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.

 CAUSES
• Low folic acid intake. Research indicates folate 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.
 TYPES OF SPINABIFIDA
There are two types of spina bifida.

1. SPINA BIFIDA OCCULTA

2. SPINA BIFIDA CYSTICA

MENINGOCELE MYELOMENINGOCELE.
 SPINABIFIDA OCCULTA
Spinabifida occulta is the mildest form of spina bifida. In occulta, the
outer part of some of the vertebrae is not completely closed. The splits
in the vertebrae are so small that the spinal cord does not protrude.
The main features are
• The skin at the site of the lesion may be normal, or it may have some
hair growing from it
• there may be a dimple in the skin, or a birthmark.
• Asymptomatic in most cases
• Most people are diagnosed incidentally from spinal X-rays
 SPINABIFIDA CYSTICA
Spina bifida cystica is a bony defect in the vertebral column that causes

a cleft in that column. The meningeal membranes that cover the spinal

cord and part of the spinal cord protrude through this cleft, and are

clearly visible. Majority of cases sac formation at level of defective

vertebra. Spina bifida is of two types meningocele and

myelomeningocele.
 MENINGOCELE

A posterior meningocele or meningeal cyst is the least common form of

spina bifida. In this form, a single developmental defect allows the

meninges to herniate between the vertebrae. When part of the spinal

meninges protrudes through the bony defect and forms a cystic sac ,the

sac contains the spinal fluid.

• Seeing as a sac like structure above the defect
• As the nervous system remains undamaged, individuals with meningocele are
unlikely to suffer long-term health problems.
• A meningocele may also form through dehiscences in the base of the skull.
 MENINGOMYELOCELE
Myelomeningocele (MMC), also known as meningomyelocele, is the

type of spina bifida that often results in the most severe complications

and affects the meninges and nerves. In individuals with

myelomeningocele, the unfused portion of the spinal column allows the

spinal cord and meninges to protrude through an opening. The sac

contains parts of meninges, spinal fluid and spinal nerves.

AS the spinal nerves includes there is some complications associated with
meningomyelocele. These are
• Paralysis or weakness of lower extremities- 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.
• 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.
• 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.
• Hydrocephalus
• Impaired bladder and bowel function
Spina bifida Meningomyocele
L1-S1 nerves associated with
movement and sensation of
lower legs.
All the lumbar and sacral nerves
is needed for the normal
walking
 ASSOCIATED SYMPTOMS
L1-L3 associated with flexing knee L4-L5 associated with extending knee
L4-L5 for raising feet S1 –S2 for lowering feet
AMNIOTIC FLUID INJURY
 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.
 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 ASSESSMENT
• 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.
• 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 INTERVENTION
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.
• 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.
• 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.
• 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.
• 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.
• 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.
 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.