Precious S. Kataika
Ruth K. Nyalubanga
By the end of this presentation,
students should acquire knowledge on
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.
A condition that
refers to a
of the spinal column
in which the arches of
one or more of the
spinal vertebrae fail
It may involve the
entire length of the
neural tube or
restricted to one area.
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.
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
1. Spinal Bifida Occulta
an abnormality is confined to the vertebrae
only and is due to an unclosed posterior
This has no visible defect to the external (no
protrusion). It occurs most at the lumbasacral
There is a dimple, hairy patch, dark spot or
swelling over affected area
spinal cords and nerves usually normal
It is the mildest
type of spina
It has no
There is gap in
one or more of
the vertebra of
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;
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
Most severe form
of spinal bifida
The cyst holds
and nerve roots of
spinal cord and
often the cord
Under normal circumstances, the
closure of the neural tube occurs
around 23rd and 27th day
However, if something interferes e.g.
Medications such as some
anticonvulsants, diabetes, having a
relative with spina bifida, obesity, and
an increased body temperature
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
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.
Joint deformities in lower extremities
due to demolition to the muscles of the
Orthopedic abnormalities (i.e. club
foot, hip dislocation, scoliosis)
Family history of the condition and if it is the
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
Weigh the child.
Conduct a neurological assessment.
• AFP screening
• Testing of Amniotic fluid
• X-ray of the spine to rule out occulta spinal
• Ultrasound of pregnancy between 6th and 8th
• CT scan to rule out hydrocephalus
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
The surgery involves putting the meninges
back in place and closing the opening in
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
Assistive technology e.g.
electric wheel chair, braces
or crutches to help the
child get around.
treating the complications
and signs of spina bifida.
Physiotherapy to improve
day to day life and boost
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.
Apply dressing (moist, no adhesions), to
avoid drying of the area due to heat in
Strictly use the sterile gauze so as to
Change dressing two-four hourly, to
Use normal saline or silver nitrate in
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.
Check vital signs and signs of increased
Assess for signs of hydrocephalus.
Cover the sacrum with sterile surgical
drape, but not latex tape.
Measure the head circumference
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.
Position the child in prone to avoid
pressure on suture, or side lying
Monitor the child`s vital signs every 30
minutes until stable.
Use all measures to avoid any infection
e. g. hand washing.
Monitor input and output.
Encourage the mother to continue
breastfeeding if the child is being
Resume the feeding after the effects of
Remove the dressings after 48hrs to
check any signs of bleeding or bulging
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,
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.
Meningitis due to infections
Hydrocephalus due to Increased
Physical and neurological problems e.g.
lack of normal bowel and bladder
control, Paralysis of the legs
Spina bifida birth defect is the most common
defect of the central nervous system with a
worldwide incidence of about 1 in every 1000
This disease is clinically referred to as
Regular checkups and intake of folic acid diet
before conception and during the first few
weeks of pregnancy can help to prevent spina
Hockenberry, M. J., & Winkelstein, W.
(2005). Wong's essential of pediatric
nursing (7th Ed).philadephia, USA:
Elsevier Mosby .