SPINA BIFIDA

Jalandoni, Sophia Loren BSN 2-A

 Content
Definition
Etiology
Symptomatology
Pathophysiology
Diagnostic Labs
Medical Treatment
Surgical Treatment
Nursing Assessment
Nursing Diagnosis
Nursing intervention
Definition

Spina bifida is part of a group of birth

defects called neural tube defects.
Caused by a defect in the neural arch
generally in the lumbosacral region,
spina bifida is a failure of the
posterior laminae of the vertebrae to
close; this leaves an opening through
which the spinal meninges and spinal
cord may protrude.
Classifications
Spina bifida occulta - A bony defect that
occurs without soft tissue involvement is
called spina bifida occulta.
Spina bifida with meningocele - When part
of the spinal meninges protrudes through the
bony defect and forms a cystic sac, the
condition is termed spina bifida with
meningocele.
Spina bifida with myelomeningocele - In
spina bifida with myelomeningocele, there is
a protrusion of the spinal cord and the
meninges, with nerve roots embedded in the
wall of the cyst.
 Etiology
Low folic acid intake - Research indicates flate
can reduce the incidence of neural tube defects by
about 70% and can also decrease the severity of
these defects when they occur.
Genetics - If a woman gives birth to a baby with
spina bifida, she has a higher-than-normal risk of
having another baby with spina bifida too (about
5% risk).

Certain medications - Some medications, such as

some for treating epilepsy or bipolar
disorder have been associated with a higher risk
of giving birth to babies with congenital defects,
such as spina bifida.
Diabetes - Women with diabetes are more likely
to have a baby with spina bifida, compared to
other females.

Obesity - Obese women, those whose BMI

(body mass index) is 30 or more have a higher
risk of having a baby with spina bifida. The
higher the woman’s BMI is over 30, the higher
the risk.
 Symptomatology
1. Paralysis- If the opening occurs at the top of the spine,
the patient’s legs are more likely to be completely
paralyzed, and there will be other problems with
movement elsewhere in the body.
2. Cognitive symptoms - Problems occurring in the neural
tube have a negative effect on brain development; the
main part of the brain (cortex), especially the frontal
part does not develop properly, leading to some
cognitive problems.
3. Arnold-Chiari malformation - There may also be Type 2
Arnold-Chiari malformation, an abnormal brain
development involving the cerebellum – this may affect
the patient’s language processing and physical
coordination skills.
4. Birthmark - There may be a small birthmark, dimple or
tuft of hair on the skin where the spinal defect is.
Pathophysiology
 Assessment and

Diagnostic Findings

AFP levels - Elevated maternal alpha fetoprotein levels in

the maternal seruma nd the amniotic fluid indicates the
probability of CNS abnormalities.
Ultrasonography - Ultrasonographic examination of the
fetus may show an incomplete neural tube.
Clinical examination - Diagnosis of spina bifida is made
from clinical observation and examination.
Other imaging studies - Additional evaluation of the
defect may include magnetic resonance imaging (MRI),
computed tomography (CT), and myelography.
 Surgical Management
Surgery - Surgery is required to close the open
defect but may not be performed immediately,
depending on the surgeon’s decision.
Prenatal surgery - In this procedure — which
takes place before the 26th week of pregnancy —
surgeons expose a pregnant mother’s uterus
surgically, open the uterus and repair the baby’s
spinal cord.
Ongoing care - Babies with myelomeningocele
may also start exercises that will prepare their
legs for walking with braces or crutches when
they’re older.
Cesarean birth - Cesarean birth may be part of the
treatment for spina bifida; many babies with
myelomeningocele tend to be in a feet-first
(breech) position.
 Nursing Management
Nursing Assessment
A routine newborn examination is conducted
with emphasis on neurologic impairment.
1. Physical examination - When collecting
date during the examination, observe the
movement and response to stimuli of the
lower extremities; carefully measure the
head circumference and examine the
fontanelles.
2. Assessment of knowledge regarding the
defect - Determine the family’s knowledge
and understanding of the defect, as well as
their attitude concerning the birth of a
newborn with such serious problems.
 Nursing Diagnosis
1. Risk for infection related to vulnerability of the
myelomeningocele sac.
2. Risk for impaired skin integrity related to
exposure to urine and feces.
3. Risk for injury related to neuromuscular
impairment.
4. Compromised family coping related to perceived
loss of the perfect newborn.
5. Deficient knowledge of the family
caregivers related to the complexities of caring
for a newborn with serious neurologic and
musculoskeletal defects.
 Nursing Interventions
News that the newborn child has a condition such as spina
bifida can naturally cause the family to feel grief, anger,
frustration, fear and sadness, however, nurses are there to
help the family cope and understand the defect the child has.

1. Prevent infection - Monitor the newborn’s vital signs,

neurologic signs, and behavior frequently; administer
prophylactic antibiotic as ordered; carry out routine
aseptic technique; cover the sac with a sterile dressing
moistened in a warm sterile solution and change it every
2 hours; the dressings may be covered with a plastic
protective covering.
2. Promote skin integrity - Placing a protective
barrier between the anus and the sac may prevent
contamination with fecal material, and diapering is
not advisable with a low defect.
3. Prevent contractures of lower extremities -
Newborns with spina bifida often have talipes
equinovarus (clubfoot) and congenital hip
dysplasia (dislocation of the hips); if there is loss of
motion in the lower limbs because of the defect
conduct range-of-motion exercises to prevent
contractures; position the newborn so that the hips
are abducted and the feet are in a neutral position;
massage the knees and other bony prominences with
lotion regularly, then pad them, and protect them
from irritation.
4. Proper positioning of the newborn- Maintain the newborn
in a prone position so that no pressure is placed on the sac;
after surgery, continue this positioning until the surgical site
is well healed.
5. Promote family coping - Be especially sensitive to their
needs and emotions; encourage family members to express
their feelings and emotions as openly as possible; provide
privacy as needed for the family to mourn together over their
loss; encourage the family members to cuddle and touch the
newborn using proper precautions for the safety of the defect.
6. Provide family teaching - Give family members information
about the defect and encourage them to discuss their concerns
and ask questions; provide information about the newborn’s
present state, the proposed surgery, and follow-up care;
information shall be provided in small segments to facilitate
comprehension; after the surgery, teach the family to hold the
newborn’s head, neck, and chest slightly raised in one hand
during feeding; also teach them that stroking the newborn’s
cheeks helps stimulate sucking.
Thank you!
References:

https://nurseslabs.com/spina-bifida/

https://www.mayoclinic.org/diseases-

conditions/spina-bifida/symptoms-

causes/syc-20377860