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SPINA BIFIDA

Presented by:- HARSHITA


M.Sc.in Pediatric Nursing
SPINA BIFIDA

SPINA BIFIDA IS ATYPE OF NEURAL TUBE DEFECT


▪ Spina bifida is a birth defect where there is incomplete closing of
the backbone and membranes around the spinal cord.
▪ It is a developmental congenital anomaly
PATHOPHYSIOLOGY

Ectoderm outer most layer of fertilized egg develop a ridge, that


eventually become neuraltube.

This neural tube form Spinal cord, Brain, Meninges

Spina bifida occur when a portion of neural tube fail to close properly .
This lead to defect or absence of vertebral arches to do failure of
mesoderm to organize the defect.
CAUSES

▪ Specific is unknown.
▪ Multiple factors such as heredity and environment are thought to interact
to produce thesedefects.
▪ The following have been identified as causative factors:
I. low levels of maternal vitamins (B 9), including folic acid;
II. obesity
III. uncontrollable diabetes
IV. medication that interfere with folate metabolism
V. hyperthermia during pregnancy.
TYPES

SPINA BIFIDA

Spina BifidaOcculta Meningocele Myelomeningocele


SPINA BIFIDA OCCULTA
SPINA BIFIDA OCCULTA

▪ Most common and least severe


▪ Noprotrusion of meninges
▪ Generally they areasymptomatic
▪ At most some children present with
1. cutaneous lesion over the defect,
2. as tufts of hair,
3. dimple in theskin
4. a birthmark or a mole on the skin (naevus),
5. a benign tumour of fatty tissue (lipoma).
SPINA BIFIDA OCCULTA

The symptomatic children usually present after 6-8 years of age with
any of the following: -
▪ Progressive deformity of foot
▪ Changein micturition pattern
▪ Alteration in gait
▪ Trophic ulcers on the toes and feet.
SPINA BIFIDA OCCULTA

▪ Progressive disorder needs surgical correction. Laminectomy is


performed for the condition and intraspinal lesion is excised.
▪ Surgery can be performed even before deficit appears, Myelogram
CT scan and MRI helps to confirm the diagnosis
MENINGOCELE
MENINGOCELE

▪ It is a protrusion that includes the meninges and a sac containing


cerebrospinal fluid (CSF).
▪ it is covered by normal skin.
▪ the spinal cord is not involved.
▪ It is generally found in lumbosacral region. It may also be found in the
thoracic region and in skull.
MENINGOCELE

The symptomsinclude
▪ Development of hydrocephalous- characterized by macrocephaly,
headache, vomiting, urinaryincontinence
▪ Spastic weakness of all four limbs
▪ An abnormally small sized head
▪ Uncoordinated musclemovements
▪ Delayed developmental milestones
▪ Vision problems
▪ Seizures
MENINGOCELE

▪ Head circumference should be measured daily.


▪ Meningocele should be protected as risk of infection is present due to
leakage ofCSF.
▪ The child should be placed on abdomen to avoid pressure on the sac.
Sac should be covered using sterile dressing.
▪ X Ray spine and skull CT scan should be done to rule out associated
anomalies.
▪ Surgical closure of sac should be done as early as possible
MYELOMENINGOCELE
MYELOMENINGOCELE

▪ cystic sac of meninges with spinal tissue and CSF, which herniate
through a defect in the posterior vertebral arch.
▪ They are of two types:
1. Myelocele -opentype
2. Myelomeningocele – closed type
MYELOMENINGOCELE

The child may present with


▪ Flaccid paralysis
▪ Absence ofsensation
▪ Drop reflex
▪ Postural abnormalities (like club foot)
▪ Hydrocephalus is usuallyassociated
▪ Musculoskeletal deformity
▪ Contracture of joints, Scliosis and kyphosis
▪ Risk of infection in CNS and rupture of sac
MYELOMENINGOCELE

Chiari malformation type II. Chiari malformation (kee-AH-ree mal-for-


MAY-shun) type II is a common brain abnormality in children with the
myelomeningocele form of spina bifida. The brainstem, or lowest part
of the brain above the spinal cord, is elongated and positioned lower
than usual. This can cause problems with breathing and swallowing.
Rarely, compression on this area of the brain occurs and surgery is
needed to relieve the pressure.
MYELOMENINGOCELE

▪ Primary diagnosis is done by clinical manifestations. X-Ray ,CT Scan, MRI, and
complete neurological assessment.
▪ Routine blood and urine examination
▪ Prenatal diagnosis can be done by amniocentesis and estimation of alpha
fetoprotein.
▪ Management of this condition can be done by surgical correction of the defect.
▪ Correction of musculoskeletal deformities and regulation of bowel and bladder
function.
▪ Additional supportive measure includes prevention of injury and infection of
the sac by appropriate positioning with sterile dressing.
▪ Monitor headcircumference
▪ Adequate nutrition
SPINA BIFIDA

SPINA BIFIDA OCCULTA MENINGOCELE MYELOMENINGOCELE

Most common and least severe Least common and not very severe Most severe

No protrusions of tissue and spinal cord Only meninges are involved not the Spinal cord and surrounding meninges
spinal nerve are involved

At most people have tuft of hair, dimple Protrusion that includes the meninges Spinal cord and meninges protrude out
or birthmark and a sac containing (CSF) of the vertebrae held together by sac of
skin
Usually no symptms Hydrocephalus, Spastic weakness Loss of sensation, paralysis, bladder or
small sized head, Seizures bowel problem ,seizures, leg
Uncoordinated musclemovements deformities
Delayed developmentalmilestones
Vision problems,Seizures
LABORATORY AND DIAGNOSTIC TESTS

▪ X-Rays- spine and skull


▪ MRI-spine andskull
Prenatally it can be diagnosed by following screening tests, though these
are non-specific:
▪ Serum Alpha Fetoprotein levels increases
▪ Ultrasonography
▪ Amniocentesis
▪ Blood test
MANAGEMENT (ASSESSMENT)

▪ MusculoskeletalAssessment and NeurologicAssessment


▪ Assess parents interactions with their infant and ability to cope with their child’s
condition.
▪ Assess extent of motor and sensory involvement, and presence of reflexes.
▪ Assess for signs and symptoms of dehydration or fluid overload.
▪ Assess parents need for preoperative and postoperative information and support
▪ Assess for wound drainage and signs of infection.
▪ Assess for increased intracranial pressure.
▪ Assess parents and child’s ability to manage home treatment regimen.
▪ Assess parents’ and child’s needs for community services
DIAGNOSIS
▪ Risk for dysfunctional Grieving
▪ Interrupted Familyprocesses
▪ Risk for Caregiver role strain,
▪ Impaired physical Mobility,
▪ Imbalanced Nutrition: less than body requirements
▪ Risk forInfection,
▪ Impaired Urinaryelimination
▪ Bowel incontinence
▪ Impaired Skinintegrity
▪ Knowledge Deficient
▪ Disturbed Body image
▪ Delayed Growth and development,
INTERVENTIONS(PRE-OPERATIVE)

1.Encourage parental expression of grief over loss of “perfect” child.


a.Feelings related to guilt, self-blame
b. Feelings of anger about child’s condition
c.Feelings of inadequacy for procreating infant
d. Feelings of being overwhelmed with the situation and the unknown
2. Provide emotional support to parents
3.Monitor infant’s vital signs and neurologic status.
INTERVENTIONS(PRE-OPERATIVE)

4. Promote optimal preoperative hydration and nutritional status.


.5. Maintain integrity of defect; prevent further injury.
6. Prepare parents and infant for surgery
INTERVENTIONS(POST-OPERATIVE)

▪ Maintain nutritional and fluid intake


▪ Monitor for signs and symptoms of infections.
▪ Promote healing of surgical site; use sterile technique when changing
and reinforcingdressing.
▪ Monitor vital signs and neurologic status.
▪ 5. Provide emotional support to parents.
DISCHARGE PLANNING AND HOME CARE

▪ Instruct parents about long-term management of bowel and bladder


training.
▪ Provide information to parent and child about techniques to facilitate
mobility and independence.
▪ Instruct parents on importance of child’s avoiding contact with latex
or naturalrubber.
▪ .Provide information about skin care and injury prevention.
▪ Provide education to parents about normal growth and development
and deviations from norm.

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