1. Spinal Bifida
The ‘Six’ Group

2. Group Members
Precious S. Kataika
Misheri Nkhani
Nelson Munthali
Benjamin Mpalabwazi
Ruth K. Nyalubanga

3. Broad Objective
 By the end of this presentation,
students should acquire knowledge on
spinal bifida

4. By the end of the presentation, students should
be able to:
 Define Spina Bifida?
 Outline the etiology of spina bifida.
 Describe the types of spina bifida.
 Explain the pathophysiology of spina bifida.
 Explain the clinical manifestations.
 List the diagnostic tests.
 Explain the medical management.
 Explain the nursing management.
 List the complications.

5.  A condition that
refers to a
developmental defect
of the spinal column
in which the arches of
one or more of the
spinal vertebrae fail
to fuse.
 It may involve the
entire length of the
neural tube or
restricted to one area.

6. ETIOLOGY
The cause is not known but has predisposing
factors and some of them are:
 Nutritional deficiency (Folic Acid) which helps in
neural tube development. In absence of this in
the first trimester of pregnancy, the child may
born with spinal bifida.
 Genetic factors; family history, if a woman bears
a child with spinal bifida, there is a chance that
of another child having spinal bifida. This is most
common in females than in males.

7. Cont’..
 CSF pressure. Blockage in the
circulation of CSF can cause pressure in
the spine of unborn baby which can
lead to spinal bifida.
 Medications such as anticonvulsants
 Conditions such as diabetes, obesity
and fever also increases the chances of
delivering of a baby with a spina bifida

8. 1. Spinal Bifida Occulta
 an abnormality is confined to the vertebrae
only and is due to an unclosed posterior
vertebral arch.
 This has no visible defect to the external (no
protrusion). It occurs most at the lumbasacral
area.
 There is a dimple, hairy patch, dark spot or
swelling over affected area
 spinal cords and nerves usually normal

9. Cont’…
 It is the mildest
type of spina
bifida
 It has no
symptoms
 There is gap in
one or more of
the vertebra of
the spine
 no treatment
needed

10. 2. Spinal bifida Cystica
 A more severe type of spinal bifida
 This refers to the visible defect with the
external saclike protrusion
 It has two major forms;
1. Meningocele
2. Myelomeningocele

11. 1. Meningocele
 Is a rarest form of which
a cyst or fluid-filled sac
pokes through an open
part of the spine.
 The sac contains
membranes that protect
spinal cord but not
spinal nerves i.e. there
is no neural elements
but only CSF and
meninges.

12. 2. Myelomeningocele
 Most severe form
of spinal bifida
cystica
 The cyst holds
both membranes
and nerve roots of
spinal cord and
often the cord
itself
 Almost 96%

13. Pathophysiology
 Under normal circumstances, the
closure of the neural tube occurs
around 23rd and 27th day
after fertilization.
 However, if something interferes e.g.
Medications such as some
anticonvulsants, diabetes, having a
relative with spina bifida, obesity, and
an increased body temperature
from fever.

14. Cont’…
 The neural tube fails to close properly
as a result a neural tube defect occurs.
 The most common location of this
malformations is the lumbar and sacral
areas

15. Clinical Manifestations
Signs and symptoms vary according
to degree of spinal defect.
 Readily apparent on inspection!
 Loss of sensation below lesion
 Poor urinary and bladder control. There
is an Overflow incontinence with
constant dripling in urine due to nerve
dysfunction that supplies the bladder.

16. Clinical Manifestations
 Joint deformities in lower extremities
due to demolition to the muscles of the
lower extremities.
 Orthopedic abnormalities (i.e. club
foot, hip dislocation, scoliosis)
 Hydrocephalus
 Swelling
 Brain damage

17. Assessment
 History taking
 Subjective data
 Family history of the condition and if it is the
first pregnancy.
 Ask the nutritional history of the mother during
pregnancy to ensure folic acid deficiency.
 Urine and faecal incontinence.
 Ask for paralysis especially in the lower
extremities.

18.  Objective data
 Weigh the child.
 Conduct a neurological assessment.
 Prick response.
 Assess cystic
 Physical examination

19. Diagnostic Tests
Prenatal Tests
• AFP screening
• Ultrasound
• Testing of Amniotic fluid
Imaging Studies
• X-ray of the spine to rule out occulta spinal
bifida
• Ultrasound of pregnancy between 6th and 8th
weak
• CT scan to rule out hydrocephalus
• MRI

20. Medical Management
 There is no cure for spina bifida.
Damaged nerve tissues can not be
repaired nor its function be restored.
 Treatment depend on how severe the
defect is. Most children with spina bifida
have a mild defect and may not need
treatment i.e. spina bifida occulta
 But a child with severe defect may need
surgery.

21.  The surgery involves putting the meninges
back in place and closing the opening in
the vertebrae.
 The surgery is done within 24 – 48 hours
after birth. There is also a surgery to treat
hydrocephalus by placing a shunt
 Fetal surgery is also done to promote early
surgical closure of the spina bifida

22. Cont’…
 Assistive technology e.g.
electric wheel chair, braces
or crutches to help the
child get around.
 Medication involves
treating the complications
and signs of spina bifida.
 Physiotherapy to improve
day to day life and boost
independence.

23. Nursing Management
Pre-Op
 Position the child in prone with legs
abducted. This reduces tension and risk
of sac trauma.
 Put the child in an incubator or warmer
area without clothes. This maintains
normal body temperature, and reduces
trauma from the clothes.

24.  Apply dressing (moist, no adhesions), to
avoid drying of the area due to heat in
the incubator.
 Strictly use the sterile gauze so as to
prevent re-infection.
 Change dressing two-four hourly, to
avoid drying.

25.  Use normal saline or silver nitrate in
dressing.
 Gentle handling of the child to avoid
any risk of trauma.
 Change the child’s position every two
hours, to promote circulation and
prevent development of decubitus sore.

26.  Check vital signs and signs of increased
intracranial pressure.
 Assess for signs of hydrocephalus.
 Cover the sacrum with sterile surgical
drape, but not latex tape.
 Measure the head circumference

27.  Prepare the mother psychologically.
 Apply gentle pressure to suprapubic
area to facilitate urine emptying.
 Gently do a range of motion of the
extremities to the child.

28. Post-Op
 Position the child in prone to avoid
pressure on suture, or side lying
position alternatively.
 Monitor the child`s vital signs every 30
minutes until stable.
 Use all measures to avoid any infection
e. g. hand washing.

29.  Monitor input and output.
 Encourage the mother to continue
breastfeeding if the child is being
breastfed.
 Resume the feeding after the effects of
anaesthesia.
 Remove the dressings after 48hrs to
check any signs of bleeding or bulging

30.  Psychologically, care the mother.
 Observe for leakage.
 Maintain passive range of motion of the
extremities to promote circulation.
 Give high fibre diet to the child (if
above 6 months), to avoid constipation,

31.  To alley anxiety, counsel the mother on
the condition of the child.
 Teach the parents to observe for signs
of complications e. g. convulsions.
 Teach on the care of the child.

32. Complications
 Meningitis due to infections
 Hydrocephalus due to Increased
Intracranial Pressure
 Physical and neurological problems e.g.
lack of normal bowel and bladder
control, Paralysis of the legs
 Latex allergy

33. Summary
 Spina bifida birth defect is the most common
defect of the central nervous system with a
worldwide incidence of about 1 in every 1000
births
 This disease is clinically referred to as
Myelomeningocele.
 Regular checkups and intake of folic acid diet
before conception and during the first few
weeks of pregnancy can help to prevent spina
bifida.

34. References
 Hockenberry, M. J., & Winkelstein, W.
(2005). Wong's essential of pediatric
nursing (7th Ed).philadephia, USA:
Elsevier Mosby .
 www.mayoclinic.org/diseases-
conditions/spina-bifida
 www.ninds.nih.gov/disorders/spina-
bifida