Spinal Bifida

The ‘Six’ Group

Group Members

Precious S. Kataika Misheri Nkhani Nelson Munthali Benjamin Mpalabwazi Ruth K. Nyalubanga

Broad Objective

By the end of this presentation, students should acquire knowledge on spinal bifida

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 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.

ETIOLOGYThe 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.

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

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

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 

2. Spinal bifida Cystica

A more severe type of spinal bifidaThis refers to the visible defect with

the external saclike protrusion It has two major forms;

1. Meningocele 2. Myelomeningocele

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.

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%

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.

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

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.

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

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.

Objective data Weigh the child. Conduct a neurological

assessment. Prick response. Assess cystic Physical examination

Diagnostic TestsPrenatal 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

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.

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

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.

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.

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.

Change the child’s position every two hours, to promote circulation and 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.

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 anaesthesia.

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.

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

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.

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