Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
36 Cards in this Set
- Front
- Back
|
Spina Bifida literally means “splitspine.” It is classified as a neuraltube defect. The neural tube is the embryonic. structure that eventually develops into the baby's brain & spinal cord & the tissues that enclose them |
Spina Bifida happens when the fetus is in the womb & the posterior portion of the neural tube does not close all of the way during the first trimester. This malformation is generally found in the lumbar-sacral region. |
|
|
They think that the explanation behind Spina Bifida occurance may be of multifactorial inheritance to include genetic, nutritional or environmental causes – or acombination of these causes. |
There does appear to be some definite genetic risk factors that increase the chance of having a baby with spina bifida. The rates are significantly higher among couples in which at least one was born with a neural tube defect. |
|
|
Also, a previous pregnancy with a baby with a neural tube defect increases a woman’s risk of having another such pregnancy by approximately 20 times. |
Be it intentional ingestion of alcohol & illegal drugs or the lack of knowledge of fetal risk of certain medications, ingestion of these products contribute to the risk. Thus alcohol & illegal drugs should be avoided .
|
|
|
Physicians should be aware of the teratogenic effects cause by certain antiepileptic & acne medications because they block the body’s ability to process folic acid & so those prescription medications should quickly be discontinued & safer alternatives prescribed. |
The most widely studied factor to be found to contribute to the increase risk of spina bifida is poor prenatal nutritional choices that lack folic acid intake. Folic acid (vitamin B-9) in the mother’s diet is key to the development of a healthy fetus. |
|
|
Lower socioeconomic status & inability to pay the higher prices for fresh produce & meats that contain that folic acid can be the reason. That is why prenatal vitamin supplements given to pregnant mothers contain folic acid & why the FDA mandated that all enriched cereals, grain products
|
(like bread and pastas), & orange juice be fortified with folic acid; all this in the effort to decrease the likelihood of spina bifida , Diabetes in the mother becomes a risk factor particularly when blood sugar levels are elevated in early pregnancy. Good blood sugar control & diabetes management may decrease the risk.
|
|
|
Elevated Maternal Core body temperatures by even three or four degrees (such as from prolonged fevers, strenuous exercise or sauna and hot tub use) very early in pregnancy has
|
been linked with increased risk of spina
|
|
|
Spina Bifida diagnostic tests. The major test that doctors rely onto detect spina bifida is the maternal serum alpha-fetal protein test, orAFP. |
This blood test is drawn at about the 17th week of gestation. AFP is a specific protein that the developing fetus produces. If the test reveals abnormally high levels of AFP, it may suggest that the fetus has a neural tube defect – such as spina bifida.
|
|
|
The AFP test generally detects about 80 percent of babies with spina bifida. If the blood test shows high levels of AFP, an ultrasound examination will be ordered to help find out the cause. A more advanced form of ultrasound examination can visualize indications of spina bifida – like an open spine.
|
Ultrasound is an effective tool for prenatal diagnosis of spina bifida & is safe for both mother & baby. If a blood test reveals high levels of AFP & the US is normal, the doctor may suggest an amniocentesis. With this procedure, a needle is introduced into the amniotic sac & a sample of fluid is removed for analysis. |
|
|
If a high AFP level is found, this points to an open neural tube defect because the protein has leaked out of the spine and into the amniotic sac. Amniocentesis does present some risk, leading to miscarriage in 1 out of 200 pregnancies.
|
Fetal MR imaging is used to evaluate the fetal brain & spine. Fetal MR imaging is used in pregnancies in which the fetus has been determined to have spina bifida since this congenital defect places the infant at increased risk for brain abnormalities. |
|
|
There are 3 types of Spina Bifida ranging in mild to severe forms. The common denominator of all 3 types is that the posterior portion of the vertebral body in the spinal column does not close all of the way during the first trimester; thus the vertebral spinous process is missing.
|
Spina Bifida Occulta is often called “hidden Spina Bifida” of healthy people have it & do not know it. The spinal cord & nerve route remain intact inside the spinal column thus making it the mildest form. Most children with this form of spina bifida have no signs or symptoms & experience no neurological problems. |
|
|
Most people find out they have it after having an X-ray done of their back for other reasons. Sometimes an infant with Spina Bifida Occulta may display an abnormal tuft of hair, a birthmark, or dimpling of the skin in the area of the defect.
|
Meningocele is the next type of Spina Bifida. A meningocele causes part of the spinal cord to come through the spine like a sac that is pushed out.
Cerebral spinal fluid and meninges are in the protruding sac but there is no nerve damage. Risk of infection is high (sac can rupture & leak). |
|
|
Myelomeningocele is the most severe form of Spina Bifida. Part of the spinal cord also comes through the spine like a sac that is pushed out. However, the spinal cord & nerves, cerebral spinal fluid & meninges come through the open part of the spine. |
It causes permanent nerve damage and severe sensory & motor disabilities. Risk of infection is also high since protruding sac can rupture & leak.
|
|
|
Spina Bifida Occulta does not have any outward skin integrity defects so treatment is not needed. However, the situation is different for babies born with Meningocele or Myelomeningocele.
|
Spina Bifida Occulta does not have any outward skin integrity defects so treatment is not needed. However, the situation is different for babies born with Meningocele or Myelomeningocele. Due to the skin integrity issue of the protruding sac,they require treatment that begins immediately after birth.
|
|
|
Medical & surgical management will be important throughout the individual’s life. Their well-being may depend on how fast & how well the treatment is delivered. |
For that reason, a woman who knows that her baby will be born with either of these two types of spina bifida should have a planned cesarean section (C-section), rather than deliver vaginally. By delivering the baby before labor begins, this approach may minimize the amount of damage.
|
|
|
Doctors generally begin treatment with antibiotics as soon as possible in order to avoid infection such as encephalitis or meningitis – both very serious, even fatal, infections. Risk is higher if the sac ruptures. Surgical closure is usually performed within 24 to 72 hours after birth. |
During Meningocele surgery, the exposed meninges are put inside the spinal column & then the neurosurgeon closes the opening with muscle & skin taken from either side of the back. |
|
|
A child with Meningocele does not have any sensory & motor disabilities, so after surgical closure these children grow up fine but should continued to follow up with their doctor. |
During the Myelomeningocele procedure, a neurosurgeon puts the exposed spinal cord & meninges inside the spinal column & then closes the opening with muscle & skin taken from either side of the back. If the area is very large & hard to close, a plastic surgeon may be called in to accomplish this part of the procedure. |
|
|
Sensory & motor damage with Myelomeningocele Spina Bifida
|
is not curable or reversible despite surgical correction
|
|
|
After surgical closure, nursing care is still aimed at protecting the incisional site along with routine postoperative observations & pain relief. The infant should be positioned prone while in the crib until the sutures are removed in 7 to 10 days.
|
The dressing is left in place for the neurosurgeon to remove & change. The infant can be held for feeding, nursing, therapy, & parental bonding.
|
|
|
Care should be taken to avoid extended periods of pressure on the lateral trunk, in particular if the defect was large which can leave sutured area skin taut.
|
Insertion of a Foley catheter in the immediate postoperative period is useful because urinary retention can develop in these infants & the prone position makes it difficult for the nursing staff to detect this. The catheter is usually left in place for several days.
|
|
|
Once Foley catheter is removed, the nurse will perform routine sterile intermittent urinary catheterization to measure residual urine volume due to patient’s permanent sensory and motor disabilities.
|
Daily head circumference should be obtained to closely watch for the development of Hydrocephalus. Shunt placement surgery should done as soon as possible. Antibiotic drugs are initiated prior to the repair & are maintained until cultures taken in the operating room are negative at 72 hours.
|
|
|
Surgeryon the newborn with spina bifida may only be the first of many operations that the child will need.
|
Many infants with spina bifida also have Hydrocephalus. |
|
|
Although the word literally means “water on the brain,” it is, in fact, a build-up of cerebrospinal fluid around & in the ventricular spaces of the brain. In a Spina Bifida patient, the spinal defect causes a Chiari malformation in which part of the cerebellum, the area of brain responsible for
|
controlling balance & coordinating movement, descends below the foramen magnum.
|
|
|
The resulting pressure on the cerebellum &brain stem blocks the flow of cerebrospinal fluid (CSF) & leads to Hydrocephalus. This condition requires surgery, in which a shunt – or drainage tube – is placed inside the head. A shunt may be needed for an entire lifetime & may need to be replaced as the child grows.
|
Hydrocephalus & shunts will be discussed in more detail in another PowerPoint presentation.
|
|
|
Orthopedic problems may include; hip dislocations, scoliosis, contracted muscles, tendons, & ligaments that may have to be surgically released. It is not uncommon for nerve damage to lead to clubfoot . |
Placing the affected foot in a cast for the first several months of the child’s life may work to straighten the foot otherwise corrective surgery may be performed. Similarly, hip dislocation (dysplasia), may also be treated with harness type bracing or be surgically corrected.
|
|
|
Many children with myelomeningocele develop a complication called progressive tethered cord syndrome. This is a condition in which the spinal cord adheres to the scar from initial surgery to close the opening in the spine.
|
Because it is attached to something that does not move, the spinal cord is not able to grow in length and keep up with the growth of the child. Tethered cord syndrome may result in further loss of nerve & muscle function in the legs, feet, bowel, & bladder & cause worsening incontinence and paralysis. |
|
|
Another surgery to detach the scar tissue & release the end of the spinal cord may allow the child to regain their prior level functioning and |
prevent further nerve deterioration.
|
|
|
Every child with severe spina bifida will need extensive & intricate care. This requires the involvement of a specially trained team of professionals. |
Included in this multidisciplinary team are pediatricians, neurosurgeons, orthopedic surgeons, neurologists, urologists, physical therapists, occupational therapists, psychologists, nurses, dietitians and social workers – among others. |
|
|
Ideally, the child with spina bifida should receive care at a facility where all the multidisciplinary specialized services can be delivered in a coordinated fashion. It will be important to develop a health plan at school to ensure appropriate physical supports
|
in the school setting including mobility, accessibility to the classroom, & adapted physical education. Providing all of the specialized educational supports facilitates growth & development & allows for the smooth transition into adulthood.
|
|
|
Here is why: Spinal cord herniation results in permanent sensory & motor function loss to the legs & feet. Treatment for paralysis usually begins soon after birth. The goal of treatment is to increase mobility, strength & independence.
|
Working with a physical therapist, parents can learn how to exercise the baby’s legs. They should start these exercises early on – not long after the initial surgery.
|
|
|
Some people with spina bifida need adaptive equipment such as braces, crutches, or wheelchairs. The location of the malformation on the spine often indicates the type of devices needed.
|
Children with a defect high up on the spine have more paralysis & will often require a wheelchair, while those with a defect lower on the spine may be able to use crutches or walkers.
|
|
|
When the child is old enough to walk, leg braces may be required. A trunk brace also may help if the child has a curvature of the spine – such as scoliosis. However, the curvature may worsen as the child grows. Severe curvature must be corrected surgically. Skin integrity needs to be maintained. |
Some children have complete sensory loss & are at risk for pressure ulcers & unknown injuries such as cuts, abrasions or burns to the legs & feet.
|
|
|
Urinary retention is common in children with Myelomeningocele due to abnormal innervation of the bladder causing a neurogenic bladder.
|
This impaired nerve function can result in an inability to voluntarily empty the bladder effectively.
|
|
|
Management of the bladder is critical since poor management can lead to kidney damage or failure. To deal with this problem, it is necessary for the parents, & eventually the patient, to learn clean intermittent catheterization to be performed several times a day.
|
Inability to effectively empty the bowels results in chronic , severe constipation & sometimes liquid stool incontinence. |
|
|
Most patients with bowel involvement will benefit from a bowel program- a combination of dietary modifications, fiber supplementation & possibly stool softeners or laxatives to stimulate emptying the rectum regularly.
|
Many physical, mental, emotional, & social changes are associated with the adolescent & teen years. Teens & adolescents develop their own personalities & interests & want to become more independent.
|
|
|
This transition period can be challenging, especially for people affected by spina bifida. It is important for the parents & caregivers of adolescents & teens with spina bifida to take active steps toward making them independent starting in childhood,
|
so that by the time they are older they can develop the necessary skills to help them reach their full potential. As people with spina bifida mature, they will perform more & more activities themselves.
|
|
|
Most teens will dress & bathe themselves, manage their bathroom plans, & move about independently in their homes & communities.
|
Make sure spina bifida families are aware of all the resources available to help them live a happy and healthy life.
|
