Symptoms and treatment of Spina bifida

Description

Spina bifida is a condition that occurs when the spine and spinal cord do not form properly. It is a type of neural tube defect. The neural tube is the structure of a developing embryo that later becomes the baby's brain and spinal cord and the tissues that enclose them.

Normally, the neural tube forms early in pregnancy, and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube does not close all the way. This affects the spinal cord and the bones of the spine.

Spina bifida can range from mild to cause severe disability. The symptoms depend on where in the spine of the opening is located and how big it is. The symptoms also depend on whether the spinal cord and the nerves are involved. When necessary, the early treatment for spina bifida involves surgery. However, surgery is not always completely restore the lost function.

Types of

Spina bifida occurs in different types: spina bifida occulta, myelomeningocele (my-uh-lo-muh-NING-go-seel) or the very rare type, meningocele (muh-NING-go-seel).

Spina bifida occulta

Occult means hidden. Spina bifida occulta is the mildest and most common type. This type of spina bifida results in a small separation or gap in one or more of the bones of the spine, called vertebrae. Many people who have spina bifida occulta do not know they have it. You can find during an imaging test, such as the X-ray is done for another reason.

Myelomeningocele

Myelomeningocele is the most severe type. It is also known as open spina bifida. The spinal canal is open along several vertebrae in the lower or middle part of the back. Part of the spinal cord, including the spinal cord of the protective cover and the spinal nerves, push through this opening in the birth, forming a sac on the baby's back. The tissues and the nerves usually are exposed. This makes the baby prone to dangerous infections. This type can also cause loss of motion in the legs, and bladder and bowel dysfunction.

Meningocele

This is a rare type of spina bifida. In this type, a sac of fluid from the spinal cord protrudes through an opening in the spinal column. There are No affected nerves and the spinal cord is not in the liquid in the bag. Babies with meningocele may have some small problems with the operation, even with the bladder and the intestines.

Symptoms

The symptoms of spina bifida vary according to the type and from one person to another.

Spina bifida occulta. Normally, there are no symptoms of spina bifida occulta, because the spinal nerves are not involved. But sometimes you can see the symptoms in the newborn's skin above the small opening in the spinal column. You can see a tuft of hair, a small dimple or birthmark. Sometimes, these marks on the skin may be symptoms of a spinal cord problem that can be found with magnetic resonance imaging or spinal ultrasound in a newborn.
Meningocele. This type can affect bladder and bowel function.
The myelomeningocele. In this most severe type of spina bifida, the spinal canal remains open along several vertebrae in the lower or middle part of the back. Membranes and part of the spinal cord or the nerves protrude at birth, forming a sac. The tissues and the nerves usually are exposed, but sometimes, the skin covering the sac. Babies with this type of spina bifida may have problems with bladder and bowel function. They may also experience weakness or lack of movement in the legs. Babies may have a buildup of fluid in the brain called hydrocephalus, which can put pressure on the brain tissue.

When to see a doctor

Normally, the myelomeningocele is diagnosed before or immediately after the birth, when medical care is available. Children diagnosed with this condition should be followed by a specialized team of health care professionals throughout their lives. Families can be educated in the different complications that must be observed.

Children with spina bifida occulta usually have no symptoms or complications. In these children, usually only the routine pediatric care is necessary.

Causes

The cause of spina bifida is not known. It is believed that a combination of genetic factors, nutritional and environmental risk factors causes of the disease. This includes having a family history of neural tube defects, and do very little acid-folic acid, also known as vitamin B-9, during pregnancy.

Risk factors

Spina bifida is more common among Hispanics and whites. Also, female infants are affected more frequently than male babies. Although the health professionals and researchers do not know why the spina bifida occurs, we have identified some risk factors:

Too little folate in pregnancy the body of the person. Folate, the natural form of vitamin B-9, is important for the development of a healthy baby. Folic acid is the synthetic form found in supplements and fortified foods. If folate levels are too low, what is known as a deficiency. A deficiency of folic acid increases the risk of spina bifida and other conditions that affect the neural tube.
The family history of neural tube defects.Having a child with a condition that affects the neural tube slightly increases the chance of having another baby with the same condition. The risk increases even more if two children have been affected by the disease. Also, being born with a neural tube defect that increases the likelihood of giving birth to a child with spina bifida. However, the majority of babies with spina bifida are born to parents with no known family history of the disease.
Some medications. Taking seizure medicines such as valproic acid during pregnancy increases the risk of having a baby with spina bifida. This can happen because the drugs interfere with the body's ability to use folate and folic acid.
Diabetes. Having diabetes is not well controlled before you become pregnant increases the risk of having a baby with spina bifida.
Obesity. Obesity at the time of pregnancy is also associated with an increased risk of spina bifida.
An increase in body temperature. Some evidence suggests that the increase in body temperature in the first few weeks of pregnancy may increase the risk of spina bifida. A high body temperature can be caused by a fever or through the use of a sauna or hot tub.

The family history of neural tube defects. Having a child with a condition that affects the neural tube slightly increases the chance of having another baby with the same condition. The risk increases even more if two children have been affected by the disease.

Also, being born with a neural tube defect that increases the likelihood of giving birth to a child with spina bifida. However, the majority of babies with spina bifida are born to parents with no known family history of the disease.

If you have known risk factors for spina bifida, talk to your health professional. You may need a higher dose or prescription of the dose of folic acid, even before the pregnancy begins.

Also tell your health care professional about all the medicines you take. If you plan ahead, some medications may be adjusted to reduce the potential risk of spina bifida.

Complications

Spina bifida can cause minimal symptoms or it can lead to more serious physical conditions. The symptoms are affected by:

The size and location of the opening in the spinal column.
If the skin covering the affected area.
Which spinal nerves come out of the affected area of the spinal cord.

A number of complications that can affect children with spina bifida. But not all children receive all of these complications. Many of the complications can be treated.

Walking and mobility problems. The nerves that control the muscles of the legs do not function properly below the area of the spinal cord that is affected. This can cause muscle weakness of the legs. Sometimes it can cause loss of movement, known as the paralysis. If a child can walk, depends on the location of the spine affected, and the size of the opening in the neural tube. The ability to walk is also dependent on the care they received before and after the birth.
Orthopedic complications. Children with myelomeningocele may have several complications in the legs and the spine, because of the weakness of the muscles. Complications depend on the location of the spine affected. Possible orthopedic problems, can include curvature of the spine, known as scoliosis.Changes that are not typical, such as the one that faces the inside of the foot, known as clubfoot.Dislocation of the hip.Bones and joints.Shortened, tight muscles, known as muscle contractures.
Curvature of the spine, known as scoliosis.
Changes that are not typical, such as the one that faces the inside of the foot, known as clubfoot.
Dislocation of the hip.
Bones and joints.
Shortened, tight muscles, known as muscle contractures.
Bowel and bladder symptoms. The nerves that innervate the bladder and the bowel usually do not function properly in children with myelomeningocele. As a result, they can't control their bladder or bowels. This is because the nerves that innervate the intestine and the bladder come from the lowest level of the spinal cord.
The accumulation of fluid in the brain, known as hydrocephalus. Babies born with myelomeningocele often have an accumulation of fluid in the brain. This condition is known as hydrocephalus.
Shunt malfunction. Shunts placed in the brain to treat hydrocephalus may stop working or become infected. Warning signs may vary. Some of the warning symptoms of a shunt that is not working include: Headaches.Vomiting.The drowsiness.Irritability.Swelling or redness along the shunt.Confusion.The changes in the eyes, as a fixed downward gaze.Feeding problems.Seizures.
Headaches.
Vomiting.
The drowsiness.
Irritability.
Swelling or redness along the shunt.
Confusion.
The changes in the eyes, as a fixed downward gaze.
Feeding problems.
Seizures.
Chiari malformation type 2. Chiari malformation (kee-AH-ree mal-for-MAY-shun) type 2 is common in children with myelomeningocele. The brain stem is the lowest part of the brain above the spinal cord. In the Chiari malformation type 2, the trunk becomes longer and lower than normal in the spinal canal or the neck area. This can cause weakness in the arms and problems with breathing and swallowing. Rarely, this condition can lead to compression in this area of the brain. Surgery is necessary to relieve the pressure.
Infection in the tissues surrounding the brain, known as meningitis. Some children with myelomeningocele may develop an infection of the tissues that surround the brain. This potentially dangerous infection can cause brain injury.
The tethered spinal cord. Tethered spinal cord is when the spinal nerves attach to the tissue and stretch. This can happen with the scar tissue that the result of the surgery. When the spinal cord is tied, it is less able to grow as the child grows. It can lead to loss of muscle function in the legs, bowel or bladder. The surgery may limit the degree of disability.
Sleep-disordered breathing. Sleep apnea or sleep conditions can affect both children and adults with spina bifida, especially those with myelomeningocele. You may need to be tested to see if they briefly stop breathing several times during sleep, known as sleep apnea. Getting treatment can improve the health and quality of life.
Problems of the skin. Children with spina bifida have less sensitivity in some parts of their bodies, and they can get the wounds in his feet, legs, buttocks, or back. Blisters or sores can turn into deep wounds, or infections of the feet that are difficult to treat. Children with myelomeningocele have a higher risk of injuries in molds.
Allergy to latex. Children with spina bifida have an increased risk of an allergic reaction to natural rubber or latex products. An allergy to latex can cause skin rash, sneezing, itching, watery eyes, and runny nose. It can also cause a dangerous condition in which the face and the airways swell and make it hard to breathe, known as anaphylaxis. It is best to wear latex gloves and equipment during the birth and care of a child with spina bifida.
Other complications. Other medical problems can arise such as children with spina bifida with age. These complications can include urinary tract infections, gastrointestinal (GI) disorders and depression. Children with myelomeningocele may have learning disabilities. They may have difficulty paying attention and learning of reading and mathematics.
Curvature of the spine, known as scoliosis.
Changes that are not typical, such as the one that faces the inside of the foot, known as clubfoot.
Dislocation of the hip.
Bones and joints.
Shortened, tight muscles, known as muscle contractures.
Headaches.
Vomiting.
The drowsiness.
Irritability.
Swelling or redness along the shunt.
Confusion.
The changes in the eyes, as a fixed downward gaze.
Feeding problems.
Seizures.

Prevention

You can reduce your risk of having a baby with spina bifida or other neural tube defects by taking folic acid supplements. Start taking supplements of at least a month before you get pregnant and continue to have during the first trimester of pregnancy.

Get the folic acid first

To have enough folic acid in her body for the first few weeks of pregnancy is critical to prevent spina bifida. But many people don't discover that they are pregnant until this moment. For this reason, experts recommend that all people of childbearing age to take a supplement of 400 micrograms (mcg) of folic acid a day.

It is also useful to eat foods that contain folic acid or who have folic acid added to them, known as fortification. Foods that are fortified with folic acid include:

Enriched bread.
Pasta.
Rice.
Some breakfast cereals.

Folic acid can be included in packages of foods such as folate, which is the natural form of folic acid found in food.

The planning of pregnancy

Adults who are planning a pregnancy or who could become pregnant need to get 400 to 800 mcg of folic acid a day.

The body does not absorb folate as easily as it absorbs folic acid, and most of the people do not get the recommended amount of folic acid through diet. Supplements of vitamins that include folic acid are necessary to prevent spina bifida. It is also possible that folic acid can help reduce the risk of other conditions that may be present at birth. These conditions include a cleft lip, cleft palate and some heart diseases.

It is also a good idea to eat a healthy diet that includes foods rich in folate or fortified with folic acid. This vitamin is naturally present in many foods, including:

Beans and peas.
Citrus fruits and juices.
The egg yolks.
The milk of a cow.
Avocados.
Dark green vegetables, such as broccoli and spinach.

When higher doses are necessary

If you have spina bifida, or if you've previously given birth to a child with spina bifida, you need extra folic acid before you get pregnant. If you are taking anti-epileptic drugs, or you have diabetes, you can also benefit from a higher dose of this vitamin B. Consult with your healthcare professional before taking additional folic acid supplements.

Diagnosis

Evidence before the birth of a baby, known as prenatal screening, you can check for spina bifida and other conditions. The tests are not perfect. Some people who have positive blood tests have a baby without spina bifida. Even if the results are negative, there is still a small possibility that the spina bifida is present. Talk with your healthcare provider about prenatal testing, its risks, and what the results mean.

Blood tests

Spina bifida can be evaluated with blood tests during pregnancy, but usually the diagnosis is made with an ultrasound exam.

Maternal serum alpha-fetoprotein (msafp) test. For the msafp test, a blood sample and the test of the alpha-fetoprotein (AFP). This is a protein produced by the baby. It is typical of a small amount of AFP to cross the placenta and enter the mother of the fathers of the bloodstream. But high levels of AFP suggests that the baby may have a neural tube defect such as spina bifida. However, high levels of AFP did not always occur in spina bifida.
Test to confirm highAFPlevels. Different levels of AFP can be caused by other factors, such as an incorrect estimation of the infant of the age, or the presence of multiple babies. You may need a follow-up blood test to confirm the results. If AFP levels are still high, you need an additional evaluation, including an examination of the ultrasound.
Other blood tests. Your healthcare provider may perform the msafp test with two or three other blood tests. These screen tests for other conditions, such as trisomy 21, down's syndrome, also known as Down syndrome. They are commonly done with the testing of maternal serum alpha-fetoprotein.

Ultrasound

An ultrasound is the most accurate way to diagnose spina bifida in the baby prior to delivery. During pregnancy, an ultrasound may be done in the first 11 to 14 weeks of pregnancy, known as the first trimester. Or it can be made up in 18 of the 22 weeks, known as the second quarter. Spina bifida can be more precisely diagnosed during the second trimester ultrasound exam. This test is crucial to identify and rule out conditions that may be present at birth.

An advanced ultrasound can detect symptoms of spina bifida, as an open column or features in the brain of the baby. Sometimes, the ultrasound can also help your healthcare provider see how serious the spina bifida is.

Amniocentesis

If the prenatal ultrasound confirms the diagnosis of spina bifida, your health care professional may request a test called amniocentesis. During this test, a needle is used to remove a sample of fluid from the amniotic sac surrounding the baby. This test can be important to rule out genetic diseases.

Talk with your health care professional about potential risks of amniocentesis. There is a slight risk of pregnancy loss.

Treatment

Spina bifida treatment depends on the severity of the disease is in your baby. Spina bifida occulta often needs no treatment at all, but other types of spina bifida.

The surgery before birth

The nerve function in babies with spina bifida, it can get worse if not treated. Prenatal surgery for spina bifida, also known as fetal surgery, is carried out before the 26th week of pregnancy. The surgeons open the pregnant person's stomach and belly, also known as the uterus. The baby of the spinal cord is repaired. The surgeon then closes the uterus and stomach. Sometimes, this procedure can be done less invasively with a special surgical instrument called a fetoscope. The instruments are inserted into the uterus through small ports to perform the surgery on the unborn baby.

The research suggests that children with spina bifida who have fetal surgery may have less disability and be less likely to need crutches or other walking devices. Fetal surgery can also reduce the risk of hydrocephalus. Ask your health care professional if this procedure may be right for you. Ask about the potential benefits. Also ask about the risks for you and your baby, such as premature labor and other complications.

It is important to have a thorough evaluation to determine if fetal surgery can be done. This specialized surgery should only be performed in a health care facility with expertise in fetal surgery experts, a multidisciplinary team, and neonatal intensive care. Normally, the equipment includes a fetal surgeon, a neurosurgeon, a fetal-maternal fetal medicine specialist, cardiologist, and a neonatologist.

A cesarean delivery

Many infants with myelomeningocele tend to be on their feet for the first position, known as breech presentation. Cesarean delivery may be a more secure way of delivery, if your baby is breech, or you have a large cyst or sac.

Surgery after birth

Myelomeningocele surgery is required to close the opening in the back of the baby within 72 hours of birth. Early surgery can help reduce the risk of infection associated with the exposed nerves. It can also help to protect the spinal cord from a major trauma.

During the procedure, a neurosurgeon places of the spinal cord and the tissues exposed on the inside of the baby's body and covered with muscle and skin. At the same time, the neurosurgeon may place a shunt in the brain of the baby for the control of hydrocephalus.

Treatment of complications

In infants with myelomeningocele, damage to the nerves that can't be repaired, it has probably already occurred in the uterus. Ongoing care from a multidisciplinary team of surgeons, doctors, and therapists is usually needed. Infants with myelomeningocele may need more surgery complications. Complications may include weakness in the legs, bowel and bladder problems, or hydrocephalus. The treatment usually begins shortly after birth.

Treatment options may include:

Walking and mobility aids. Some babies may start exercises to prepare your legs for walking with braces or crutches, when the children are older. Some children may need walkers or wheelchairs. Aid to the disabled, along with regular physical therapy, can help a child to be independent. Even the children who need a wheelchair can learn to function well and to be self-sufficient.
Bowel and bladder.The routine of the bladder and bowel assessment and management help to reduce the risk of organ damage and disease. The tests include X-rays, kidney scans, ultrasounds, blood tests, and the function of the bladder studies. These assessments are more common in the first years of life and are less often as children grow older. A specialist in pediatric urology with experience in performing the surgery in children with spina bifida can offer the most effective management options. The handling of the intestines may include oral medications, suppositories, enemas, surgery, or a combination of these approaches. The management of the bladder may include medications, catheters to drain the bladder, surgery, or a combination of treatments.
Surgery for hydrocephalus.Most babies with myelomeningocele need surgery to place a tube that allows the fluid in the brain to drain in another part of the body. The tube is called a shunt ventricular. Can be placed immediately after the birth, during the surgery to close the jacket in the back. Or you may be placed to later as the fluid builds up. A less invasive procedure called endoscopic third ventriculostomy is an option for some babies. But certain criteria must be met before you perform this procedure. The surgeon uses a small video camera to see inside the brain. Then, the surgeon makes a hole in the bottom or between the brain cavities. This allows the cerebrospinal fluid to flow out of the brain.
Management and treatment of other complications. Special equipment, such as bath chairs, commode chairs of standing and frameworks can help with the daily functioning. Most cases of spina bifida complications can be treated or managed to improve the quality of life. These include complications, orthopedic, tethered spinal cord, GI issues, skin conditions and other complications.

Bowel and bladder. The routine of the bladder and bowel assessment and management help to reduce the risk of organ damage and disease. The tests include X-rays, kidney scans, ultrasounds, blood tests, and the function of the bladder studies. These assessments are more common in the first years of life and are less often as children grow older. A specialist in pediatric urology with experience in performing the surgery in children with spina bifida can offer the most effective management options.

The handling of the intestines may include oral medications, suppositories, enemas, surgery, or a combination of these approaches. The management of the bladder may include medications, catheters to drain the bladder, surgery, or a combination of treatments.

Surgery for hydrocephalus. Most babies with myelomeningocele need surgery to place a tube that allows the fluid in the brain to drain in another part of the body. The tube is called a shunt ventricular. Can be placed immediately after the birth, during the surgery to close the jacket in the back. Or you may be placed to later as the fluid builds up.

A less invasive procedure called endoscopic third ventriculostomy is an option for some babies. But certain criteria must be met before you perform this procedure. The surgeon uses a small video camera to see inside the brain. Then, the surgeon makes a hole in the bottom or between the brain cavities. This allows the cerebrospinal fluid to flow out of the brain.

Course of care

Children with spina bifida may need a close follow-up care and observation. Their health professionals to assess their growth, the need for vaccinations and general health issues. The medical care is coordinated among the specialists.

Children with spina bifida often need treatment and ongoing care of health professionals with experience in:

Physical medicine and rehabilitation.
Neurology.
Neurosurgery.
Urology.
Orthopedics.
The physical therapy.
Occupational therapy.
Special education.
The Social work.
Nutrition.

Parents and other caregivers are a key part of the team. They can learn to help manage the condition of a child and how to encourage and support the child emotionally and socially.

Coping and support

The news that his newborn son has a condition such as spina bifida, of course, can make you feel many emotions. It is important to know that people with spina bifida to lead a life that is active, productive, and fulfilling lives — especially with the encouragement and support of loved ones. Children with spina bifida can go to college, hold jobs, and have families.

Special accommodations may be needed along the way. But encourage your child to be as independent as possible.

Independent mobility is an important and appropriate goal for all children with spina bifida. This may mean walking with or without braces, the use of walking aids, such as canes or crutches, or a wheelchair. Encourage your child to participate in activities with their peers. Caregivers can help to adjust the activities to accommodate physical disabilities.

Many children with spina bifida are typical of the intelligence, but some may need educational help for learning disabilities. May have problems with attention, concentration, or the language that requires treatment by professionals outside of the school.

As for any child with a chronic medical condition, children with spina bifida may benefit from meeting with mental health professionals. A child psychologist and other mental health professionals can help with the adjustment and coping. The majority of children with spina bifida are flexible and adapt to their challenges with the support of their parents, teachers, and other caregivers.

If your child has spina bifida, you may benefit from finding a support group of other parents who are dealing with the disease. Talk with other people who understand the challenges of living with spina bifida can be useful.

Preparing for your appointment

Your health care professional may suspect or diagnose the status of the baby during pregnancy. It is likely that you consult with a multidisciplinary team of doctors, surgeons and physiotherapists in a center that specializes in the treatment of spina bifida.

Here's some information to help you prepare for your appointment and know what to expect.

What you can do

To prepare for the appointment:

Be aware of the pre-appointment instructions. At the time you make the appointment, be sure to ask if there is anything that you need to do beforehand. For example, you may need to drink more water before an ultrasound exam.
Make a list of all the medications, vitamins, herbs and supplements that you take before and during your pregnancy, and how much.
Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who comes with you may remember something that you missed or forgot.
Create a list of questions to ask, starting with the most important.

For spina bifida, some basic questions to ask include:

Is spina bifida this and how serious is it?
There is evidence of an accumulation of fluid in my baby's brain?
Can my baby be treated during pregnancy?
What can I do to my baby immediately after birth?
It will be the treatment to cure my son?
There will not be any kind of lasting effects?
Who can I contact to find out about community resources that may be able to help my child?
What is the likelihood of this happening again in future pregnancies?
How can I avoid this happen again in the future?
Are there brochures or other printed material I can have? What sites do you recommend?

In addition to the questions you have prepared, do not hesitate to ask questions during your appointment.

What to expect from your doctor

Be prepared to answer the questions of your health care professional may give you time to go through all the points that you want to focus on. You may ask:

Have you ever had a child with spina bifida or other conditions in the birth?
There is a family history of spina bifida?
How to take folic acid, also known as vitamin B-9, before and during your pregnancy?
Are you taking anti-epileptic drugs, or they were taking at the beginning of your pregnancy?
If necessary, you are able to travel to a center that provides specialized care?