Myelomeningocele is a disorder of the nervous system particularly the spine and spinal cord, before we go further in this presentation there are some terms to know to aid understanding. ➢Neural tube; The neural tube forms the early brain and spine, As development progresses, the top of the neural tube becomes the brain, and the rest of the tube becomes the spinal cord. An NTD happens when this tube doesn't close completely somewhere along its length. Neural tube closure is completed 28 days (four weeks) from conception. ➢Alpha fetoprotein; AFP is a protein that the liver makes when its cells are growing and dividing to make new cells. AFP is normally high in unborn babies. After birth, AFP levels drop very low. Healthy children and adults who aren't pregnant have very little AFP in their blood. Maternal AFP serum level is used to screen for Down syndrome, neural tube defects, and other chromosomal abnormalities. ➢Spinal bifida; Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD). Nursing management of myelomeningocele Types of spinal Bifida Pathophysiology of myelomeningocele

1. MYELOMENINGOCELE
A PRESENTATION BY AJISAFE ZAINAB

2. INTRODUCTION
A myelomeningocele is a sac that contains:
part of the spinal cord
its covering (called the meninges)
spinal fluid
It is also called an open spinal bifida, Myelomeningocele can happen anywhere along the baby’s
spinal cord.

3. INTRODUCTION
Myelomeningocele is a disorder of the nervous system particularly the spine and spinal cord,
before we go further in this presentation there are some terms to know to aid understanding.
Neural tube; The neural tube forms the early brain and spine, As development progresses, the
top of the neural tube becomes the brain, and the rest of the tube becomes the spinal cord. An
NTD happens when this tube doesn't close completely somewhere along its length. Neural tube
closure is completed 28 days (four weeks) from conception.
Alpha fetoprotein; AFP is a protein that the liver makes when its cells are growing and dividing
to make new cells. AFP is normally high in unborn babies. After birth, AFP levels drop very low.
Healthy children and adults who aren't pregnant have very little AFP in their blood. Maternal
AFP serum level is used to screen for Down syndrome, neural tube defects, and other
chromosomal abnormalities.
Spinal bifida; Spina bifida is a condition that affects the spine and is usually apparent at birth. It
is a type of neural tube defect (NTD).

4. INTRODUCTION
Day 18 of pregnancy the heart starts to develop and between week 5 to 8 the baby's spine
starts to grow very early in your pregnancy – often before you know you're pregnant.
SPINAL BIFIDA
Spina bifida can happen anywhere along the spine if the neural tube does not close all the way.
When the neural tube doesn’t close all the way, the backbone that protects the spinal cord
doesn’t form and close as it should. This often results in damage to the spinal cord and nerves.
Spina bifida might cause physical and intellectual disabilities that range from mild to severe. The
severity depends on:
The size and location of the opening in the spine.
Whether part of the spinal cord and nerves are affected.

5. TYPES OF SPINA BIFIDA
The three main types of spinal bifida are;
Spinal bifida occulta; This type of spina bifida usually does not cause any disabilities.
Meningocele; There is usually little or no nerve damage. This type of spina bifida can cause
minor disabilities.
Myelomeningocele; This type of spina bifida causes moderate to severe disabilities, such as
problems affecting how the person goes to the bathroom, loss of feeling in the person’s legs or
feet, and not being able to move the legs.

6. SPINAL BIFIDA OCCULTA

7. MENINGOCELE

8. MYELOMENINGOCELE

9. CAUSES AND SYMPTOMS
Causes
We do not know all the causes of spina bifida. The role
that genetics and the environment play in causing
spina bifida needs to be studied further. Some risk
factors include;
Folic acid deficiency
Maternal age
Gestational or type 2 diabetes
Obesity
takes some types of seizure medicines during
pregnancy
already has had a baby with spina bifida
Always high temperature
Symptoms
A newborn with this disorder will have an open area or
a fluid-filled sac on the mid to lower back.
Symptoms may include:
Loss of bladder or bowel control
Partial or complete lack of sensation
Partial or complete paralysis of the legs
Weakness of the hips, legs, or feet of a newborn
Other signs and/or symptoms may include:
Abnormal feet or legs, such as clubfoot
Buildup of fluid inside the skull (hydrocephalus)

10. SIGNS AND SYMPTOMS
In general, infants with spina bifida cystica
present with the following:
Lethargy
Poor feeding
Irritability
Stridor
Ocular motor incoordination
Development delay
Older children may present with the following:
Cognitive or behavioral changes
Decreased strength
Increased spasticity
Changes in bowel or bladder function
Lower cranial nerve dysfunction
Back pain
Worsening spinal or lower extremity
orthopedic deformities

11. PATHOPHYSIOLOGY
Normally the neural tube should close all the way down and there won’t be space in the spinal
cord, but as a result of folic acid deficiency, maternal age, gestational diabetes the neural tube
doesn’t close all the way down like it should, the backbone that protects the spinal cord doesn’t
form and close as it should and cerebrospinal fluid and the spinal cord and nerves protrudes into
this space that was created which is evidenced by a bump like feature at the back of the baby the
severity of the disability depends on
1. The size and location of the opening in the spine
2. Whether part of the spinal cord and nerves are affected.

12. COMPLICATIONS
Paralysis and/or loss of sensation to the body parts below the site of the fluid-filled sac (lesion).
Decreased mobility due to muscle weakness.
Orthopaedic problems associated with paralysis, such as scoliosis, contractures and hip
dislocation.
Loss of bladder and/or bowel control.
Frequent urinary tract infections (UTIs).
Meningitis (brain infection).
Latex allergy.
Learning differences or delayed milestones (cognitive impairments).
Seizures.

13. PROGNOSIS
No two people with myelomeningocele are affected in the same way, and the prognosis
(outlook) for myelomeningocele depends on several factors, including:
The initial condition of their spinal cord and nerves.
How high or low on their spine the opening is.
If the sac is open or closed.
If they received surgery before or after birth.
People with spina bifida have a mortality (death) rate of about 1% per year from 5 to 30 years
of age. The higher the lesion is on their spine, the greater the risk of complications and
mortality.

14. DIAGNOSIS
Spina bifida can be diagnosed during pregnancy or after
the baby is born. Spina bifida occulta might not be
diagnosed until late childhood or adulthood, or might
never be diagnosed.
During Pregnancy; During pregnancy there are
screening tests (prenatal tests) to check for spina bifida
and other birth defects. Talk with your healthcare
provider about any questions or concerns have about
this prenatal testing.
AFP – AFP stands for alpha-fetoprotein (sounds like: al-
fa–fee-toe-pro-teen), a protein the unborn baby
produces. This is a simple blood test that measures how
much AFP has passed into the mother’s bloodstream
from the baby. A high level of AFP might mean that the
baby has spina bifida. An AFP test might be part of a
test called the “quad screen” that looks for neural tube
defects and other issues.
Ultrasound – An ultrasound is a type of picture of the
baby the doctor can see if the baby has spina bifida or
find other reasons that there might be a high level of
AFP. Frequently, spina bifida can be seen with this test.
Amniocentesis (sounds like: am-knee-oh-sin-te-sus;
hear how “amniocentesis” sounds) – For this test, the
doctor takes a small sample of the amniotic fluid
surrounding the baby in the womb. Higher than
average levels of AFP in the fluid might mean that the
baby has spina bifida.

15. DIAGNOSIS AND TREATMENT
After the Baby Is Born
In some cases, spina bifida might not be
diagnosed until after the baby is born.
Sometimes there is a hairy patch of skin or a
dimple on the baby’s back that is first seen after
the baby is born. A doctor can use an image scan,
such as an, X-ray, MRI, or CT, to get a clearer view
of the baby’s spine and the bones in the back.
Sometimes spina bifida is not diagnosed until
after the baby is born because the mother did not
receive prenatal care or an ultrasound did not
show clear pictures of the affected part of the
spine.
After delivery, a baby born with a
myelomeningocele will need:
surgery to close the skin over the
myelomeningocele (usually within 3 days)
testing for Chiari malformation and
hydrocephalus with an ultrasound, CT scan, or
MRI
regular checks of head size to see if
hydrocephalus develops
regular checks of movements to see how the
spinal cord and nerves are working

16. TREATMENT
Other medical care will depend on a child's needs.
Treatments can include:
a shunt for hydrocephalus (the shunt drains the spinal
fluid into the belly so it doesn't build up in the spaces in
the brain)
leg braces to help with walking
a wheelchair
a tube (called a catheter) to help empty the bladder
surgery on the spine or legs
surgery for Chiari malformations
physical therapy (PT)
occupational therapy (OT)
special help at school
Some myelomeningoceles found before birth are treated
with surgery while the baby is still in the womb.
Sometimes this can lower the chances of the baby getting
hydrocephalus later. And it might increase the strength of
the child's legs. There are risks to the mom and baby from
this surgery, so doctors and families have to decide
together if the surgery is right for them.

17. PREVENTION
If you are pregnant or could get pregnant, use the following tips to help prevent your baby from
having spina bifida:
Take 400 micrograms (mcg) of folic acid every day. If you have already had a pregnancy affected
by spina bifida, you may need to take a higher dose of folic acid before pregnancy and during
early pregnancy. Talk to your doctor to discuss what’s best for you.
Talk to your doctor or pharmacist about any prescription and over-the-counter drugs, vitamins,
and dietary or herbal supplements you are taking. Learn about medication and pregnancy »
If you have a medical condition―such as diabetes or obesity―be sure it is under control before
you become pregnant.
Avoid overheating your body, as might happen if you use a hot tub or sauna.
Treat any fever you have right away with Tylenol® (or store brand acetaminophen).

18. NURSING MANAGEMENT
Nurse baby in prone or lateral position.
Measure head circumference daily.
Monitor vital signs and check for any abnormalities.
Health education of the mother.
Wound dressing under aseptic technique.
Administration of prescribed pain medications or antibiotics’

19. SURGICAL REPAIR OF
MYELOMENINGOCELE

20. MYELOMENINGOCELE

21. https://www.cdc.gov/ncbddd/spinabifida/facts.html
https://medlineplus.gov/ency/article/001558.htm
https://kidshealth.org/en/parents/myelomeningocele.html#:~:text=Myelomeningoc
ele%20(my%2Duh%2Dlo,part%20of%20the%20spinal%20cord
https://my.clevelandclinic.org/health/diseases/22813-myelomeningocele
REFERENCES