Spina Bifida

SPINA BIFIDA DEFINITION • •

Broadly used term Congenital problem in which there is a defective closure of the vertebral column.

ETIOLOGY • • •

Unsure of cause, but current theory links this occurrence to decreased amounts of Folic Acid in the mother during pregnancy. (0.4mg/day) – Cereals now fortified with FA – Green leafy vegetables 21 day inutero vertebral column grows together

DIAGNOSIS •

Increased levels of alpha-fetoprotein (AFP) in the amniotic fluid can indicate the presence of Spina Bifida. Can be diagnosed in utero o Elevated levels HIGH risk for SB o Test usually done at 16-18 weeks o Decreased may be Downs Syndrome o MRI, Ultrasound, CT, Myelography o Amniocentesis with 2+ AFP test

TYPES •

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Occulta o Not visible – Externally (L5, S1) Minor with small opening extra hair/skin/different o Exercise, limit activities – Adulthood may have back problems. Spinal cord not involved Meningocele o Not associated with neurologic deficits(Meninges / Spinal fluid) o Surrounded with thin, fragile skin. Increased R/F Meningitis (transillumination) o Protrudes out of the skin but no nerve roots are involved. o CANNOT BE BORN VAGINALLY Myelomeningocele o Meninges, Spinal fluid, nerves. o C-Section o WORST TYPE – Patient at spine have deficit (Usually Lumbar / Sacral) bowel / bladder problems. Decrease in extremity with deformed position form waist down o Most all children with this type will have bowel and bladder problems and see them in a wheelchair. It all depends on where the injury occurs. o Problems are at the waist down o A majority of these children born with this type of SB will have Hydrocephalous  Because this started at 28 days in utero.  The spinal fluid has trouble flowing; it backs up in the ventricle where it is made. o When born with this type of SB; within the first 24 hours they are taken to surgery o Very individualized treatment o Because they are at great risk for INFECTION. MENINGITIS. Cystica o Meningocele – least severe – spinal cord not involved

CLINICAL MANIFESTATIONS • • • • • •

Sensory disturbances (Par to Pt spine) Bowel and bladder dysfunction Motor dysfunction (Possible partial paralysis) Joint deformities Increased Latex allergies – possible due to increased hospitalization Food allergies

TREATMENT • • • • • • •

Need to be prepared at birth and be in an appropriate facility Immediate surgery (1st 24 hours because of increase risk for meningitis) Cover sac with moist rag, careful not to rupture Life-Long follow up and care for Myelomeningocele Individualized with very aggressive treatment The hydrocephalous may cause some mental problems. But may be normal Mainstreamed in school; In and Out Cath

NURSING DIAGNOSIS • • • • • •

High R/F infection (SAC) High R/F neurologic trauma (Hydrocephalus) High R/F impaired skin integrity Altered family process High R/F impaired parent-infant attachment Altered bowel / bladder function

MYLO BED: Prone with foam straddle keeps on stomach; align lower extremities