CHILD HEALTH NURSING
PRESENTATION ON
SPINA BIFIDA
SUBMITTED BY : HARNEET KOUR
75150306619
Bsc (H) Nursing 4th Year
SUBMITTED TO : MRS. PREETHY DINESAN
FACULTY, COLLEGE OF NURSING
VMMC & SJH
INTRODUCTION
● Spina bifida is a Latin term meaning 'open spine" or split spine.
Medically, it refers to a neural tube defect characterized by
incomplete closure of neural tube and vertebrae
● Spina bifida occurs in about 1.5 per 1000 live births.
● Spina bifida might cause physical and intellectual disabilities
that range from mild to severe.
DEFINITION
Spina bifida (Latin: "split spine") is a developmental congenital
disorder caused by the incomplete closing of the embryonic neural
tube.
Spina bifida is a condition that affects the spine and is usually
apparent at birth.
ETIOLOGY
The exact cause is unknown but it has predisposing factors which
are :
●
●
●
●
●
●
Nutritional deficiency (Zinc & folic acid) in mother
Genetic factor, family history
Exposure to alcohol & radiation
Insulin dependent diabetes mellitus
Use of certain drugs during pregnancy (valporate)
Obesity
PATHOPHYSIOLOGY
● During third week of gestation neural tube is created and the
ends of neural tube, the anterior and posterior neuropores
close by the end of 4th week.
● The walls of the neural tube thicken and form spinal cord and
brain, Spina bifida occurs when the ventral induction of neural
tube fails to occur.
● The degree of defect is determined by the level of defect on
the spinal cord and the size of the defect.
CLASSIFICATION
1. Spina bifida occulta
2. Spina bifida cystica
•Meningocele
•Myelomeningocele
SPINA BIFIDA OCCULTA
●
●
●
●
●
●
Mildest type of spina bifida.
Failure of formation of bony arch around the spinal cord.
Small gap in one or more of vertebrae
Meninges and spinal cord are normal. No involvement
It is not visible externally and is asymptomatic.
Lumbosacral region.
SPINA BIFIDA CYSTICA
It is a defect in the closure of posterior vertebral arch with
protrusion of spinal cord & meninges through the defect into a
sac.
Further subdivided into :
● MENINGOCELE
● MYELOMENINGOCELE
MENINGOCELE
● Sac like protrusion of meninges through the bony
malformation
● Covered by thin transparent membrane or skin
● It contains meninges and cerebrospinal fluid
● Found in lumbosacral region, thoracolumbar region
MYELOMENINGOCELE
● Most serious form of spina bifida
● Protrusion of meninges , spinal cord containing CSF, nerve
roots into sac
● Found in lumbar or lumbosacral region
CLINICAL FEATURES
SPINA BIFIDA OCCULTA :
● Usually asymptomatic
● Dimple , tuft of hair , or port wine nevi or cutaneous lesion
over the defect
● Symptomatic children presents after 6-8 years of age with - Progression deformity of foot
- Change in micturition pattern
- Alteration of gait , foot weakness
MENINGOCELE :
● Sac like cyst protrudes outside the spine
● Bowel and bladder incontinence
MYELOMENINGOCELE :
●
●
●
●
●
●
Neurological deficit occurs due to nerve involvement
Flaccid paralysis, muscle weakness
Sensory deficit in trunk and legs
Urinary and fecal incontinence
Hydrocephalus
Arnold Chiari malformation
DIAGNOSIS
● Prenatal diagnosis by elevated alpha - fetoprotein level in the
maternal blood between 14 and 16th weeks of gestation
● Fetal ultrasound is the most accurate method to diagnose
spina bifida.
● Investigations such as X-ray, MRI , and myelography
PREVENTION
● Genetic counselling of at risk couple maybe recommended
● If severe defect is detected early in pregnancy, abortion may
be considered
● Folic acid supplementation : 400 mcg folic acid consumption
daily during antenatal period reduces the risk of developing
NTDs
MANAGEMENT
● Surgical correction for spina bifida cystica is done within 24 to
48 hours of birth
● Surgery includes closure of the defect and a VP shunt, if
hydrocephalus
● Open lesions draining CSF should be closed within 24 hours
● Closed lesions should be operated within 48 hours
LORBER’S CRITERIA FOR SELECTIVE SURGERY
Surgery is not done if there is severe paraplegia at or
below L3 level , kyphosis or scoliosis , gross
hydrocephalus , associated congenital anomalies before
the closure of back.
IMMEDIATE CARE
● Place the child in prone position.
● Cover the affected area with sterile gauze piece dipped in
normal saline.
● Maintain hydration.
● Monitor for associated defects.
NURSING MANAGEMENT
PRE OPERATIVE :
● Encourage parental expression of grief, overwhelmed with
the situation unknown
● Provide emotional support to parents
● Monitor infants vital signs and neurological status
● Promote optimal preoperative, hydration and nutritional
status
● Maintain integrity of defect, prevent further injury
PREVENTING INFECTION & INJURY TO THE SAC :
● Position the infant on abdomen to avoid pressure on the sac.
● Gently cleanse the sac with sterile normal saline or prescribed
solution.
● Apply a sterile moist normal saline or antibiotic dressing.
● Change the dressing every 2-4 hourly to prevent drying.
● Assess for opening in the sac with CSF leakage.
● Keep the area clean of urine, feces to prevent contamination.
● Change the position to side lying if required with small rolled
blanket behind the head and buttocks.
● Handle the infant carefully to prevent the injury.
POST OPERATIVE:
1. Maintaining skin integrity —
● Change position frequently
● Keep the skin clean and dry
● Watch for any skin breakdown
● Place infant on soft surface like covered foam rubber pad
1. Maintaining nutrition—
● Provide frequent interval during one feeding as burping
cannot be done
● Turn the head to one side and tilt upwards to feed the infant
in prone position
3. Promoting mobility—
● Determine the degree of mobility impairment
● Applies planes, braces and cast’s as required
● Perform passive range of motion exercises
● Use Bradford frame to maintain correct position
4. Regulating bowel and bladder function —
● Apply Crede method for relieving urinary retention
● Teach intermittent, clean self catheterisation
● Administer suppositories in constipation
COMPLICATIONS
•Difficult delivery with problems resulting from a traumatic birth
•Frequent urinary tract infections
•Hydrocephalus
•Loss of bowel or bladder control
•Meningitis
•Permanent weakness or paralysis of legs
PARENT EDUCATION
● Long term management of bowel and bladder training.
● Techniques to facilitate mobility and independence.
● Instruct parents on importance of child avoiding contact with
latex or natural rubber
● Skin care and injury prevention
● Normal growth and development and deviations from normal
for the child
● Involve the parents in child care
CONCLUSION
● The spina bifida involves congenital problems that result in
abnormal bone formation in the spine and spinal cord.
● Various nutritional, maternal and environmental factors play
a role in the etiology and pathogenesis of the spina bifida.
● Regular checkups and intake of folic acid diet before
conception and during antenatal period can help to prevent
spina bifida.