Nursing care of a child with spina bifida

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 2 nd and 4 th 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 1 st 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

10. 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

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

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

13. 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.

14. 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.

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

16. 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

17. 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

18. 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

19. 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

20. 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 1 st 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 1 st trimester

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

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

23. 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.

24. THANK YOU