General Objective:

After 1 hour of interactive lecture

discussion, the students will be able
to gain knowledge, skills and develop
positive attitude towards the care of
an Infant with Spina Bifida.
Specifically the students will be able
to:
1.describe spina bifida;
2.identify the types and/or forms of
spina bifida;
3. assess an infant with a lower
motor neuron damage;   
4.recognize the Pathophysiology;
5. determine the assessment and /
Diagnostic Test;
6. formulate a nursing diagnoses for
an infant with spina bifida;
7. establish appropriate outcomes
based on the priority needs of an
infant with a spina bifida;
8. evaluate expected outcomes for
achievement and effectiveness of
nursing care;
9. discuss the therapeutic
management of spina bifida;
1o.  identify the preventions of spina
bifida;
11. state the nursing considerations.
 A happy baby is a source of joy to its
parents and to others lucky to be near
it. Its smile is infectious and its
defencelessness makes it adorable.
But the moment this young bundle of
happiness falls sick, the mother just
do not know what to do. The baby
cannot talk . So it can’t express its
pain or itching on anything make it
uncomfortable . So we have to depend
on visible symptoms. And you should be
attentive to your infant’s signals of
distress and find a cure for its sickness.
Health Problems during
INFANCY

NEURAL TUBE DISORDER

Spina Bifida
What is Spina Bifida?
Spina Bifida
• Latin for “divided spine”
• The most common defect of the CNS,
resulting from the incomplete closure
of the embryonic neural tube.
2 Types/ Forms of Spina Bifida

• Spina Bifida Occulta

• Spina Bifida Cystica

- Meningocele
- Myelomeningocele
Spina Bifida Occulta
• Is a malformation in
which the posterior
portion of the laminas
fails to close but the
spinal cord or
meninges do not
herniate or protrude.
Spina Bifida Occulta
• Refers to the defect that
is not visible externally.
• It occurs most commonly
in the lumbosacral area...
• dimple, hairy patch, dark
spot or swelling over
affected area
• spinal cords and
nerves usually normal…
Spina Bifida Cystica

• Refers to a
visible defect
with an
external
saclike
protrusion.
Spina Bifida Cystica
MENINGOCELE
• Occur if the
meninges covering
the spinal cord
herniate through a
defect in the
vertebral column.
• It generally occurs in
the lumbar region…
Spina Bifida Cystica
MYELOMENINGOCELE
• The spinal cord and
the meninges
protrude through the
vertebrae the same
as the meningocele
except that it
contains nerves.
• It is usually covered
with a very fragile,
thin membrane…
Spina Bifida Cystica
MYELOMENINGOCELE
• is visible at birth, often at lumbosacral area.
Clinical Manifestations due to
lower motor neuron damage:

• The child will have flaccidity;

• Lack of sensation of the lower
extremities;
• Loss of bowel and bladder control;
Clinical Manifestations due to
lower motor neuron damage: (continuation)

• Children often have

accompanying
talipes (clubfoot)
disorders;
• Developmental hip
dysplasia.
• Hydrocephalus
accompanies
myelomeningocele...
Hydrocephalus
Pathophysiology
• Most authorities believe that the primary
defect in Neural Tube Disorders
(NTD’s) is a failure of the neural tube
to closure during early development
(the first 3 to 5 weeks) of the embryo.
Multifactorial Etiology:
• Drugs;
• Radiation;
• Maternal malnutrition;
• Chemicals;
• Possibly a genetic mutation in folate
pathways in some cases may result in
abnormal development.
Predisposing / Risk Factors:
• Prepregnancy maternal obesity
• Previous NTD pregnancy
• Use of antiepileptic drugs in pregnancy
ASSESSMENT and /
Diagnostic Test
• The diagnosis of Spina Bifida is made
on the basis of clinical manifestations
and examination of meningeal sac.
Neural tube disorders may be
discovered earlier during intrauterine
life by:

• Prenatal
ultrasound
Neural tube disorders may be
discovered earlier during intrauterine
life by:

• analysis of alpha fetoprotein (AFP) in

the maternal serum.

• Amniocentesis (discovery of increased

AFP in amniotic fluid)
Amniocentesis
• is another test following
positive results from the
blood tests and
negative results from
the ultrasound. 
• This detects alpha-
fetoproteins in the
amniotic fluid
surrounding the baby.
 Nursing Diagnoses and Related
Interventions: Immediate Concerns
Nursing Diagnoses and Related
Interventions: Immediate Concerns
Nursing Diagnosis:
• Risk for infection
related to rupture of
the neural tube sac.

Outcome Evaluation:
• Neural tube sac
remains intact;
axillary temperature
remains below 37°C
INTERVETION(S):
Proper Positioning Preoperatively
• Position infants carefully to prevent
pressure on the exposed meninges,
either in a prone position or
supported on their side.
Prone Position
• A folded towel under the abdomen
helps to flex the infant’s hips, reduce
pressure on the sac, and ensure good
leg position.
Side-lying Position
• Use a rolled blanket or diaper placed
behind their upper back (above the
disorder) and a separate one behind
their lower back (below the disorder)
INTERVETION(S):

• Place a piece of plastic wrap below the

meningocele on the child’s back like an
apron and taping it in place.
INTERVETION(S):

• A sterile wet compress of saline,

antiseptic, or antibiotic gauze over the
lesion may be used to keep the sac
moist.
INTERVETION(S):

• No pressure should be exerted on the

open lesion by a top sheet, make
certain that the child is adequately
warm.
• The infant may need to be kept in an
incubator to maintain body heat if a
large area of the back cannot be
covered.
INTERVETION(S):

• Any seepage of clear fluid from the

defect should be reported promptly.
Because this is probably escaping CSF.
• Checking any leakage for evidence of
glucose will confirm the fluid is CSF.
Postoperative Care
• After surgery, a child is again placed on
the abdomen until the skin incision has
healed (about 7 days).
Nursing Diagnoses and Related
Interventions: Immediate Concerns
Nursing Diagnosis:
• Impaired physical mobility related to
neural tube disorder

Outcome Evaluation:
• Child ambulates with the least amount
of accessory equipment possible.
INTERVETION(S):

• Encourage them to take the infant to the

places children normally accompany
parents... Encouraging children to be
independent , helps them lead as active
a life as possible.
INTERVETION(S):

• Informed them - Parents will need to

perform passive exercises to prevent
muscle atrophy and formation of
contractures if a child has impaired
lower extremity motor control.
• Leg braces – if needed to help maintain
good alignment and enable walking with
crutches.
INTERVETION(S):

• Instruct parents to make a routine

inspection of the child’s lower
extremities and buttocks daily for any
area irritation or possible infection.
Nursing Diagnoses and Related
Interventions: Immediate Concerns
Nursing Diagnosis:
• Risk for impaired elimination related to
neural tube disorder

Outcome Evaluation:
• Child demonstrates ability to
independently manage bowel and bladder
elimination by school age.
INTERVETION(S):

• Inserting a clean catheter through the

urethra into the bladder every 4 hours to
drain urine from the bladder.
INTERVETION(S):
• Prescription of drug such as oxybutynin
chloride (Ditropan)
 INTERVETION(S):

• In some children,
uterosigmoidostomy
is done to bypass the
non-functioning
bladder.
Therapeutic Management
• Infants may be delivered thru cesarean
birth to avoid pressure and injury to the
spinal cord.
Therapeutic Management (continuation)
• Children with spina bifida occulta need
no immediate surgical correction...

• Some children may eventually need

surgery to prevent vertebral
deterioration because of the unbalanced
spinal column.
Therapeutic Management (continuation)
• Treatment for meningocele and
myelomeningocele involves surgery
•
• Currently, surgery is done as soon after
birth as possible (usually 24 to 48
hours) so infection through the exposed
meninges does not occur.
Can Spina Bifida be prevented?

• Exact cause is not known

• Medical research confirms link between
folic acid and Spina Bifida*
• Women who take 400 mcg of folic acid
every day reduce the risk by up to 70%.
– BEFORE becoming pregnant
– During first three months of pregnancy

* (and other birth defects)

 What is folic acid?
• B-vitamin that builds healthy cells
• Found in most multivitamins
• Foods
– Leafy green vegetables (broccoli and
spinach)
– Fruits and juices (orange juice)
– Folic acid-fortified breakfast cereals and
other bread and grain products

The surest way to get enough folic acid every day

is to take a vitamin with folic acid. 

Nurse Considerations
• Encourage folic acid intake.
• Do not take rectal temperatures in
infants with Spina Bifida.
• Observe early sign of infections.
Prognosis
• The early prognosis for the child with
myelomeningocele depends on the
neurologic deficit present at birth,
including motor ability and bladder
innervation and the presence of
associated anomalies.
Prognosis (continuation)
• Early surgical repair of the spinal defect,
antibiotic therapy to reduce the
incidence of meningitis and ventriculitis,
prevention of urinary system
dysfunction, a program of bowel
management, and early detection have
significantly increased the survival rate
and quality of life in such children.