SPINA BIFIDA

BY: ELOISA ANNE N. RECTO & ANE KYLA M. WAMINAL

Neural Tube Defects
● The neural tube forms very early in
embryonic development.
● It starts as a flat, ribbon like structure
that rolls together, lengthwise, to form
the tube that will normally grow into the
brain and spinal cord.
● Neural tube defects is a problem in the
development of your brain or skull,
spinal column and the bones that
protect the central nervous system.
Spina Bifida
● Most common type of neural tube defects.
● Is a birth defect that occurs when the spine
and spinal cord don't form properly.
● It can present as an open defect with a sac
coming out or it can be closed
 Pathophysiology
Predisposing Factor: Precipitating Factor:
● Family history of neural tube defects ● Medications
● Previous pregnancy with neural tube ● Maternal Diabetes
defects ● Obesity
● Race, Gender ● Increased body temperature
● Lack Of Folic Acid

When the cells found in the

ectoderm, mesoderm,
endoderm move into the
primitive point they form
nodal cord

Nodal cord starts

releasing growth factors,
then it tells the ectoderm
to start proliferating
 Neural plate form

Embryo will allow this plate to begin to kind of pulling

down the center of the plate. The edges of plate are
gonna starts working towards another

Edges called Neural folds, U shape here is called Neural groove. Cells
called Neural crest cells and they form towards around the edges of
neural folds.

Neural folds fused with one another, Neural groove

will completely closed forming neural tube that
comes underneath the ectoderm. The neural crest
cells are on the top of neural tube. Nodal cord
found below the neural tube.

Complete neural tube forms, Neural

pores are still open.
 Folate need to close it

The caudal part Neural tube has 3 layers, Alar plate will form the posterior &
forms the spinal Marginal zone, mantle anterior grey horn that. Sensory
cord zone & neuroepithelial neuron located in posterior horn and
zone. The cells here will motor neuron located in anterior horn.
proliferate to form ALAR The little circle here is spinal canal
PLATE that has spinal fluid.
 Lack of folate, the cranial
pore and caudal pore
doesn’t close

Failure of the caudal or Spina bifida Is a birth defect that occurs

posterior neuropore to when the spine and spinal cord don't form
close will lead to SPINA properly.
BIFIDA It can present as an open defect with a sac
coming out or it can be closed

Spina Bifida types:

Spina bifida oculta Meningocele (Is a birth defect where

( Bones of the spine,
called vertebrae, don’t
properly close that leaves
small gaps that can
expose the sensitive spinal
column to injury.)
there is a sac protruding from the
spinal column.The sac includes spinal
fluid, but does not contain neural
tissue. It may be covered with skin or
with meninges. The sac often is visible
from the outside of the back.)
Myelomeningocele (The spinal canal
is open along several vertebrae in the
lower or middle back. The membranes
and spinal nerves push through this
opening at birth, forming a sac on the
baby's back, typically exposing tissues
and nerves.
 Spina bifida oculta Meningocele Myelomeningocele

Signs & symptoms

Signs & symptoms Signs & symptoms

● Problems moving parts of the body

● ●
Abnormal tuft of hair, or a
small dimple or birthmark
● Back pain
● Dimple or indent on your
back
● Hairy patch on your back
A fluid-filled sac visible on a
baby's back. below the opening in the back
● The swelling may pulsate
● Lack of sensation in their legs and
synchronously with the
contractions of the heart, while feet
straining (crying or crying a
child), increase, and when ● Poor or no bowel and bladder control
pressure is applied to it,
● Twisted or abnormal legs and feet;
decrease
for example, clubfoot

Complications

● Arnold Chiari type 2 malformation ● Accumulation

● Tethered cord syndrome
of fluid in the
● Walking and mobility problems
brain
● Skin problems
(hydrocephalus
● Orthopedic complications
)
● Bowel and bladder problems
Spina Bifida Types
● Spina bifida occulta
● Myelomeningocele
● Meningocele
 01
● "Occulta" means hidden, It's the mildest and
Spina Bifida ●
most common type.
The exact cause is unknown, risk factor
Occulta insufficient intake of folic acid during
pregnancy.

Symptoms:

● Back pain
● Scoliosis, or a curving of the spine
● Dimple or indent on your back
● Hairy patch on your back
 02
● This is seen as mild to moderate and is the least
common
Meningocele ● The exact cause is unknown, risk factor
insufficient intake of folic acid during pregnancy.

Symptoms:
● A fluid-filled sac visible on a baby's back.
● The swelling may pulsate synchronously with the
contractions of the heart, while straining (crying
or crying a child), increase, and when pressure
is applied to it, decrease
 03
● Is a severe form of spina bifida in which
● The exact cause is unknown, but a lack of folic
Myelomeningocele acid, exposure to viruses, exposure to radiation,
and/or genetics are suspected.

Symptoms

● Problems moving parts of the body below the opening in the back
● Lack of sensation in their legs and feet
● Poor or no bowel and bladder control
● Twisted or abnormal legs and feet; for example, clubfoot
 LABORATORY
DIAGNOSIS

Alpha Fetoprotein
(AFP) Test
● Prenatal test
● Blood test performed
between 15 and 20 weeks
pregnancy
● Measures levels of AFP, hCG,
and estriol
Ultrasound Amniocentesis
● Performed between weeks 15
● Harmless, non- and 20 of pregnancy
invasive test ● Recommended to women wh
● Detect a spinal have high levels of AFP that
cord defect couldn’t be explained by an
ultrasound
 MEDICAL
MANAGEMENT
Nutritional and Supportive Therapy

Eat a healthy diet, including foods rich in folate or

enriched with folic acid. This vitamin is present naturally
in many foods, including:

- Beans and peas

- Citrus fruits and juice
- Egg yolks
- Milk
- Avocados
- Dark green vegetables, such as broccoli and
spinach
 SURGICAL MANAGEMENT

Prenatal repair of myelomeningocele

(MMC), the most common and severe form
of spina bifida, is a delicate surgical
procedure where fetal surgeons open the
uterus and close the opening in the baby's
back while they are still in the womb.
Because spinal cord damage is progressive
during gestation, prenatal repair of
myelomeningocele may prevent further
damage.
SURGICAL
MANAGEMENT

● 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.
● Surgery after birth. During the procedure, a
neurosurgeon places the spinal cord and exposed
tissue inside the baby’s body and covers them with
muscle and skin.
NURSING
MANAGEMENT

● Prevent infection
● Promote skin integrity
● Prevent contractures of lower
extremities
● Proper positioning of the newborn
● Promote family coping
● Provide family teaching
NURSING
MANAGMENT
PRE-OP
● Position the child in prone with legs abducted.
● Put the child in an incubator or warmer area without clothes.
● Apply dressing (moist, no adhesions)
● Strictly use the sterile gauze
● Change dressing two-four hourly
● Check vital signs of increases intracranial pressure
● Assess for signs of hydrocephalus
● Cover the sacrum with sterile surgical drape, but not latex tape
● Measure the head circumference
● Prepare the mother psychologically
NURSING
MANAGEMENT
POST-OP

● Position the child in prone position to avoid pressure on suture

● Monitor the child’s vital signs every 30 minutes until stable
● Use all measures to avoid infection
● Encourage the mother to continue breastfeeding if the child is being
breastfeed
● Remove the dressings after 48 hrs
● Psychologically, care the mother
● Give high fiber diet to the child (if above 6 months)
 REFERENCE
● Maternal and Child Health Nursing care of the child Bearing and Childbearing Family
6th edition page 796
● https://www.mayoclinic.org/diseases- conditions/spina- bifida/symptomscauses/syc-
20377860
● https://www.youtube.com/watch?v=Dbr1VXVhhF4
● https://www.ucsfbenioffchildrens.org/conditions/spina_bifida/diagnosis.html
● https://www.mayoclinic.org/diseases-conditions/spina-bifida/diagnosis-treatment/dr
c-20377865#:~:text=Nerve%20function%20in%20babies%20with,repair%20the%20ba
by's%20spinal%20cord
.
THANK YOU!