Spina bifida - Child Health Nursing

Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD). Spina bifida can happen anywhere along the spine if the neural tube does not close all the way.

1. SPINA BIFIDA

2. INTRODUCTION Spina bifida is a birth defect in which the spinal column and sometimes the spinal cord do not complete their development. Spina bifida is among a group of birth defects called neural tube defects.

3. DEFINITION 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

4. 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 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

5. TYPES OF SPINA BIFIDA

6. 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 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

7. CLINICAL MANIFESTATIONS

8. ASSESSMENT

9. 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 8 th weak CT scan to rule out hydrocephalus MRI

10. MEDICAL MANAGEMENT There is no cure for spina bifida. 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. 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

11. SURGICAL MANAGEMENT PRE NATAL FETOSCOPIC REPAIR 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

12. NURSING MANAGEMENT NURSING DIAGNOSIS Risk for infection related to vulnerability of the myelomeningocele sac. Risk for impaired skin integrity related to exposure to urine and feces. Risk for injury related to neuromuscular impairment. Compromised family coping related to perceived loss of the perfect newborn. Deficient knowledge of the family caregivers related to the complexities of caring for a newborn with serious neurologic and musculoskeletal defects

13. NURSING MANAGEMENT NURSING INTERVENTIONS 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. 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. Use normal saline or silver nitrate in dressing. Gentle handling of the child to avoid any risk of trauma .

14. NURSING MANAGEMENT Cont …. Change the child’s position every 2 hours, promotes circulation & prevent development of decubitus sore. 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 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

15. NURSING MANAGEMENT NURSING INTERVENTIONS 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. Monitor input and output. Encourage the mother to continue breastfeeding if the child is being breastfed. Resume the feeding after the effects of an aesthesia. Teach on the care of the child

16. NURSING MANAGEMENT Cont … 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 parents on the condition of the child. Teach parents to observe for signs of complications e. g. convulsions .

17. COMPLICATIONS

18. SUMMARY Definition of Spina Bifida, Etiology Types Pathophysiology Clinical manifestation Diagnostic tests Medical management Nursing management Complications

19. CONCLUSION 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

20. BIBLIOGRAPHY Hockenberry , M. J., & Winkelstein , W. (2005). Wong's essential of pediatric nursing (7th Ed). philadephia , USA: Elsevier Mosby . 1.S.RIMPLE; Text Book of Essesntials of Pediatric Nursing;2ND EDITION; 2017; Published by Jaypee brothers medical publishers(P)LTD; PAGE NO-417-424. 2. https://www.mayoclinic.org/diseases- conditions/spina-bifida/symptoms- causes/syc-20377860 http://www.ninds.nih.gov/disorders/spina-bifida https://nurseslabs.com/spina-bifida/