Helps both UG and PG nursing students Helps to know the congenital anomalies

1. WHAT ARE NEURAL TUBE DEFECTS
(NTDs)?
The neural tube forms in the embryo and then
closes (between the 2nd and 4th week of gestation)
A neural tube defect occurs when the neural
tube fails to close properly
The two most common NTDs are anencephaly
and spina bifida

2. Neural Tube Defects

3. Embryology

4. When do neural tube defects occur?

5. SPINA BIFIDA
• (Latin: "split spine")

6. Neural Tube Defects
Congenital deformities involving the
coverings of the nervous system are called
neural tube defects (NTDs).

7. What Causes Spina Bifida?
• Largely unknown
• Some evidence suggests that genes may be
involved. (Northrup H et al, 2000)
• A high fever during pregnancy or epileptic
women who have taken the drug valproic acid
to control seizures may have an increased risk
of having a baby with spina bifida. (Lewis DP
et al, 1998)

8. Causes of Neural Tube Defects
• Environmental (diet, folic acid deficiency,
exposures during 1st trimester)
• Genetics (previous child born with an NTD, )
• 95 percent of the time: UNKNOWN

9. Types of Myelodysplasia*
• Spina bifida occulta
• Lipomeningocele
• Meningocele
• Myelomeningocele = Spina Bifida
*defective development of the spinal cord

11. Spina bifida occulta
• In this group of neural tube defects, the
meninges do not herniate through the bony
defect. This lesion is covered by skin (ie,
closed),
• hairy patch,
• dermal sinus tract,
• dimple,
• hemangioma,
• lipoma

12. Neurologic pathology
Lipomeningocele
(lipo = fat)
lipoma or fatty tumor
located over the
lumbosacral spine.
Associated with bowel &
bladder dysfunction
Lipomeningocele

13. Neurologic pathology
Meningocele (cele = sac)
Fluid-filled sac with meninges involved but neural
tissue unaffected

14. Spina bifida cystica
• myelomeningocele
• Meningocele
SITE
• Cervical and thoracic
regions are the least
common sites, and
lumbar and lumbosacral
regions are the most
common sites for these
lesions.

15. Clinical manifestations
• Sensory disturbances
• Flaccid partial paralysis of lower extremities
• Overflow incontinence with constant dribbling
of urine
• Lack of bowel control
• Joint deformities
• Club foot, hip dislocation.

16. Tests to Detect NTDs
AFP-maternal blood test done between 14-21
wks of pregnancy
• Ultrasounds prenatally
• Postnatal Radiology exams (CT, MRI)
• Clinical examination

17. Management - People involved in the
care of NTDs
• OB/GYN
• Pediatrician
• General Surgeon
• Orthopedic Surgeon
• Urologist
• Neurosurgeon
• Geneticist
• OT/PT
• Plastic Surgeon
• Radiologist
• Special Ed Teacher

18. Management cont’d
• Assessment of associated anomalies
• Prevention of infection
• Surgery-12-18 hrs-prevents stretching of nerve
roots
• Assistive devices- mobility
• Correction of deformities and preventing joint
contractures.
• Hydrocephalus- shunt
• UTI, meningitis, pneumonia- antibiotics

19. Nursing care-pre operative
• Examine- intact of the sac, movement of the extremities,
retention of urine, bladder distension, fontanels, HC.
• Prevent trauma- during transport
• Prevent drying of the sac
• Prevent contamination of the sac
• Observe for s/s of infection
• Positioning – prone, legs abducted
• Special mattress
• Feeding- lateral position
• Bladder care- CIC
• Range of motion exercises

20. Nursing care-post operative
• Pain management
• Vital signs
• s/s of infection, leakage of CSF
• I/O chart
• Feeding
• Position
• Support the family
• Educate on home care

21. How Can NTDs be Prevented?
• ALL women of childbearing age should receive 0.4 mg
(400 micrograms) of folic acid daily prior to conception
of planned or unplanned pregnancies and continue
thru 1st trimester
• Women with a history of NTD and should receive daily
supplementation of 4 mg (4000 micrograms) of folic
acid starting three months prior to conception and
continuing thru the 1st trimester

26. Encephalocele
• anterior neuropore fails to close during days 26-28 of
gestation.

28. Complications
• Bowel/bladder function
• Paralysis (paraplegic/quadriplegic)
• Club feet
• Motor skills
• Ambulation
• Skin Sensation
• Weight/over eating
• Seizures
• Hydrocephalus
• Visual Disturbances

29. Prognosis
Spina bifida is a:
static
non-progressive defect
with worsening from secondary problems.
The prognosis for a normal life span is generally
good for a child with good health habits and a
supportive family/caregiver.

30. THANK YOU