Greetings Everyone

Spina Bifida
Presented by: Shahad Alshareef & Farah Alharbie
Nurses Intern phase I

Supervised by : NICU CRN Ms. Eman Bazbouz

Outlines
 Definition  Prognosis
 Risk factors  Rehabilitation
 Types  Prevention
 Diagnosis  Family support
 Management
 Complications
Anatomy & Physiology Spinal cord
Spina Bifida
Defination : It is a type of neural tube defect (NTD), A birth

defect in the baby that occurs when the spine and the spinal

cord do not develop completely

(KFSH&RC) - October 2000 until December 2012

• 620 mothers who underwent antenatal ultrasonography
• 392 (63%) were diagnosed at birth,
• (95%) did not take folic acid 3 months prior to
pregnancy
• (76%) did not take folic acid during the 3 months after
conception with the affected child
• Only (5%) received folic acid prior to conception.
Risk Factors
 Folate deficiency

 Family history of neural tube defects

 Some medications: Anti-seizure medications & valproic acid.

 Diabetes & obesity: Pre-pregnancy obesity is associated with an

increased risk of neural tube birth defects.

 Increased body temperature: Maternal fever.

Types

• Spina bifida occulta

• Meningocele

• Myelomeningocele
Spina bifida occulta
Spina bifida occulta
 Occulta means hidden

Defination
 Small separation or gap in one or more of the bones of

the spine (vertebrae).

 Mildest and most common type.

Clinical
manifestation  Dimple, patch of hair, or red patch at the base of the spine
Diagnosis
 Clinical manifestation, x-ray, MRI
Managment
 No need for medical treatment.
Spina bifida occulta

 ASK ABOUT THIS INFO IF TO MENTION.

 Some people with spina bifida occulta also have a tethered cord. It is the spinal cord that

can't move freely inside the spinal canal

 needs to be released with surgery.

 It can stretch (especially during a growth spurt) and lead to pain

Management
 Most people with spina bifida occulta do not need medical treatment.
Meningocele
Meningocele
Defination
 Characterized by a sac of spinal fluid bulging through an
opening in the spine. (CSF + Meninges)
 No nerves are affected in this type
 Spinal cord isn't in the fluid sac.
Clinical
manifestation  Cyst or fluid-filled sac pokes through open part of the

spine.
Diagnosis
 Prenatal ultrasound or fetal MRI
Managment
 Meningocele repair
Myelomeningocele
Myelomeningocele

Defination
 Sac of fluid comes through an opening in the baby’s back.

 Part of the spinal cord and nerves are in this sac and are

damaged.

 The most serious type

Clinical
manifestation  Both meninges and spinal cord protrude into the skin of

the back, leakage of CSF is common

Diagnosis
 Prenatal ultrasound or fetal MRI
Managment
 Myelomeningocele repair

Hydrocephalus COMMMONNN
Spina bifida occulta Myelomeningocele Meningocele
Antenatal Diagnosis

 Maternal serum alpha-fetoprotein (MSAFP) test.

 Ultrasound
 Prenatal MRI
Antenatal Management

 Prenatal surgery before

the 26th week of
pregnancy
Post-delivery in delivery room ( NRT )
• In presence of Physician:
• Preparation:  Maintain prone
 Warm saline  Assess the defect
 Sterile gauze  Note for CSF leakage
 Plastic wrap  Soak the sterile gauze
 Wrap it with plastic wrap
 Admit to NICU
 NICU
Nursing & Medical Management
Nursing care
Care of the defect:

 Prevent injury of defect by using sterile constant moist saline dressing is

maintained on the defect to prevent drying and change dressing as per
neurosurgeon recommended.

 Positioning: on prone to avoid pressure on the defect

 Inspect the defect for leak CSF or any sign of infection.

 Assess for hydrocephalus.

Nursing care
Care of the defect:

 Assess skin for pressure injury.

 Assess sensation and movement

 Assess for Neurogenic bladder

 Pain management.
Medical Management

 Multidisciplinary team approach involving the specialties of neurology,

neurosurgery, neonatologist, urology, plastic, rehabilitation, physical

therapy, occupational therapy

 Surgical intervention early closure within the first 24 to 72 hours

Spina bifida; Complication

 Spina bifida can range from mild to severe, it depends on the site of the spina bifida

 Traumatic birth and difficult delivery of the baby.

 Frequent urinary tract infections.

 Hydrocephalus

 Loss of bowel or bladder control.

 Meningitis

 Permanent weakness or paralysis of exterminates

Prognosis of SB

 The prognosis for individuals with SB depends on the number and severity of
abnormalities.

 People with spina bifida who have milder forms of the condition and do not
have any other major health problems will have good prognosis
 Rehabilitation
• A team of specialists to provides a range of rehabilitative treatments for
children with spina bifida.
• Physical, occupational, and speech therapy are often an integral part of care. 
Physical Therapy

 Exercises and other methods are used in

physical therapy to enhance balance, muscle
coordination, and gait. Additionally, it can
strengthen weak muscles, increase flexibility
in stiff muscles, maintain joint range of
motion and using assistive device to move
independently.
Rehabilitation
Occupational Therapy

 The ability of the child to carry out daily tasks is improved by occupational therapists.
Their aim is to teach children crucial life skills including washing, dressing, and using
the bathroom.
Rehabilitation
Speech Therapy

 Speech therapists use exercises that train the brain to pronounce, understand, and
interpret particular words, sounds, numbers, and gestures to improve a child's oral
motor skills and communication abilities.
Family Support
The family need to know how to continue at home the care that has been initiated in the
hospital:
 Education
 Positioning
 Feeding
 Skin care
 Range of motion exercises
 Signs of complications and how to reach assistance when needed.
Prevention
• By daily consumption of 0.4 mg of folic acid by women of
child- bearing age

• Drugs that affect folic acid metabolism and increase the

risk for myelomeningocele should be avoided before
pregnancy

• Medical conditions such as obesity and diabetis should be

controlled well.
 Spina Bifida Evidence Based
Conducted on 18 of September to describe the age distribution of common surgical
procedures and health outcomes in patients with SB.Using serial cross-sectional data from
the National Spina Bifida Patient Registry they examined surgical procedures (GI,
neurologic, orthopedic, skin, urologic) and health outcomes (fecal and urinary
continence , skin breakdown, and ambulation status) of patients with SB by age and SB
type.
Results:
• 91.4 % of procedures occurred among participants with myelomeningocele SB . For both types
of SB , the distribution of procedures varied by age .
• 53 % of neurologic procedures were performed on infants who were under one year old ;
orthopedic and urologic procedures were next in frequency but tended to be done at older age.
• The health outcomes for patients with myelomeningocele SB revealed lower frequencies of
positive health outcomes than those for patients with nonmyelomeningocele SB across all age
groups
• The rates of fecal and urinary continence and skin breakdown increased with age whereas the
ability to ambulate declined with age .
Video
 References

1. Anzilotti, A. W. (Ed.). (2022, January). Meningocele (for parents) - nemours kidshealth. KidsHealth. Retrieved October 30, 2022, from
https://kidshealth.org/en/parents/meningocele.html 
2. Campbell, J. W. (Ed.). (2019, April). Myelomeningocele (for parents) - nemours kidshealth. KidsHealth. Retrieved October 30, 2022, from
https://kidshealth.org/en/parents/myelomeningocele.html 
3. Campbell, J. W. (Ed.). (2019, April). Spina bifida occulta (for parents) - nemours kidshealth. KidsHealth. Retrieved October 30, 2022, from
https://kidshealth.org/en/parents/spina-bifida-occulta.html 
4. Campbell, J. W. (Ed.). (2019, April). Spina bifida occulta (for parents) - nemours kidshealth. KidsHealth. Retrieved October 30, 2022, from
https://kidshealth.org/en/parents/spina-bifida-occulta.html?ref=search 
5. Centers for Disease Control and Prevention. (2020, September 3). What is Spina Bifida? Centers for Disease Control and Prevention. Retrieved
October 30, 2022, from https://www.cdc.gov/ncbddd/spinabifida/facts.html 
6. Centers for Disease Control and Prevention. (2020, September 3). What is Spina Bifida? Centers for Disease Control and Prevention. Retrieved
October 30, 2022, from https://www.cdc.gov/ncbddd/spinabifida/facts.html 
7. Mayo Foundation for Medical Education and Research. (2022, January 8). Spina bifida. Mayo Clinic. Retrieved October 30, 2022, from
https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860 
8. U.S. Department of Health and Human Services. (n.d.). Spina bifida. National Institute of Neurological Disorders and Stroke. Retrieved October
30, 2022, from https://www.ninds.nih.gov/health-information/disorders/spina-bifida 
9. Alabi, N. B. ( 1 ), Thibadeau, J. ( 1 ), Valdez, R. ( 1 ), Wiener, J. S. ( 2 ), Conklin, M. J. ( 3 ), Dias, M. S. ( 4 ), & Sawin, K. J. ( 5 ). (2018).
Surgeries and health outcomes among patients with spina bifida. Pediatrics, 142(3). https://doi-org.sdl.idm.oclc.org/10.1542/peds.2017-3730
 Thank you for
listening
Any questions/discussions ?