The document discusses Spinal Bifida, beginning with the group members presenting and objectives of the presentation. It defines Spinal Bifida as a birth defect involving failure of vertebral arch fusion. It describes the types (Occulta, Cystica with Meningocele and Myelomeningocele forms) and discusses etiology, pathophysiology, clinical manifestations, diagnostic tests, medical and nursing management, and complications of Spinal Bifida. The presentation aims to provide knowledge on Spinal Bifida and its characteristics to students.

1. Spinal Bifida
The ‘Six’ Group

2. Group Members
Precious S. Kataika
Misheri Nkhani
Nelson Munthali
Benjamin Mpalabwazi
Ruth K. Nyalubanga

3. Broad Objective
 By the end of this presentation,
students should acquire knowledge on
spinal bifida

4. By the end of the presentation, students should
be able to:
 Define Spina Bifida?
 Outline the etiology of spina bifida.
 Describe the types of spina bifida.
 Explain the pathophysiology of spina bifida.
 Explain the clinical manifestations.
 List the diagnostic tests.
 Explain the medical management.
 Explain the nursing management.
 List the complications.

5.  A condition that
refers to a
developmental defect
of the spinal column
in which the arches of
one or more of the
spinal vertebrae fail
to fuse.
 It may involve the
entire length of the
neural tube or
restricted to one area.

6. ETIOLOGY
The cause is not known but has predisposing
factors and some of them are:
 Nutritional deficiency (Folic Acid) which helps in
neural tube development. In absence of this in
the first trimester of pregnancy, the child may
born with spinal bifida.
 Genetic factors; family history, if a woman bears
a child with spinal bifida, there is a chance that
of another child having spinal bifida. This is most
common in females than in males.

7. Cont’..
 CSF pressure. Blockage in the
circulation of CSF can cause pressure in
the spine of unborn baby which can
lead to spinal bifida.
 Medications such as anticonvulsants
 Conditions such as diabetes, obesity
and fever also increases the chances of
delivering of a baby with a spina bifida

8. 1. Spinal Bifida Occulta
 an abnormality is confined to the vertebrae
only and is due to an unclosed posterior
vertebral arch.
 This has no visible defect to the external (no
protrusion). It occurs most at the lumbasacral
area.
 There is a dimple, hairy patch, dark spot or
swelling over affected area
 spinal cords and nerves usually normal

9. Cont’…
 It is the mildest
type of spina
bifida
 It has no
symptoms
 There is gap in
one or more of
the vertebra of
the spine
 no treatment
needed

10. 2. Spinal bifida Cystica
 A more severe type of spinal bifida
 This refers to the visible defect with the
external saclike protrusion
 It has two major forms;
1. Meningocele
2. Myelomeningocele

11. 1. Meningocele
 Is a rarest form of which
a cyst or fluid-filled sac
pokes through an open
part of the spine.
 The sac contains
membranes that protect
spinal cord but not
spinal nerves i.e. there
is no neural elements
but only CSF and
meninges.

12. 2. Myelomeningocele
 Most severe form
of spinal bifida
cystica
 The cyst holds
both membranes
and nerve roots of
spinal cord and
often the cord
itself
 Almost 96%

13. Pathophysiology
 Under normal circumstances, the
closure of the neural tube occurs
around 23rd and 27th day
after fertilization.
 However, if something interferes e.g.
Medications such as some
anticonvulsants, diabetes, having a
relative with spina bifida, obesity, and
an increased body temperature
from fever.

14. Cont’…
 The neural tube fails to close properly
as a result a neural tube defect occurs.
 The most common location of this
malformations is the lumbar and sacral
areas

15. Clinical Manifestations
Signs and symptoms vary according
to degree of spinal defect.
 Readily apparent on inspection!
 Loss of sensation below lesion
 Poor urinary and bladder control. There
is an Overflow incontinence with
constant dripling in urine due to nerve
dysfunction that supplies the bladder.

16. Clinical Manifestations
 Joint deformities in lower extremities
due to demolition to the muscles of the
lower extremities.
 Orthopedic abnormalities (i.e. club
foot, hip dislocation, scoliosis)
 Hydrocephalus
 Swelling
 Brain damage

17. Assessment
 History taking
 Subjective data
 Family history of the condition and if it is the
first pregnancy.
 Ask the nutritional history of the mother during
pregnancy to ensure folic acid deficiency.
 Urine and faecal incontinence.
 Ask for paralysis especially in the lower
extremities.

18.  Objective data
 Weigh the child.
 Conduct a neurological assessment.
 Prick response.
 Assess cystic
 Physical examination

19. Diagnostic Tests
Prenatal Tests
• AFP screening
• Ultrasound
• Testing of Amniotic fluid
Imaging Studies
• X-ray of the spine to rule out occulta spinal
bifida
• Ultrasound of pregnancy between 6th and 8th
weak
• CT scan to rule out hydrocephalus
• MRI

20. Medical Management
 There is no cure for spina bifida.
Damaged nerve tissues can not be
repaired nor its function be restored.
 Treatment depend on how severe the
defect is. Most children with spina bifida
have a mild defect and may not need
treatment i.e. spina bifida occulta
 But a child with severe defect may need
surgery.

21.  The surgery involves putting the meninges
back in place and closing the opening in
the vertebrae.
 The surgery is done within 24 – 48 hours
after birth. There is also a surgery to treat
hydrocephalus by placing a shunt
 Fetal surgery is also done to promote early
surgical closure of the spina bifida

22. Cont’…
 Assistive technology e.g.
electric wheel chair, braces
or crutches to help the
child get around.
 Medication involves
treating the complications
and signs of spina bifida.
 Physiotherapy to improve
day to day life and boost
independence.

23. Nursing Management
Pre-Op
 Position the child in prone with legs
abducted. This reduces tension and risk
of sac trauma.
 Put the child in an incubator or warmer
area without clothes. This maintains
normal body temperature, and reduces
trauma from the clothes.

24.  Apply dressing (moist, no adhesions), to
avoid drying of the area due to heat in
the incubator.
 Strictly use the sterile gauze so as to
prevent re-infection.
 Change dressing two-four hourly, to
avoid drying.

25.  Use normal saline or silver nitrate in
dressing.
 Gentle handling of the child to avoid
any risk of trauma.
 Change the child’s position every two
hours, to promote circulation and
prevent development of decubitus sore.

26.  Check vital signs and signs of increased
intracranial pressure.
 Assess for signs of hydrocephalus.
 Cover the sacrum with sterile surgical
drape, but not latex tape.
 Measure the head circumference

27.  Prepare the mother psychologically.
 Apply gentle pressure to suprapubic
area to facilitate urine emptying.
 Gently do a range of motion of the
extremities to the child.

28. Post-Op
 Position the child in prone to avoid
pressure on suture, or side lying
position alternatively.
 Monitor the child`s vital signs every 30
minutes until stable.
 Use all measures to avoid any infection
e. g. hand washing.

29.  Monitor input and output.
 Encourage the mother to continue
breastfeeding if the child is being
breastfed.
 Resume the feeding after the effects of
anaesthesia.
 Remove the dressings after 48hrs to
check any signs of bleeding or bulging

30.  Psychologically, care the mother.
 Observe for leakage.
 Maintain passive range of motion of the
extremities to promote circulation.
 Give high fibre diet to the child (if
above 6 months), to avoid constipation,

31.  To alley anxiety, counsel the mother on
the condition of the child.
 Teach the parents to observe for signs
of complications e. g. convulsions.
 Teach on the care of the child.

32. Complications
 Meningitis due to infections
 Hydrocephalus due to Increased
Intracranial Pressure
 Physical and neurological problems e.g.
lack of normal bowel and bladder
control, Paralysis of the legs
 Latex allergy

33. Summary
 Spina bifida birth defect is the most common
defect of the central nervous system with a
worldwide incidence of about 1 in every 1000
births
 This disease is clinically referred to as
Myelomeningocele.
 Regular checkups and intake of folic acid diet
before conception and during the first few
weeks of pregnancy can help to prevent spina
bifida.

34. References
 Hockenberry, M. J., & Winkelstein, W.
(2005). Wong's essential of pediatric
nursing (7th Ed).philadephia, USA:
Elsevier Mosby .
 www.mayoclinic.org/diseases-
conditions/spina-bifida
 www.ninds.nih.gov/disorders/spina-
bifida