SPINA BIFIDA

Also called as myelodysplasia

it is a condition in which there is
abnormal development of the back
bones, spinal cord, surrounding
nerves and the fluid-filled sac that
surrounds the spinal cord. This
neurological condition can cause a
portion of the spinal cord and the
surrounding structures to develop
outside, instead of inside the body.
Spina bifida is a birth defe ct that involves the incomple te develo pment
of the spinal cord or its coverings. The term spina bifida comes from
Latin and literally means "split" or "open" spine.
Spina bifida occurs at the end of the first month of pregnancy when the
two sides of the embryo's spine fail to jo in together, le aving an open
area. In some cases, the spinal cord or other membranes may push
through this opening in the embryo's back.
The conditio n can typic ally be detected befo re a baby is born and
treated rig ht away.
Types:
1. Spina Bifida Occulta- a mild form of spina bifida in which the spinal cord and the
surrounding structures remain inside the baby, but the back bones in the lower
back area fail to form normally.
2. Meningocele- a moderate form of spina bifida in which a fluid-fil ed sac is visible
outside of the back area.
3. Myelomeningocele- a severe form of spina bifida in which the spinal cord and nerves
develop outside of the body and are contained in a fluid-fil ed sac that is visible outside
the back area.
The condition can typically be detected before a baby is born and
treated right away.
The causes of spina bifida are largely unknown. Some evidence
suggests that genes may be involved, but in most cases there is no
familial connection. A high fever during pregnancy may increase a
woman's chances of having a baby with spina bifida.
Women with epilepsy who have taken the drug valproic acid to control
seizures may have an increased risk of having a baby with spina bifida.
Causes:
- During pregnancy, the human brain and spine begin as a flat plate of cells,
which rolls into a tube called the nueral tube. If all part of the nueral tube fails
to close, leaving an opening, this is known as an open neural tube defect. This
opening may be left exposed or covered eith bone or skin.
- Anencephaly and spina bi Anencephaly and spina bifida are the most types of
ONTD, while encephalocele ( in which there is a protrusion of the brain or its
covering through the skull is much rare. Anencephaly occurs when the neural
tube fails to close at the base of the skull, while spina bifida occurs when the
neural tube fails to close somewhere along the spine.
- ONTD results from combination of genes inherited from both parents, coupled
with environmental factors. For this reason, ONTD are considered multi factorial
traits meaning “many factors” both genetic and environmental, contribute to
their occurrence.
Signs and Symptoms:
- Abnormal appearance of the baby’s back, varying from small, hairy patch or a
dimple birth mark, to a sac-like protrusion that is found along the back bone
area.
- Bowel and Bladder problems
- Loss of feeling below the area of the lesion, especial y in babies born with a
meningocele
- Inability to move the lower legs
- The baby may also have problems related to spina bifida that include the
fol owing:
- Hydrocephalus
- Heart problems
- Heart problems
- Orthopedic problems
- Lower than normal intel igence level
Diagnostic Tests:
- Blood Test, a blood test be offered between 15 to 20 weeks to all women who
are pregnant who have not previously had a child with an ONTD and who do not
have a family history of ONTD. This blood test measures alpha-fetoprotein (AFP)
levels and other biochemical markers in the mother’s blood determine whether
her pregnancy is at increased risk for an ONTD.
AFP is a protein normally produced by the fetus that crosses the placenta into the
mother’s blood. Generally if the fetus an ONTD, the alpha-tetoprotein level in the
mother’s blood wil be increased. Although this test does not tel for certain whether a
fetus has an ONTD, it wil determine which pregnancies are at greater risk, so the
additional testing may be performed.
- Prenatal Ultrasound (Sonography), prenatal ultrasound may be able to detect on
ONTD, and may be used to examine other organs and body systems of the
fetus.
- Amniocentesis- a procedure that involves inserting a long, thin needle through
the mother’s abdomen into the amniotic sac to withdraw a small sample of the
amniotic fluid for examination.
Nursing and Medical Managements:
- repair and closure of the lesion
- treatment of hydrocephalus
- orthopedic problems
- bowel and bladder problems
- examining the skin, especial y over bony areas such as the elbows, buttocks,
back of the thighs, heel and foot areas.
- Ways to feed the baby and monitor baby’s nutrition
- Promoting activity and mobility
- Encouraging age-appropriate growth and development
- Provide comfort measures and sensory stimulation
Complications:
- ankle and foot deformities
- contracted muscles
- hip dislocation
- curvatures of the back