1

PRESENTATION
ON
SPINA BIFIDA
SUBJECT:Child Health Nursing
SUBMITTED TO: SUBMITTED BY:
Miss. Ruhi Gupta Priya Kumari
Lecturer, C.H.N M.Sc Nursing 2nd Year
NSCNP Roll No. 08
SUBMITTED ON:
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BACKGROUND OF INFORMATION

 Title of Course : M.Sc.Nursing 2nd Year

 Unit: 3rd
 Name of Teacher: Priya Kumari
 Name of Topic: Spina Bifida
 Duration: 40 minute
 Date and Time: 40 min.
 Place: Classroom
 Methods of Teaching: Lecture cum discussion
 Total Students: 3
 AV-Aids: PPT, Greenboard , Chart , Flashcards, Pamphlets
 Name of Evaluator: Miss. Ruhi Gupta
 Previous Background of Trainees: Students has little bit knowledge about Spina Bifida (yes/no)
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General Objective:
By the end of this lecture students will gain knowledge, attitude skills, practice about the Spina Bifida.

Specific Objective:
At the end of lecture students will be able to

 to define Spina Bifida

 to explain about the types of Spina Bifida
 to explain causes of Spina Bifida
 to desscribe the clinical manifestation of Spina Bifida
 to explain about the diagnostic evaluation of Spina Bifida
 to explain the management of Spina Bifida
 to explain about preventation of Spina Bifida
 to explain possible complication of Spina Bifida
 to explain about nursing management of Spina Bifida
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Sr.No Time Specific Content matter Teaching AV-aids Evaluation

Objectives Learning
Methods

1. 30 Self introduction Good morning everyone. - - -

seconds My name is Priya Kumari. I am student of
M.Sc.Nursing 2nd Year.

2. 30 To introduce the Today’s topic for presentation is “Spina Bifida”. - - -

seconds topic

3. 1 min. To assess the Previous knowledge assessment: - - -

previous Do you have any idea about Spina Bifida ?
knowledge of the
students

1 min. Introduction of INTRODUCTION Lecture cum PPT -

Spina Bifida Spina bifida is part of a group of birth defects called discussion
neural tube defects. Spina bifida is a neural tube
defect where there is an incomplete closure of the
vertebrae and neural tube, caused by a defect in the
neural arch generally in the lumbo-sacral 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.

4. 2 min. To define Spina Definition . Lecture cum PPT What is Spina

Bifida Spina bifida is a malformation of spine, in which discussion Bifida?
posterior portion of lamina of vertebra fail to close
with or without defective development of spinal
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cord.
TYPES
There are three main types: Chart

 spina bifida occulta
 meningocele 
 myelomeningocele.

5. 5 min. To explain about 1. Spina bifida occulta: It is a defect which Explain about types
the types of results from failure of formation of bony of Spina Bifida?
Spina Bifida arch around the spinal cord, but spinal cord L
and meninges are normal. It is not visible E
externally and is asymptomatic. This type of C
defect occurs in 5% cases of spina bifida. T PPT
U
2. Spina bifida cystica: Spina bifida cystica is R
a defect in the closure of posterior vertebral E
arch with protrusion of spinal cord and
meninges through the defect.
a. Meningocele: It is a sac-like herniation C
through the bony malformation, containing U
meninges and cerebrospinal fluid. The M
covering of the sac may be thin and
D
translucent or membranous.
I
A posterior meninocele or meningeal cystis S
the least common form of spina bifida. In C
this form, a single developmental defect U
allows the meninges to herniate between the S
vertebrae. As the nervous system remains S
undamaged, individuals with meningocele I
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O
are unlikely to suffer long-term health
N
problems.
Causes of meningocele include teratoma and
other tumors of the sacrococcyx and of
the presacral space, and Currarino
syndrome.
A meningocele may also form through
dehiscences in the base of the skull. These
may be classified by their localisation to
occipital, frontoethmoidal, or nasal.
Endonasal meningoceles lie at the roof of
the nasal cavity and may be mistaken for
a nasal polyp. They are treated surgically.
b. Myelomenigocele: It is a sac like protrusion
of spinal cord, CSF and meninges through
spinal cleft. During the embryonic life, the
lumbar segment of spinal cord is the last
part of neural tube to close, therefore in
most of the cases, menigo-myelocele are L
found in lumbar or lumbosacral region. E
• The defect may occur in lumbosacral region C
(70%) T
U
• lower lumbar region (47%) R
E
• upper lumbar region (23%) and
• sacral region (2.6%).
C
The etiology in most cases of spina bifida is U
multifactorial, involving genetic, racial, and M
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environmental factors, in which nutrition,

particularly folic acid intake, is key. D
• Myelomeningocele (MMC), also known as I
meningomyelocele, is the type of spina S
bifida that often results in the most severe C
complications and affects the meninges and U
nerves. S
S
•  In individuals with myelomeningocele, the I
unfused portion of the spinal column allows O
the spinal cord to protrude through an N
opening.
• Myelomeningocele occurs in the third week
of embryonic development, during neural
tube pore closure. MMC is a failure of this
to occur completely. The meningeal
membranes that cover the spinal cord also
protrude through the opening, forming a sac
enclosing the spinal elements, such as
meninges, cerebrospinal fluid, and parts of
the spinal cord and nerve roots.
•  Myelomeningocele is also associated
with Arnold–Chiari malformation,
necessitating a VP shunt placement.
o Toxins and conditions associated with
MMC formation include: 
o calcium-channel blockers
o  carbamazepine
o  cytochalasins
o  hyperthermia and 
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o valproic acid
• Myelomeningocele is a neural tube defect in
which the bones of the spine do not
completely form. This results in an
incomplete spinal canal. The spinal cord and
meninges protrude from the child's back.
• This condition may affect as many as 1 out
of every 4,000 infants.
Other disorders of the spinal cord or
musculoskeletal system may be seen, including:
 Syringomyelia (a fluid-filled cyst within the
spinal cord)
 Hip dislocation

6. 3 min. To explain causes CAUSES L PPT What are the causes

of Spina Bifida • Maternal Age: The disorder is twice more E of Spina Bifida?
common in pregnant mothers over 35 years C
of age or of below 20 years age. T
U
• Environmental: Radiations increase the R
risk of defective neural tube development. E Flashcard
Regional differences are also seen. s
• Low folic acid intake. Research indicates
folate can reduce the incidence of neural C
tube defects by about 70% and can also U
decrease the severity of these defects when M
they occur.
D
• Genetics. If a woman gives birth to a baby I
with spina bifida, she has a higher-than- S
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normal risk of having another baby with C

spina bifida too (about 5% risk). U
S
• Certain medications. Some medications, S
such as some for treating epilepsy or bipolar I
disorder have been associated with a higher O
risk of giving birth to babies with congenital N
defects, such as spina bifida. As they
interfere with the metabolism of the folic L
acid. E
• Diabetes. Women with diabetes are more C
likely to have a baby with spina bifida, T
compared to other females. U
R
• Obesity. Obese women, those whose BMI E
(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 C
30, the higher the risk. U
M
• Normally, during the first month of a
pregnancy, the two sides of the baby's spine D
(or backbone) join together to cover the I
spinal cord, spinal nerves, and meninges S
(the tissues covering the spinal cord). The C
developing brain and spine at this point are U
called the neural tube. Spina bifida refers to S
any birth defect in which the neural tube in S
the area of the spine fails to close I
completely. O
N
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7. 5 min. To desscribe the CLINICAL MANIFESTATION L PPT What are the clinical
clinical Spina Bifida Cystica E manifestation of
manifestation of a. Meningocele C Spina Bifida?
Spina Bifida • An external cystic defect can be seen at the T
back. The sac is composed only of meninges U
and is filled with CSF. The spinal cord and R
nerves are normal. E
• There is seldom evidence of weakness of
legs or lack of sphincter control. C
b. Myelomeningocele U
• Seen in 1 out of every 800 infants, M
manifestations of myelomeningocele depend
on the location and extent of defect. The D
higher the deformity the more neurological I
deficits will be present. S
C
• A round, raised, poorly epithelialized, U
herniated mass is present over the vertebral S
column, mainly in the lumbosacral region. S
I
• Approximately, 90% of infants with severe O
spina bifida develop hydrocephalus due to N
associated Arnold-chiari syndrome.
• Loss of motor control and sensation occurs,
below the level of lesion.
• A low thoracic lesion may cause total
flaccid paralysis.
• A Sacral lesion leads to weakness of the
lower limbs.
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• Bowel and bladder may or may not be

affected; there may be faecal and urinary L
incontinence. E
C
• There may be renal impairment due to faulty T
renal innervation. Urinary tract infections U
are common complication associated with R
the defect. E
• Congenital skeletal anomalies may be
present in these children due to denervation
of muscles like club foot, developmental C
dysplasia of hip, kyphosis or scoliosis. U
These deformities are not only a cosmetic M
problem; they may also lead to back pain,
D
respiratory distress, recurrent skin
I
breakdown and difficulty in movement.
S
• Developmental delays are commonly seen C
in speech, mobility etc. U
S
• Spina bifida with myelocele is the most S
severe form of myelomeningocele. In this I
type, the involved area is represented by a O
flattened, plate-like mass of nervous tissue N
with no overlying membrane. The exposure
of these nerves and tissues make the baby
more prone to life-threatening infections
such as meningitis. L
• The protruding portion of the spinal cord E
and the nerves that originate at that level of C
the cord are damaged or not properly T
developed. As a result, there is usually some U
degree of paralysis and loss of sensation R
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E
below the level of the spinal cord defect.
Thus, the more cranial the level of the
defect, the more severe the associated nerve C
dysfunction and resultant paralysis may be. U
Symptoms may include ambulatory M
problems, loss of sensation, deformities of
the hips, knees or feet, and loss of muscle D
tone. I
• Loss of bladder or bowel control S
• Partial or complete lack of sensation C
• Partial or complete paralysis of the legs U
• Weakness of the hips, legs, or feet of a S
newborn S
• Abnormal feet or legs, such as clubfoot I
• Buildup of fluid inside the skull O
(hydrocephalus) N

8. 4 min. To explain about DIAGNOSTIC EVALUATION L PPT Explain about

the diagnostic Tests done on the baby after birth may include x- E diagnostic
evaluation of rays, ultrasound, CT, or MRI of the spinal area. C evaluation of Spina
Spina Bifida T Bifida.
U
Prenatal diagnosis of neural tube defects is R
possible by using following tests: E
Prenatal screening can help detect this condition.

During the second trimester, pregnant women can C

have a blood test called the quadruple screen. This U
test screens for myelomeningocele, Down M
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syndrome, and other congenital diseases in the

baby. Most women carrying a baby with spina D
bifida will have an increased level of a protein I
called maternal alpha fetoprotein (AFP). S
If the quadruple screen test is positive, further C
testing is needed to confirm the diagnosis. U
S
• Ultrasound S
I
• Foetal MRI O
N
• Amniocentesis: It may reveal an increase in
alpha-fetoprotein, a fetal specific gamma-
globulin in the amniotic fluid that indicates
presence of meningomyelocele. This test
should be done between 14th to 16th week
of gestation in all the pregnant females who
are at risk.
• Myelomeningocele can be seen after the L
child is born. E
• A neurologic exam may show that the child C
has loss of nerve-related functions below the T
defect. For example, watching how the U
infant responds to pinpricks at various R
locations may tell where the baby can feel E
the sensations.

Diagnosis after birth is made on the following C

basis: U
• On neonatal examination, a sac may be seen M
on the back of the baby.
D
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• If a lesion is present, its contents can be I

determined using trans-illumination test S
(shining light through the sac). If the sac C
becomes translucent when light source is U
held to it, it is a meningocele, if the sac does S
not become translucent, it is a S
myelomeningocele. I
O
• CT scan and MRI of spinal cord and brain N
are used to determine bony deformities and
spinal cord herniation. They also help in
diagnosing presence of other structural
defects like hydrocephalus or Arnold-chiari
malformation.
• Laboratory tests like urine test for presence
of infection, Renal function test, WBC
counts, ESR etc may be done.
• Other tests include neurological assessment
for motor response and sensory reactions,
developmental assessment to detect any
delay in milestones etc.

9. 4 min. To explain the MANAGEMENT Explain management

management of  The management of spina bifida depends on of Spina Bifida.
Spina Bifida the nature and extent of defect. Usually no
intervention is required for spina bifida
occulta. For spina bifida cystica surgery is L
required- E
C
 Laminectomy and closure of the defect or PPT
T
removal of the sac is done within 24-48
U
hours of birth.
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 T-Closure of skin graft is done. R

E
 A co-ordinated multidisciplinary team
approach is required to maximize the
physical and intellectual potential of each C
affected child. A team of neurologist, U
neurosurgeon, orthopedic surgeon, M
urologist, primary care provider, nurse,
speech therapist and physiotherapist need to D
work together for managing the child. I
 The health care provider may suggest S
genetic counseling. C
 Intrauterine surgery to close the defect U
(before the baby is born) may reduce the S
risk of some later complications. S
I
 After baby is born, surgery to repair the
O
defect is most often suggested within the
N
first few days of life. Before surgery, the
infant must be handled carefully to reduce
damage to the exposed spinal cord. This
may include:
 Special care and positioning
 Protective devices
 Changes in the methods of handling,
feeding, and bathing
 Children who also have hydrocephalus may
L
need a ventriculoperitoneal shunt placed.
E
This will help drain the extra fluid from the
C
ventricles (in the brain) to the peritoneal
T
cavity (in the abdomen).
U
 Antibiotics may be used to treat or prevent R
infections such as meningitis or urinary tract
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infections. E
 Most children will need lifelong treatment
for problems that result from damage to
th,e.. spinal cord and spinal nerves.There is C
no known cure for nerve damage caused by U
spina bifida. M

Standard treatment is surgery after delivery. D

This surgery aims to prevent further damage of I
the nervous tissue and to prevent S
infection; pediatric neurosurgeons operate to C
close the opening on the back. U
The spinal cord and its nerve roots are put back S
inside the spine and covered with meninges. In S
addition, a shunt may be surgically installed I
to provide a continuous drain for the excess O
cerebrospinal fluid produced in the brain, as N
happens with hydrocephalus. Shunts most
commonly drain into the abdomen or chest wall.
The child may not develop bladder control. In
this case, they may need a catheter to help drain
the bladder.
Due to effect on child’s lower limbs, they may
need to wear braces. Braces are orthopedic
devices that support the legs or main part of the
body.
 In most cases, treatment will be lifelong.
They’ll need to regularly to assess any
developing problems. They may also need
to use a wheelchair for life.
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10. 2 min. To explain about Prevention Lecture cum PPT Explain about
preventation of • Folic acid supplements may help reduce the discussion preventation of
Spina Bifida risk of neural tube defects such as Spina Bifida.
myelomeningocele. It is recommended that Pamphlets
any woman considering becoming pregnant
take 0.4 mg of folic acid a day. Pregnant
women with high risk need higher dosage.
• It is important to remember that folic acid
deficiencies must be corrected before
becoming pregnant, because the defects
develop very early.
• Women who plan to become pregnant may
be screened to determine the amount of folic
acid in their blood.

11. 2 min. To explain Possible Complications Lecture cum PPT What are the
possible discussion possible
complication of  Traumatic birth and difficult delivery of the complication of
Spina Bifida Spina Bifida?
baby
 Frequent urinary tract infections
 Fluid buildup on the brain (hydrocephalus)
 Loss of bowel or bladder control
 Brain infection (meningitis)
 Permanent weakness or paralysis of legs

12. 5 min. To explain about NURSING MANAGMENT L PPT Explain the nursing
nursing E management of
management of The main aims of pre and post-operative nursing C Spina Bifida.
care are:
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Spina Bifida • Prevention of infection T

U
• Preventing injury to the sac R
• Prevention of skin breakdown E

• Preventing urinary tract infection

C
• Preventing leg and hip deformities
U
• Provision of adequate nutrition M
PRE OPERATIVE MANAGEMENT D
1. Nursing Diagnosis: Risk of impaired skin I
integrity related to altered motor and S
sensory functions. C
Nursing Interventions U
• Avoid positioning the baby on back to S
prevent pressure on the sac. S
I
• Change the position of the baby frequently. O
N
• Provide meticulous skin and back care to
keep the skin clean and dry.
• Skin may be massaged periodically to L
stimulate blood circulation, with special E
attention to bony prominences. C
T
2. Nursing Diagnosis: Risk of injury and U
infection to the sac. R
Nursing Interventions E
• Do not position the baby on the back, as
pressure over the sac may lead to rupture of C
sac. U
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• Clean the sac aseptically using normal M

saline.
D
• Cover the sac with sterile gauze pieces I
dipped in normal saline. This prevents the S
sac from dryness and rupture. C
• Change the wet saline gauze dressings every U
2-4 hours, in order to keep the sac moist. S
S
• Prevent contamination of the sac with urine I
and feces. So, do not put diaper, as passing O
urine or stool inside the diaper keeps care N
giver unaware of soiling.
• Frequently check the sac for any CSF
leakage.
• Prophylactic antibiotics must be
administered to the infant.
3. Nursing Diagnosis: Impaired bladder and
bowel function related to neurological
deficit.
Nursing Interventions L
• Children with spina bifida may have the E
problem of retention of urine so intermittent C
catheterization is done and also taught to T
parents. U
R
• Since bladder is an abdominal organ in E
infancy, pressure is applied gently on the
lower abdomen to manually express urine.
• Monitor for sign and symptoms of urinary C
20

tract infection like cloudy or foul-smelling U

urine, fever etc. M
• Administer prophylactic antibiotics to D
decrease the risk of urinary tract infection I
among patients who are catheterized. S
• Administer increased amount of fluids to the C
child as it helps in flushing out the bladder U
and urinary tract. S
S
• If the child has urine incontinence, then also I
catheterization is essential. O
• In case of bowel incontinence, keep the N
child clean and dry.
• Provide, frequent buttock care and perianal
care to infants with fecal incontinence, to
prevent excoriation of perianal skin.
L
• Provide soft bland food to the child having E
fecal incontinence. C
T
• In case, the child has constipation U
administer laxatives as prescribed. R
4. Nursing Diagnosis: Inadequate cerebral E
tissue perfusion related to complications
like hydrocephalus.
C
Nursing Interventions U
• Monitor for signs of hydrocephalus M
líkeiritability, feeding difficulty, reduced
alertness, tense or bulging fontanelle etc. D
I
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• Administer diuretics like Mannitol and S

Acetazolamide as prescribed, to reduce the C
intra cranial pressure. U
S
1. Nursing Diagnosis: Ineffective S
themoregulation related to surgery. I
Nursing Interventions O
Monitor the vital signs frequently after surgery. N

POST OPERATIVE MANAGEMENT

•
• Keep the infant warm, using radiant warmer
or incubator.
• Avoid exposing the child unnecessarily.
• Maintain thermoneutral environment.
2. Nursing Diagnosis: Risk of development L
of infection related to surgery. E
C
Nursing Interventions T
• Keep the operated site clean and dry. U
Observe for any drainage from the operated R
site. E

• Keep the baby in prone position, to avoid

pressure on the operated site. C
U
• Dressing of the site should be done using
M
aseptic techniques.
• Administer the prescribed antibiotics. D
I
22

3. Nursing Diagnosis: Altered nutrition less S

than body requirement related to disease C
process. U
S
Nursing Intervention S
• Administer intravenous fluids as ordered. I
• Maintain intake and output chart. O
N
• Begin oral feeds as soon as infant starts
tolerating the feeds,
L
• Feed the infant in side lying position.
E
• The baby can be held gently for feeding as C
soon as the surgical area is sufficiently T
healed, U
R
• Burp the infant frequently between the E
feeds.
4. Nursing Diagnosis: Risk of development
of complications related to the disease C
process. U
M
Nursing Intervention
o In order to prevent development of D
hip or joint deformity, the nurse I
must pay attention to the position in S
which the infant is placed. C
o An infant with associated hip U
dysplasia is placed in prone position S
with legs slightly to moderately S
abducted. A pillow is placed I
between the knees to counteract hip O
N
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subluxation.
o In order to reduce chances of CSF
leakage from the incision site, the
infant may be placed in low
trendelenburg's position as this helps
in reducing CSF pressure at the site.
o Monitor for development of
hydrocephalus

13. 3 min. Summarization of Summarization PPT Lecture Summarization done

the topic Black board cum
Define Spina Bifida discussion
Explain about the types of Spina Bifida
Explain causes of Spina Bifida
Desscribe the clinical manifestation of Spina
Bifida
Explain about the diagnostic evaluation of
Spina Bifida
Explain the management of Spina Bifida
Explain about preventation of Spina Bifida
Explain possible complication of Spina
Bifida
Explain about nursing management of Spina
Bifida

14. 2 min. Recaptulization Recaptulization Verbal PPT Recaptulizaton done

of the topic
 What is Spina Bifida?
 Explain types of Spina Bifida?
24

 What are the clinical manifestation of Spina

Bifida?
 What are the management of Spina Bifida?

BIBLIOGRAPHY

 Datta Parul .editor.Pediatric Nursing: Spina Bifida.3rd edition.2014. page no; 380 - 381

 Yadav Manoj. Editor. Child Health Nursing: Spina Bifida. Pee Vee; 2017. Page no.; 583

 Arulappan Judie.Rodgers C. Cheryl.editor.Wong’s Essentials Of Pediatric Nursing: Spina Bifida. 2nd South Asia edition. Elesevier;
2018.page no.; 675 - 679