with legs abducted.
This reduces tension and risk of sac trauma.
• Put the child in an incubator or warmer . This
maintains normal body temperature.
• Apply moist and sterile dressing to avoid
drying of the area due to heat in the incubator.
• Change dressing two-four hourly to avoid
infection.

16. Post-Op
• Position the child in prone to avoid pressure on
suture, or side lying position alternatively.
• Monitor the child`s vital signs every 30 minutes
until stable.
• Monitor input and output.
• Encourage the mother to continue breastfeeding if
the child is being breastfed.
• Remove the dressings after 48hrs to check any
signs of bleeding or bulging. Observe for leakage.

17. COMPLICATIONS
• Frequent urinary tract infections
• Hydrocephalus
• Loss of bowel or bladder control
• Meningitis
• Permanent weakness or paralysis of legs

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