Spina bifida is a neural tube defect characterized by incomplete closure of the backbone and membranes around the spinal cord, resulting in various forms such as occulta, meningocele, and myelomeningocele. Its causes are multifactorial, including genetics and environmental factors like maternal vitamin deficiencies. Management involves surgical correction and long-term care for associated complications like hydrocephalus and musculoskeletal issues.

1. SPINA BIFIDA
Presented by :- HARSHITA
M.Sc. in Pediatric Nursing

3. SPINA BIFIDA
SPINA BIFIDA IS ATYPE OF NEURALTUBE DEFECT
▪ Spina bifida is a birth defect where there is incomplete closing of
the backbone and membranes around the spinal cord.
▪ It is a developmental congenital anomaly

4. PATHOPHYSIOLOGY
Ectoderm outer most layer of fertilized egg develop a ridge, that
eventually become neural tube.
This neural tube form Spinal cord, Brain, Meninges
Spina bifida occur when a portion of neural tube fail to close properly .
This lead to defect or absence of vertebral arches to do failure of
mesoderm to organize the defect.

6. CAUSES
▪ Specific is unknown.
▪ Multiple factors such as heredity and environment are thought to interact
to produce these defects.
▪ The following have been identified as causative factors:
I. low levels of maternal vitamins (B 9), including folic acid;
II. obesity
III. uncontrollable diabetes
IV. medication that interfere with folate metabolism
V. hyperthermia during pregnancy.

7. TYPES
SPINA BIFIDA
Spina Bifida Occulta Meningocele Myelomeningocele

8. SPINA BIFIDA OCCULTA

9. SPINA BIFIDA OCCULTA
▪ Most common and least severe
▪ No protrusion of meninges
▪ Generally they are asymptomatic
▪ At most some children present with
1. cutaneous lesion over the defect,
2. as tufts of hair,
3. dimple in the skin
4. a birthmark or a mole on the skin (naevus),
5. a benign tumour of fatty tissue (lipoma).

10. SPINA BIFIDA OCCULTA
The symptomatic children usually present after 6-8 years of age with
any of the following: -
▪ Progressive deformity of foot
▪ Change in micturition pattern
▪ Alteration in gait
▪ Trophic ulcers on the toes and feet.

11. SPINA BIFIDA OCCULTA
▪ Progressive disorder needs surgical correction. Laminectomy is
performed for the condition and intraspinal lesion is excised.
▪ Surgery can be performed even before deficit appears, Myelogram
CT scan and MRI helps to confirm the diagnosis

12. MENINGOCELE

13. MENINGOCELE
▪ It is a protrusion that includes the meninges and a sac containing
cerebrospinal fluid (CSF).
▪ it is covered by normal skin.
▪ the spinal cord is not involved.
▪ It is generally found in lumbosacral region. It may also be found in the
thoracic region and in skull.

14. MENINGOCELE
The symptoms include
▪ Development of hydrocephalous- characterized by macrocephaly,
headache, vomiting, urinary incontinence
▪ Spastic weakness of all four limbs
▪ An abnormally small sized head
▪ Uncoordinated muscle movements
▪ Delayed developmental milestones
▪ Vision problems
▪ Seizures

15. MENINGOCELE
▪ Head circumference should be measured daily.
▪ Meningocele should be protected as risk of infection is present due to
leakage of CSF.
▪ The child should be placed on abdomen to avoid pressure on the sac.
Sac should be covered using sterile dressing.
▪ X Ray spine and skull CT scan should be done to rule out associated
anomalies.
▪ Surgical closure of sac should be done as early as possible

16. MYELOMENINGOCELE

17. MYELOMENINGOCELE
▪ cystic sac of meninges with spinal tissue and CSF, which herniate
through a defect in the posterior vertebral arch.
▪ They are of two types:
1. Myelocele -open type
2. Myelomeningocele – closed type

18. MYELOMENINGOCELE
The child may present with
▪ Flaccid paralysis
▪ Absence of sensation
▪ Drop reflex
▪ Postural abnormalities (like club foot)
▪ Hydrocephalus is usually associated
▪ Musculoskeletal deformity
▪ Contracture of joints, Scliosis and kyphosis
▪ Risk of infection in CNS and rupture of sac

19. MYELOMENINGOCELE
Chiari malformation type II. Chiari malformation (kee-AH-ree mal-for-
MAY-shun) type II is a common brain abnormality in children with the
myelomeningocele form of spina bifida. The brainstem, or lowest part
of the brain above the spinal cord, is elongated and positioned lower
than usual. This can cause problems with breathing and swallowing.
Rarely, compression on this area of the brain occurs and surgery is
needed to relieve the pressure.

20. MYELOMENINGOCELE
▪ Primary diagnosis is done by clinical manifestations. X-Ray , CT Scan, MRI, and
complete neurological assessment.
▪ Routine blood and urine examination
▪ Prenatal diagnosis can be done by amniocentesis and estimation of alpha
fetoprotein.
▪ Management of this condition can be done by surgical correction of the defect.
▪ Correction of musculoskeletal deformities and regulation of bowel and bladder
function.
▪ Additional supportive measure includes prevention of injury and infection of
the sac by appropriate positioning with sterile dressing.
▪ Monitor head circumference
▪ Adequate nutrition

21. SPINA BIFIDA
SPINA BIFIDA OCCULTA MENINGOCELE MYELOMENINGOCELE
Most common and least severe Least common and not very severe Most severe
No protrusions of tissue and spinal cord Only meninges are involved not the
spinal nerve
Spinal cord and surrounding meninges
are involved
At most people have tuft of hair, dimple
or birth mark
Protrusion that includes the meninges
and a sac containing (CSF)
Spinal cord and meninges protrude out
of the vertebrae held together by sac of
skin
Usually no symptms Hydrocephalus, Spastic weakness
small sized head, Seizures
Uncoordinated muscle movements
Delayed developmental milestones
Vision problems, Seizures
Loss of sensation, paralysis, bladder or
bowel problem ,seizures, leg
deformities

22. LABORATORY AND DIAGNOSTIC TESTS
▪ X-Rays- spine and skull
▪ MRI-spine and skull
Prenatally it can be diagnosed by following screening tests, though these
are non-specific:
▪ Serum Alpha Fetoprotein levels increases
▪ Ultrasonography
▪ Amniocentesis
▪ Blood test

23. MANAGEMENT (ASSESSMENT)
▪ Musculoskeletal Assessment and Neurologic Assessment
▪ Assess parents interactions with their infant and ability to cope with their child’s
condition.
▪ Assess extent of motor and sensory involvement, and presence of reflexes.
▪ Assess for signs and symptoms of dehydration or fluid overload.
▪ Assess parents need for preoperative and postoperative information and support
▪ Assess for wound drainage and signs of infection.
▪ Assess for increased intracranial pressure.
▪ Assess parents and child’s ability to manage home treatment regimen.
▪ Assess parents’ and child’s needs for community services

24. DIAGNOSIS
▪ Risk for dysfunctional Grieving
▪ Interrupted Family processes
▪ Risk for Caregiver role strain,
▪ Impaired physical Mobility,
▪ Imbalanced Nutrition: less than body requirements
▪ Risk for Infection,
▪ Impaired Urinary elimination
▪ Bowel incontinence
▪ Impaired Skin integrity
▪ Knowledge Deficient
▪ Disturbed Body image
▪ Delayed Growth and development,

25. INTERVENTIONS(PRE-OPERATIVE)
1. Encourage parental expression of grief over loss of “perfect” child.
a. Feelings related to guilt, self-blame
b. Feelings of anger about child’s condition
c. Feelings of inadequacy for procreating infant
d. Feelings of being overwhelmed with the situation and the unknown
2. Provide emotional support to parents
3. Monitor infant’s vital signs and neurologic status.

26. INTERVENTIONS(PRE-OPERATIVE)
4. Promote optimal preoperative hydration and nutritional status.
.5. Maintain integrity of defect; prevent further injury.
6. Prepare parents and infant for surgery

27. INTERVENTIONS(POST-OPERATIVE)
▪ Maintain nutritional and fluid intake
▪ Monitor for signs and symptoms of infections.
▪ Promote healing of surgical site; use sterile technique when changing
and reinforcing dressing.
▪ Monitor vital signs and neurologic status.
▪ 5. Provide emotional support to parents.

28. DISCHARGE PLANNING AND HOME CARE
▪ Instruct parents about long-term management of bowel and bladder
training.
▪ Provide information to parent and child about techniques to facilitate
mobility and independence.
▪ Instruct parents on importance of child’s avoiding contact with latex
or natural rubber.
▪ . Provide information about skin care and injury prevention.
▪ Provide education to parents about normal growth and development
and deviations from norm.