11.05 Spina Bifida – Neural Tube Defect (NTD)

Hey guys, in this lesson we are going to talk about Spina Bifida. Spina Bifida is a spinal cord or neural tube defect.

There is a spectrum of these neural tube defects that vary in terms of severity. The two most common are anencephaly and myelomeningocele. Anencephaly is the most severe neural tube defect and both the cerebellum and cerebrum are missing. This is usually incompatible with life.

The other three, are depicted in the photo. Spina bifida occulta isn’t usually visible from the outside. There’s a small gap in the spine, but no opening on the skin. There may be hair or dark skin over the site.
A meningocele is a larger gap in the spine where a sac of fluid protrudes through the skin. A myelomeningocele is when spinal cord, meninges and nerves are protruding in the sac of fluid.

The cause of spina bifida is multifactorial. There seems to be a genetic element, but a huge factor is lack of folic acid in the mother’s diet. It is recommended that women of childbearing age take a supplement of folic acid daily, 0.4 mg, to help prevent spina bifida from occurring.

Spina bifida is usually discovered either during a neonatal ultrasound or at birth during the neonatal assessment. Symptoms will vary with each patient, but if it is a myelomeningocele, and the spinal column and nerves are protruding the patient will have some amount of paralysis and sensory loss, as well as bowel and bladder dysfunction. So it’s important, that during our nursing assessment of this newborn, we are looking for movements and response to touch. We also need to keep a close eye on bowel and bladder function. They may have a meconium ileus and become constipated. They may also have bladder distention from the neurogenic bladder.

Joint deformities, like contractures and clubfoot are associated with spina bifida, as is hydrocephalus. So check all limbs and also perform a daily head circumference looking for hydrocephalus and increased intracranial pressure.

These babies will usually go to surgery within 24-72 hours of being born. Prior to surgery the top priority is to protect the protruding sac. It needs to be covered with a sterile, moist dressing. The baby needs to be kept in the prone position with hips flexed to reduce pressure and strain. They are at risk for hypothermia so they will usually be in an infant warmer. Never take a rectal temp in a newborn, but especially if they have spina bifida because they are at increased risk for having rectal anomalies.

They may need intermittent catheterization if their bladder becomes distended. And remember, kids with spina bifida are more likely to develop latex allergies so always double check that the equipment is latex free.

Once the malformation is repaired, our nursing care focuses on long-term management of the problems associated with the damage. This will vary per patient, but the most common issues are neurogenic bladder, neurogenic bowel and paralysis of lower extremities.

Both neurogenic bladder and bowel control require routine and careful planning to prevent problems. Clean intermittent catheterization is done periodically to empty the bladder and oxybutynin is given to decrease bladder spasms. Bowel control is achieved through scheduled evacuations that are planned according to the kids schedule. It’s important to prevent constipation with fiber, fluid intake and laxatives.

Often, these kids will have a wheelchair or other mobility devices to help maximize their independence. Your priority nursing concepts are functional ability, mobility and elimination.
Your key points for this lesson are- Knowing that spina bifida is a neural tube defect. There are a variety of diagnoses that fall under this category. The two most common are Anencephaly and myelomeningocele. Anencephaly is incompatible with life and myelomeningocele often causes the most symptoms because the spinal cord and nerves have protruded out of the spine into the sac.

The symptoms that occur with myelomeningocele are lower limb paralysis, bladder and bowel dysfunction and joint deformities.

These babies need surgery within a few days of being born. Prior to surgery the top priority for our nursing care is to protect the sac with a sterile, moist dressing and by positioning the patient on their stomach.
Long-term care is focused on bladder and bowel function and maximizing mobility and independence.

Patient education is super important. All women of childbearing age should take a folic acid supplement daily to help prevent these spinal malformations from occurring.

That's it for our lesson on Spina Bifida. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!