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Neural Tube Defects

Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first
month of pregnancy, often before a woman even knows that she is pregnant. The two most
common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal
column doesn't close completely. There is usually nerve damage that causes at least some
paralysis of the legs. In anencephaly, most of the brain and skull do not develop. Babies with
anencephaly are usually either stillborn or die shortly after birth. Another type of defect, Chiari
malformation, causes the brain tissue to extend into the spinal canal.

Clinical Manifestations

Clinical manifestations may vary depending on the type of spina bifida.

 Paralysis. 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.

 Birthmark. There may be a small birthmark, dimple or tuft of hair on the skin where the
spinal defect is.

 The main sign of NTDs is physical deformities. Symptoms can include paralysis,
developmental delays, and seizures.

Treatment

NTDs do not have cures. Treatment options focus on relieving pain and preventing future
damage. Babies who have spina bifida may need surgery to help correct damage.

Nursing Interventions
 News that the newborn child has a condition such as spina bifida can naturally cause the
family to feel grief, anger, frustration, fear and sadness, however, nurses are there to help the
family cope and understand the defect the child has.

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.