SlideShare a Scribd company logo

Spina bifida

•
•
Binand Moirangthem
Binand Moirangthem

Neural tube defects occur when the neural tube, which develops into the brain and spinal cord, fails to close properly between the 17th and 30th day after conception. The two most common neural tube defects are anencephaly and spina bifida. Spina bifida is a malformation of the spine where the posterior portion of the vertebrae fail to close, sometimes with an associated defect of the spinal cord. It most commonly occurs in the lumbosacral region. Spina bifida can range from occulta, which has no external symptoms, to myelomeningocele, the most severe form where the spinal canal remains open along several vertebrae, exposing the spinal cord and membranes in a sac

Related slideshows

Spina bifida - Child Health Nursing
Spina bifida - Child Health NursingSpina bifida - Child Health Nursing
Spina bifida - Child Health Nursing
 
Apgar score
Apgar scoreApgar score
Apgar score
 
Hydrocephalus
HydrocephalusHydrocephalus
Hydrocephalus
 
1 of 40
NEURAL TUBE DEFECTS Mr. M. Binanda Singh RINPS
NEURAL TUBE • The neural tube is the embryonic structure that eventually develops into the baby's brain and spinal cord and the tissues that enclose them.
What are neural tube defects (NTDs)? Between the 17th and 30th day after conception (or 4 to 6 weeks after the first day of a woman's last menstrual period), the neural tube forms in the embryo (developing baby) and then closes. The neural tube later becomes the babys spinal cord, spine, brain, and skull.
Spina bifida
Contd…….  A neural tube defect (NTD) occurs when the neural tube fails to close properly, leaving the developing brain or spinal cord exposed to the amniotic fluid.  The two most common neural tube defects are Anencephaly and Spina bifida.
Anencephaly
SPINA BIFIDA
INTRODUCTION • Spina bifida is part of a group of birth defects called neural tube defects.
DEFINITION • It is a malformation of spine, in which posterior portion of lamina of vertebra fail to close with or without defective development of spinal cord.
INCIDENCE • Most common developmental defect of central nervous system, occurring in about 1 or 2 per 1000 live births. • May occur in any area of spine but most commonly occurs in the lumbosacral area. **Why commonly in the lumbosacral area?**
ETIOLOGY • Genetic- (15 times more probability of inheriting the defect) • Maternal age- ( twice more common in pregnant mother over 35 year or below 20 year) • Environment • Diet lack in folic acid
Classification Spina bifida Spina bifida cystica Meningocele Myelomeningocele Spina bifida Occulta
Spina bifida Occulta • A defect which results from failure of formation of bony arch around the spinal cord, but spinal cord and meninges are normal. • It is not visible externally and is asymptomatic. • Occurs in 5% cases of spina-bifida.
Spina bifida
Clinical features • Most of the patients are asymptomatic. • A dimple in the skin or growth of hair over malformed vertebra. • As the child grows, he may develop foot weakness or disturbances of bladder and bowel sphincter.
Spina bifida
Spina bifida cystica
• An external cystic defect can be seen at the back. • The sac is composed only of meninges and is filled with CSF. • Spinal cord and nerves are normal. • Patient may have weakness of legs or lack of sphincter control. Meningocele
Spina bifida
Myelomeningocele • Also known as open spina bifida, Myelomeningocele is the most severe form. • Spinal canal remains open along several vertebrae in the lower or middle back. • Both the membranes and the spinal cord protrude forming a sac on the baby's back. • In some cases, skin covers the sac. However, tissues and nerves are exposed, making the baby prone to life-threatening infections.
• Manifestations of myelomeningocele depend on the location and extent of defect. • The higher the deformity the more neurological deficits will be present. • Approx. 90% of infants with severe spina bifida develop hydrocephalus due to associated Arnold-chiari syndrome. (a condition in which brain tissue extends into your spinal canal.) Myelomeningocele
Spina bifida
• Loss of motor control and sensation occurs according to the level of the lesion. 1. A low thoracic lesion may cause total flaccid paralysis. 2. A sacral lesions leads to weakness of lower limbs. Myelomeningocele
Spina bifida
Spina bifida
Clinical features • UTI are more common. • Congenital skeletal anomalies may be present due to denervation (any loss of nerve supply regardless of the cause) e.g club foot, dysplasia of hip, kyphosis and scoliosis.
Club foot
dysplasia of hip
dysplasia of hip
kyphosis and scoliosis
• These deformities are not only a cosmetic problem, they may lead to back pain, respiratory distress, difficulty movement, recurrent skin breakdown. Clinical features
DIAGNOSTIC EVALUATION • Prenatal diagnosis : USG Fetal MRI Amniocentesis • After birth:  Neonatal examination  CT scan, MRI  Neurological assessment  Laboratory tests
Amniocentesis • Amniocentesis can also detect neural tube defects, such as spina bifida, by measuring levels of alpha-fetoprotein in the amniotic fluid. • High levels of AFP may suggest the developing baby has a neural tube defect such as spina bifida or anencephaly. • Test should be done between 14th to 16th week of gestation who are at risk.
TREATMENT • Spina bifida treatment depends on the severity of the condition.
SURGERY
Spina bifida occulta • Often doesn't require treatment at all, but other types of spina bifida do.
Spina bifida cystica • Required Laminectomy and closure of the defect or removal of the sac is done in 24-48 hours of birth. • T-closure of skin graft is done.
NURSING MANAGEMENT Aim: • Prevention of infection. • Preventing injury to the sac. • Prevention of skin breakdown. • Preventing urinary tract infection. • Preventing leg and hip deformities. • Adequate nutrition.
REFERENCE • Marlow Dorothy, “Text book of pediatric nursing”, 6th ed., W.B. Saunders Company, 1988 • Marilyn J. Hockenberry “Wong’s essentials of pediatric nursing”, 7thEd., Mosby Publication 2005 • Pediatric nursing as per INC syllabus 4th edition by Parul dutta. • Nelson essential of pediatrics First south asian ediation, Elsevier By Karen Marcdante, Robert m kiegman • Essential pediatric nursing book by rimple Sharma jaypee publishers.
THANK YOU

More Related Content

Spina bifida

  • 1. NEURAL TUBE DEFECTS Mr. M. Binanda Singh RINPS
  • 2. NEURAL TUBE • The neural tube is the embryonic structure that eventually develops into the baby's brain and spinal cord and the tissues that enclose them.
  • 3. What are neural tube defects (NTDs)? Between the 17th and 30th day after conception (or 4 to 6 weeks after the first day of a woman's last menstrual period), the neural tube forms in the embryo (developing baby) and then closes. The neural tube later becomes the babys spinal cord, spine, brain, and skull.
  • 5. Contd…….  A neural tube defect (NTD) occurs when the neural tube fails to close properly, leaving the developing brain or spinal cord exposed to the amniotic fluid.  The two most common neural tube defects are Anencephaly and Spina bifida.
  • 8. INTRODUCTION • Spina bifida is part of a group of birth defects called neural tube defects.
  • 9. DEFINITION • It is a malformation of spine, in which posterior portion of lamina of vertebra fail to close with or without defective development of spinal cord.
  • 10. INCIDENCE • Most common developmental defect of central nervous system, occurring in about 1 or 2 per 1000 live births. • May occur in any area of spine but most commonly occurs in the lumbosacral area. **Why commonly in the lumbosacral area?**
  • 11. ETIOLOGY • Genetic- (15 times more probability of inheriting the defect) • Maternal age- ( twice more common in pregnant mother over 35 year or below 20 year) • Environment • Diet lack in folic acid
  • 12. Classification Spina bifida Spina bifida cystica Meningocele Myelomeningocele Spina bifida Occulta
  • 13. Spina bifida Occulta • A defect which results from failure of formation of bony arch around the spinal cord, but spinal cord and meninges are normal. • It is not visible externally and is asymptomatic. • Occurs in 5% cases of spina-bifida.
  • 15. Clinical features • Most of the patients are asymptomatic. • A dimple in the skin or growth of hair over malformed vertebra. • As the child grows, he may develop foot weakness or disturbances of bladder and bowel sphincter.
  • 18. • An external cystic defect can be seen at the back. • The sac is composed only of meninges and is filled with CSF. • Spinal cord and nerves are normal. • Patient may have weakness of legs or lack of sphincter control. Meningocele
  • 20. Myelomeningocele • Also known as open spina bifida, Myelomeningocele is the most severe form. • Spinal canal remains open along several vertebrae in the lower or middle back. • Both the membranes and the spinal cord protrude forming a sac on the baby's back. • In some cases, skin covers the sac. However, tissues and nerves are exposed, making the baby prone to life-threatening infections.
  • 21. • Manifestations of myelomeningocele depend on the location and extent of defect. • The higher the deformity the more neurological deficits will be present. • Approx. 90% of infants with severe spina bifida develop hydrocephalus due to associated Arnold-chiari syndrome. (a condition in which brain tissue extends into your spinal canal.) Myelomeningocele
  • 23. • Loss of motor control and sensation occurs according to the level of the lesion. 1. A low thoracic lesion may cause total flaccid paralysis. 2. A sacral lesions leads to weakness of lower limbs. Myelomeningocele
  • 26. Clinical features • UTI are more common. • Congenital skeletal anomalies may be present due to denervation (any loss of nerve supply regardless of the cause) e.g club foot, dysplasia of hip, kyphosis and scoliosis.
  • 31. • These deformities are not only a cosmetic problem, they may lead to back pain, respiratory distress, difficulty movement, recurrent skin breakdown. Clinical features
  • 32. DIAGNOSTIC EVALUATION • Prenatal diagnosis : USG Fetal MRI Amniocentesis • After birth:  Neonatal examination  CT scan, MRI  Neurological assessment  Laboratory tests
  • 33. Amniocentesis • Amniocentesis can also detect neural tube defects, such as spina bifida, by measuring levels of alpha-fetoprotein in the amniotic fluid. • High levels of AFP may suggest the developing baby has a neural tube defect such as spina bifida or anencephaly. • Test should be done between 14th to 16th week of gestation who are at risk.
  • 34. TREATMENT • Spina bifida treatment depends on the severity of the condition.
  • 36. Spina bifida occulta • Often doesn't require treatment at all, but other types of spina bifida do.
  • 37. Spina bifida cystica • Required Laminectomy and closure of the defect or removal of the sac is done in 24-48 hours of birth. • T-closure of skin graft is done.
  • 38. NURSING MANAGEMENT Aim: • Prevention of infection. • Preventing injury to the sac. • Prevention of skin breakdown. • Preventing urinary tract infection. • Preventing leg and hip deformities. • Adequate nutrition.
  • 39. REFERENCE • Marlow Dorothy, “Text book of pediatric nursing”, 6th ed., W.B. Saunders Company, 1988 • Marilyn J. Hockenberry “Wong’s essentials of pediatric nursing”, 7thEd., Mosby Publication 2005 • Pediatric nursing as per INC syllabus 4th edition by Parul dutta. • Nelson essential of pediatrics First south asian ediation, Elsevier By Karen Marcdante, Robert m kiegman • Essential pediatric nursing book by rimple Sharma jaypee publishers.