Spina bifida is a birth disorder that involves the incomplete development of the spine. In the first month of pregnancy, a special set of cells forms the “neural tube;” the top of the tube becomes the brain, and the remainder becomes the spinal cord and structures around it. In spina bifida, the neural tube doesn’t close completely and some of the bones of the spine do not close in the back. This can result in an opening anywhere along the spine and may cause damage to the spinal cord and nerves.There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. The symptoms of spina bifida vary from person to person, depending on the type and level of involvement. Most cases are mild and do not require special treatment. The more serious cases involve nerve damage. Occulta is the mildest and most common form in which one or more bones of the spinal column (vertebrae) are malformed. The name “occulta,” which means “hidden,” indicates that a layer of skin covers the opening in the bones of the spine. It usually shows no symptoms and is often found by accident on an x-ray or similar test. Closed neural tube defects are a diverse group of disorders in which the spine may have malformations of fat, bone, or the membranes (the meninges) that cover the spinal cord. Many of these neural tube defects require surgery in childhood. People with this type of spina bifida may have weakness of the legs and trouble with bowel and bladder control. These issues may change or progress as children grow. It is important to have close communication with doctors to minimize these changes as much as possible. Meningocele occurs when the meninges protrude through the spine and cause a sac of spinal fluid on the back. This fluid is typically only around the brain and spine, but a problem with the bony covering over the spine allows it to poke out. The malformation contains no nerves and may or may not be covered by a layer of skin. Individuals with meningocele may have minor symptoms.Myelomeningocele is the most severe form of spina bifida. A portion of the spinal cord or nerves are exposed in a sac through an opening in the spine that may or may not be covered by the meninges. The opening can be closed surgically while the baby is in utero or shortly after the baby is born. Most people with myelomeningocele experience changes in brain structure, leg weakness, and bladder and bowel dysfunction. Myelomeningocele is often called a "snowflake condition" because no two people with the condition are the same. Typically, if the opening in the spine is lower down the back, the person will experience less symptoms. People with myelomeningocele require close follow-up with physicians throughout their childhood and lifespan to maximize their function and prevent complications like kidney failure.Complications of spina bifida may include: Abnormal sensation or paralysis, which mostly occurs with closed neural tube defects and myelomenin

4. Spina bifida is a birth defect that occurs when the spine and spinal cord don't form
properly. It falls under the broader category of neural tube defects. The neural tube
is the embryonic structure that eventually develops into the baby's brain and spinal
cord and the tissues that enclose them.

5. • Normally, the neural tube forms early in
pregnancy, and it closes by the 28th day after
conception.
• In babies with spina bifida, a portion of the
neural tube fails to develop or close properly,
causing defects in the spinal cord and in the
bones of the spine.
• Spina bifida can range from mild to severe,
depending on the type of defect, size, location
and complications.
• When early treatment for spina bifida is
necessary, it's done surgically, although such
treatment doesn't always completely resolve
the problem.

6. Types
• Spina bifida occulta
• Spina bifida cystica
 Meningocele
 Myelomeningocele

7. Spina bifida occulta
"Occulta" means hidden. The mildest form, spina bifida occulta results in a
small separation or gap in one or more of the bones of the spine (vertebrae).
Many people who have spina bifida occulta don't even know it, unless the
condition is discovered during an imaging test done for unrelated reasons.

8. Meningocele
In a form of spina bifida called
meningocele, the protective
membranes around the spinal cord
(meninges) push out through the
opening in the vertebrae, forming a
sac filled with fluid.
But this sac doesn't include the spinal
cord, so nerve damage is less likely,
though later complications are
possible.

9. Myelomeningocele
Also known as open spina bifida, myelomeningocele is the most severe form. The
spinal canal is open along several vertebrae in the lower or middle back. The
membranes and spinal nerves push through this opening at birth, forming a sac on
the baby's back, typically exposing tissues and nerves. This makes the baby prone
to life-threatening infections.

10. Causes
Unknown causes spina bifida. As with many other problems, it appears to
result from a combination of genetic and environmental risk factors, such as
a family history of neural tube defects and folate deficiency.

11. Risk factors
Spina bifida is more common among whites and Hispanics, and females are
affected more often than males.
Folate (vitamin B-9) is important to the healthy development of a baby.
Folate is the natural form of vitamin B-9. The synthetic form, found in
supplements and fortified foods, is called folic acid. A folate deficiency
increases the risk of spina bifida and other neural tube defects.
of neural tube defects. Couples who've had one child with a
neural tube defect have a slightly higher chance of having another baby with
the same defect.

12. Women with diabetes who don't control their blood sugar well have a
higher risk of having a baby with spina bifida.
Pre-pregnancy obesity is associated with an increased risk of neural
tube birth defects, including spina bifida.
Some evidence suggests that increased body temperature
(hyperthermia) in the early weeks of pregnancy may increase the risk
of spina bifida. Elevating body temperature, due to fever or the use of
saunas or hot tubs, has been associated with a possible slight increased
risk of spina bifida.

13. Symptoms
Signs and symptoms of spina bifida vary by
type and severity. Symptoms can also differ
for each person.
Because the spinal nerves usually aren't
involved, typically there are no signs or
symptoms.
But visible indications can sometimes be seen
on the newborn's skin above the spinal
defect, including an abnormal tuft of hair, or a
small dimple or birth mark.

14. The membranes around the spinal cord push out through an opening in
the vertebrae, forming a sac filled with fluid, but this sac doesn't
include the spinal cord.

15. Myelomeningocele.
• In this severe form of spina bifida: The spinal canal remains open
along several vertebrae in the lower or middle back.
• Both the membranes and the spinal cord or nerves protrude at birth,
forming a sac.
• Tissues and nerves usually are exposed, though sometimes skin
covers the sac.
Children with spina bifida occulta typically don't have any symptoms or
complications, so usually only routine pediatric care is needed.

16. Blood tests
For the MSAFP test, a sample of the
mother's blood is drawn and tested for
alpha-fetoprotein (AFP) — a protein
produced by the baby. It's normal for a
small amount of AFP to cross the placenta
and enter the mother's bloodstream. But
abnormally high levels of AFP suggest that
the baby has a neural tube defect, such as
spina bifida, though some spina bifida
cases don't produce high levels of AFP.
Diagnosis

17. May perform the MSAFP test with two or three other blood tests. These tests
are commonly done with the MSAFP test, but their objective is to screen for
other abnormalities, such as trisomy 21 (Down syndrome), not neural tube
defects.
Many obstetricians rely on ultrasonography to screen for spina bifida. If blood
tests indicate high AFP levels, will suggest an ultrasound exam to help
determine why. The most common ultrasound exams bounce high-frequency
sound waves off tissues in body to form images on a video monitor.
If a blood test shows high levels of AFP in blood but the ultrasound is
normal,may offer amniocentesis. During amniocentesis,uses a needle to remove
a sample of fluid from the amniotic sac that surrounds the baby.

18. Treatment
Surgery before birth
Nerve function in babies with spina bifida can
worsen after birth if it's not treated.
Prenatal surgery for spina bifida (fetal surgery)
takes place before the 26th week of pregnancy.
Expose a pregnant mother's uterus surgically, open
the uterus and repair the baby's spinal cord.
Research suggests that children with spina bifida
who had fetal surgery may have reduced disability
and be less likely to need crutches or other walking
devices.

19. Many babies with myelomeningocele tend to be in a feet-first
(breech) position. If baby is in this position or if has detected a
large cyst or sac, cesarean birth may be a safer way to deliver
baby.

20. • Meningocele involves surgery to put the meninges back in place and close
the opening in the vertebrae.
• Because the spinal cord develops normally in babies with meningocele,
these membranes often can be removed by surgery with little or no
damage to nerve pathways.

21. Myelomeningocele also requires surgery.
• Performing the surgery early can help minimize risk of infection that's
associated with the exposed nerves and may also help protect the spinal
cord from more trauma.
• During the procedure, a places the spinal cord and exposed tissue inside
the baby's body and covers them with muscle and skin.
• Sometimes a shunt to control hydrocephalus in the baby's brain is placed
during the operation on the spinal cord.

22. Surgery for hydrocephalus.

23. • Most babies with myelomeningocele will
need a ventricular shunt — a surgically placed
tube that allows fluid in the brain to drain into
the abdomen.
• This tube might be placed just after birth,
during the surgery to close the sac on the
lower back or later as fluid accumulates.
• A less invasive procedure, called endoscopic
third ventriculostomy, may be used, but
candidates must be carefully chosen and
meet certain criteria.
• The surgeon uses a small video camera to see
inside the brain and makes a hole in the
bottom of or between the ventricles so
cerebrospinal fluid can flow out of the brain.

24. The nerves that control the leg muscles don't work properly below the area of the
spina bifida defect, causing muscle weakness of the legs, sometimes involving
paralysis.
Whether a child can walk typically depends on where the defect is, its size, and the
care received before and after birth.
Children with myelomeningocele can have a variety of problems in the legs and
spine because of weak muscles in the legs and back. The types of problems depend
on the level of the defect.
Possible problems include a curved spine (scoliosis), abnormal growth or
dislocation of the hip, bone and joint deformities, muscle contractures and other
orthopedic concerns.
Complications

25. • Nerves that supply the bladder and bowels usually don't work properly when
children have myelomeningocele. This is because the nerves that supply the
bowel and bladder come from the lowest level of the spinal cord.
• Accumulation of fluid in the brain (hydrocephalus). Babies born with
myelomeningocele commonly experience accumulation of fluid in the brain, a
condition known as hydrocephalus.
• Shunts can stop working or become infected. Warning signs may vary.
• Some of the warning signs of a shunt that isn't working include headaches,
vomiting, sleepiness, irritability, swelling or redness along the shunt,
confusion, changes in the eyes (fixed downward gaze), trouble feeding, or
seizures.

26. • Chiari malformation 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.
• Some babies with myelomeningocele may develop meningitis, an
infection in the tissues surrounding the brain.
• This potentially life-threatening infection may cause brain injury.

27. • Tethered spinal cord results when the spinal nerves become bound to
the scar where the defect was closed surgically, making the spinal cord
less able to grow as the child grows.
• This progressive tethering can cause loss of muscle function to the legs,
bowel or bladder. Surgery can limit the degree of disability.
• Both children and adults with spina bifida, particularly
myelomeningocele, may have sleep apnea or other sleep disorders.
• Assessment for a sleep disorder in those with myelomeningocele helps
detect
• sleep-disordered breathing, such as sleep apnea, which warrants
treatment to improve health and quality of life.

28. • Children with spina bifida may get wounds on their feet, legs, buttocks or back.
They can't feel when they get a blister or sore.
• Sores or blisters can turn into deep wounds or foot infections that are hard to
treat. Children with myelomeningocele have a higher risk of wound problems in
casts.
• Children with spina bifida have a higher risk of latex allergy, an allergic reaction to
natural rubber or latex products. Latex allergy may cause rash, sneezing, itching,
watery eyes and a runny nose.
• It can also cause anaphylaxis, a potentially life-threatening condition in which
swelling of the face and airways can make breathing difficult.
• So it's best to use latex-free gloves and equipment at delivery time and when
caring for a child with spina bifida.

29. • More problems may arise as children with spina bifida get older, such
as urinary tract infections, gastrointestinal (GI) disorders and
depression.
• Children with myelomeningocele may develop learning disabilities,
such as problems paying attention, and difficulty learning reading and
math.

30. Prevention
Folic acid, taken in supplement form starting at least one month before conception
and continuing through the first trimester of pregnancy, greatly reduces the risk of
spina bifida and other neural tube defects.
It's critical to have enough folic acid in system by the early weeks of pregnancy to
prevent spina bifida.
Because many women don't discover that they're pregnant until this time, experts
recommend that all women of child bearing age take a daily supplement of 400
micrograms (mcg) of folic acid.
Several foods, including enriched bread, pasta, rice and some breakfast cereals, are
fortified with 400 mcg of folic acid per serving. Folic acid may be listed on food
packages as folate, which is the natural form of folic acid found in foods.

31. Long Term Out Look
Coping and support
• Newborn child has a condition such as spina bifida can naturally cause to
feel grief, anger, frustration, fear and sadness.
• There's good reason to hope, however, because most people with spina
bifida live active, productive and full lives — especially with
encouragement and support from loved ones.
• Independent mobility is an important and appropriate goal for all children
with spina bifida. This may mean walking with or without braces, using
walking aids (such as canes or crutches) or exclusively using a wheelchair.
• They benefit from encouragement to participate in activities with their
peers, and caregivers can help adjust activities to accommodate physical
limitations.

32. Nursing diagnosis-
Preoperative:-
• Risk for injury & infection to the sac.
• Impaired bladder & bowel function related to neurological deficit.
Post operative-
 Ineffective thermoregulation related to surgery.
 Risk of development of infection related to surgery.
 Altered nutrition less than body requirement related to disease process.
 Risk of develpment of complication related to the disease process.
 Altered bladder & bowel function related to neurological deficit.

33. Conclusion

34. Sarvodaya College Of Nursing
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