NEURAL TUBE DEFECTS

2. NEURAL TUBE DEFECTS
PREPARED BY:-
Mrs.SHALI MSc
NURSING
MCON

3. INTRODUCTION
During pregnancy, the brain and spine begin
as a flat plate of cells. This plate rolls into a
tube, called the neural tube. The tube is
completely formed 28 to 32 days after
conception. If all or part of the neural tube
fails to close, this leaves an opening. The
opening is called an open neural tube defect.
The opening in the tube may be left exposed
or covered with bone or skin

5. INTRODUCTION
• Neural tube defects are the congenital
malformations of the CNS resulting from a
defective closure of the neural tube during
early embryogenesis between 3rd and 4th
week of intrauterine life.
• It involves the defects in the skull, vertebral
column, the spinal cord and other portion of
CNS.

6. DEFINITIONS:
• The failure of closure of a portion of the
neural tube disrupts the differnation of
central nervous system induction of the
vertebral arches.
• A number of developmental malformations
of along the neuraxis from developing brain
the sacrum that are called Neural Tube
Defects

7. INCIDENCE
• It occurs in about 1 to 5 per 1000 live births.

8. ETIOLOGY
• Maternal radiation exposure, drugs(valproic
acid),
• Exposure to chemicals,
• Malnutrition especially folic acid deficiency
and
• Genetic factors

10. SPINA BIFIDA CYSTICA

11. Spina Bifida
• Spina Bifida latin word for split spine.
• Most common group of birth defects called
neural tube defects (NTD).
• The neural tube develops into the brain and
spinal cord.
• Birth defect resulting from the incomplete
closure of the embryonic neural tube

12. “Split Spine caused by incomplete
closure of the neural tube, usually in
the lumbar or sacral region
What is spina bifida?

13. What is Spina Bifida?
• It’s a defect of the spine in a developing fetus, it
affects the brain, spinal cord, and it’s muscles
surrounding it, and resulting in loss of
movement and or sensation to the legs and feet
as well as bowel movement and bladder
dysfunction.
• An unfortunately common birth defect
• that affects about 1,300 babies each year-

15. When does Spina Bifida occur?
• Occurs between days 24 and 28 of gestation.
• This disorders arise from abnormalities
occurring during three major concurrent
migrations of cell groups during
embryogenesis which include those of the
neural tube, the notochord, and the
mesenchymal tissue.

16. • It plays an important role in inducing
formation of the spinal cord and spinal
column.

17. Etiology
• History of previous affected pregnancy
• Inadequate intake of folic acid
• Pre gestational diabetics
• Valpronic acid and carbazepmine
SUSPECTED:
• Maternal hyperthermia
• LES
• Chlorination of disinfection by produces in
drinking water.

18. TYPES OF THE SPINA BIFIDA
• Occulta
• Meningocele
• Myelomeningocele

19. Three forms of Spina Bifida
• Occulta-There is a small defect or gap
in one or more vertebrae of the spine,
most affected individuals have no
problems.
• Mildest form
• No symptoms
• Gap in one or more of the vertebra of
the spine
• Dimple, hairy patch, dark spot or
swelling over affected area
• Spinal cords and nerves usually normal
• no treatment needed

21. MENINGOCELE
It is hernia protrusion of
the meninges through a
midline defect in the
posterior vertebral arch.
It forms a fluctuating
cystic swelling filled
with CSF and covered by
a thin transparent
membrane or with skin.

22. • The Meningocele sac
should be protected
from infection and
injury. The infant
should be positioned
on the abdomen to
avoid pressure on the
sac. If the sac is not
covered with skin, it
should be protected
with sterile moist
dressing.

23. Myelomeningocele
• Most severe form
• Cyst holds both membranes
and nerve roots of spinal cord
and, often, the cord itself
• Sometimes, a fully exposed
section of spinal cord and
nerves
• Closed surgically after birth
• affected babies: leg paralysis
and bladder and bowel control
problems

24. Causes
• Causes of spina bifida are
not completely understood
scientists believe both
genetic and environmental
factors cause this
• However, 95% of affected
babies are born to parents
with no family history of
these disorders

25. CAUSES:-
• Women with certain chronic health problems
such as diabetes and seizure disorders have
an increased risk of having a baby with spina
bifida especially if taking anticonvulsant
medications. Approximately 1/100 of having
a baby with spina bifida.

26. Who is at risk ?
• ANYONE!
• Couples who already had an affected baby has an increased
risk of having another affected baby.
• Women who are obese, have poorly controlled diabetes, or
who are treated with certain anti-seizure medications have
a higher risk

27. Signs and symptoms:-
• Flaccid paralysis, absence of sensation and
drop reflex.
• Postural abnormalities like club foot,
subluxation of hips may be present.
• Spasticity and hyperactive
• Hydrocephalus is usually associated with
this anomaly.
• contractures of joints, scoliosis and
kyphosis may develop.

28. Screening and Diagnosis
Prenatal Tests
 AFP
 Ultrasound
 Testing of Amniotic fluid
Evaluation
• Analysis of individual medial history
• Physical examination
• Evaluation of critical body systems
Imaging Studies
• X-rays
• Ultrasound
• CT scan
• MRI

29. What are the effects of Spina Bifida?
Ongoing medical challenges
– Full or partial paralysis
– Nervous system complications
– Bladder and bowel control difficulties
– Learning disabilities
– Depression
– Social and sexual issues

30. Treatment
• No cure
• Regular check ups with
physician
• Surgery (24 hours after
birth)
• Medication
• Physiotherapy

31. How can spina bifida be managed?
-Detection
-Triple screening
-Maternal blood test for a-fetoprotein
-Ultrasound for bone defects
-Amniocentesis
- a-fetoprotein is elevated in 75-80%
of cases of spina bifida
(myelomeningocele)

32. How can spina bifida be
managed?
-Antibiotics
- In some cases the spinal cord is
exposed to the environment
- Antibiotics are essential in preventing
infection of the CNS

33. How Is Spina Bifida treated?
• One way that Spina Bifida is being treated is
by operating on the fetus while still in the
womb. This procedure is done as if fetus is
being delivered via cesarean section.
• Another way is that it is usually treated
surgically between 24 to48 hours after birth.

34. How can spina bifida be managed?
Treatment for spina bifida depends on the
extent of spinal cord involvement:-
- Spina bifida occulta usually requires no treatment
unless pain from tethering develops
- Meningocele usually requires removal and early
management of the cyst
- Myelomeningocele usually requires the most
extensive treatment, but treatment is variable

35. Surgery
• Usually performed with in 24 hours after
birth.
• They remove the infected area and replace it
with muscle tissue and skin.
• Helps protect against hydrocephalus.

36. Assistive Devices
• Braces
• Crutches
• Wheel chairs

37. Complications
Factors that affect the severity of complications
include:
• The size and location of the neural tube defect .
• Whether skin covers the affected area
• Whether spinal nerves come out of the affected
area of the spinal cord.
• Children with myelomeningocele may experience
physical and neurological problems, including
lack of normal bowel and bladder control, and
partial or complete paralysis of their legs.

38. • Babies born with myelomeningocele also
commonly experience accumulation of fluid in the
brain, a condition known as hydrocephalus.
• Most babies with myelomeningocele will need a
shunt .
• The majority of newborns with myelomeningocele
survive.
• some may develop meningitis, an infection in the
tissues surrounding the brain

40. -Children with myelomeningocele often
have hydrocephalus (blockage of CSF)
- Children may present with paralysis,
blindness, MR, inability to speak,
convulsions
-Any changes in mental status or
behavior should be quickly brought to
the attention of the child’s physician(s)
Careful Observation

41. Goals of Intervention
• Teaching gross motor and spatial skills to facilitate
coordination.
• Developing and maintaining fitness and flexibility to
emphasize self sufficiency.
• Encouraging movement and fitness to overcome
susceptibility to obesity.
• Developing physical skills that generalize to
activities of daily living and vocational skills.
• Promoting social development in recreational and
group play activities, such as aquatics.
• Providing appropriate social outlets for enjoyment
and self satisfaction on an individual basis as well as
with family or peers within the community.

42. Activities and Exercise
• Body Awareness
• Group Play
• Parachute activities
• Upper body activities
• Strength training
• Aquatics
• Flexibility
• Relays
• Wheel chair activities

43. Prevention
• Folic Acid -- 70% can be
prevented
• multivitamin of 400
micrograms of folic acid
every day
• every day foods: grain
products, fortified foods,
leafy-green vegetables,
dried beans, oranges, orange
juice

44. prognosis
• Prognosis depends on the number and
severity of abnormalities and associated
complications.

45. DIAGNOSIS:-
• Primary diagnosis is done by clinical
manifestations.
• Associated anomalies can be detected by X-
ray, CT scan, MRI and complete
neurological assessment.
• Routine blood and urine examination are
also necessary.
• Prenatal diagnosis done by amniocentesis
and estimation of alpha fetoprotein.

46. NURSING MANAGEMENT

47. • Prevention of injury and infection of the sac
by appropriate positioning with protective
covering (sterile dressing)
• Prevention of skin break down and
monitoring of signs of hydrocephalus( head
circumference, fontanel, feeding behavior).
• Provision of adequate nutrition, promotion
of urinary elimination and bowel regularity,
prevention of leg or hip deformities and
other complications.

48. • Preoperative care, promotion of growth and
development, emotional and psychological
support, health teaching regarding care of
the child are also important aspect of
management.

49. Thank you for listening!