SPINA BIFIDA- ENGLISH
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SPINA
BIFIDA-
Spina
bifida is a congenital anomaly that occurs when the spine and spinal cord is
not developed properly. It's a type of neural tube defect. The neural tube is
the structure in a developing embryo that eventually becomes the baby's brain,
spinal cord and the tissues that enclose them.
TYPES
OF SPINA BIFIDA-
Spina
bifida can occur in different types:
Ø Spina bifida occulta- "Occulta"
means hidden. It's the mildest and most common type. Spina bifida occulta
results in a small separation or gap in one or more of the bones of the spine
(vertebrae)
Ø Meningocele- It
is moderate form of spina bifida where only meningeal membrane protrude from the defect as a sac
and contains cerebrospinal fluid.
Ø Myelomeningocele - Myelomeningocele is the most severe
type of spina bifida. 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.
CAUSES
OF SPINA BIFIDA-
Causes
and Risk factors for Spina bifida includes:
Folate deficiency. Folate, the natural form of vitamin B-9
(Folic Acid), is important to the development of a healthy baby. A folate
deficiency increases the risk of spina bifida and other neural tube defects.
Family history of neural tube defects. Couples who've
had one child with a neural tube defect have a slightly higher chance of having
another baby with the same defect. In addition, a woman who was born with a
neural tube defect has a greater chance of giving birth to a child with spina
bifida.
Some medications. For example, anti-seizure medications,
such as valproic acid seem to cause neural tube defects when taken during
pregnancy. This might happen because they interfere with the body's ability to
use folate and folic acid.
SIGN
AND SYMPTOMS-
With
spina bifida occulta, the most obvious sign might be a tuft of hair or
a birthmark at the site of the defect.
In
the case of meningocele, there may be a thin layer of skin over the sac.
Babies with this condition can have health problems if the nerves around the
spine are damaged. For example, if the nerves that control the release of the
bowels or bladder are affected, it may be difficult for a child to control
these body functions.
In
the case of mylomeningocele, there may be a thin layer of skin over the
sac containing spinal nerves. A baby with this type of spina bifida usually has
some paralysis, and muscle or bone problems as a result of the paralysis. This
is due to the abnormal development of nerves in the spine, or to nerves being
stretched or pressed as a result of the defect.
DIAGNOSTIC
INVESTIGATIONS-
q
Physical
examination-Observation.
q
Ultra-sonograpy.(USG)
q
X-ray
Examination
q
Blood
investigations-alphafetoprotein
q
Prenatal
diagnosis is also possible by USG
TREATMENT-
Treatment
for spina bifida depends on its severity. Because spina bifida can involve many
different body systems, like the nervous and skeletal systems, children may
need support from a team of medical professionals. This team may include
neurosurgeons, urologists, and orthopedic surgeons physical and occupational
therapists, and social workers.
Babies
with spina bifida occulta might not need any treatment, unless
their spinal cord is tethered. Tethering can lead to problems later in life
(during growth spurts) so it's necessary to surgically detach the spinal cord
from surrounding tissue. After surgery, babies usually have no long-term health
problems, but may need surgery again later in childhood if the spinal cord
reattaches.
Babies
with a meningocele need surgery to push the meninges back into
the body and close the hole in the vertebrae or skull. This is usually done in
the first few months of life.
Babies
with a myelomeningocele need surgery 1 to 2 days after birth
to protect the exposed area and central nervous system, and to prevent these
areas from becoming infected.
NURSING MANAGEMENT-
Ø
The
baby should be handled carefully to prevent injury to the sac.
Ø
The
baby should be kept in prone position.
Ø
A
soft protective sterile covering is placed over the sac to protect it and prevent
infection.
Ø
-
Intake output chart is maintained so that nutritional status and water balance
is assessed.
Ø
-
IV fluid may be started to correct electrolyte and water imbalance as per
doctor’s order.
Ø
Skin
breakdown should be prevented by carefully changing the position of baby (prone
and lateral only)
Ø
Contamination
of sac by babies urine and stools must be prevented by proper positioning .
Ø
-
Parents should be explained about the disorder and possible treatment to alleviate their anxiety.
Ø
-
The body alignment of the baby should be maintained in every position (prone
and lateral).
Ø
After surgery vital signs are monitored such
as heart rate , respiratory rate and temperature and recorded.
Ø
Surgical site care is provided with aseptic
technique to prevent infection and promote healing.
Ø
Other Nursing interventions – includes all nursing
care of hospitalized child that we have discussed in previous lecture under
heading Nursing care of hospitalized child in the lecture “Child Health
Nursing”.
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