Neural Tube Defects

How are neural tube defects detected before delivery?

1. AFP (maternal alpha‑fetoprotein) levels 2. Level II Ultrasound 3. Amniocentesis

How are pressure ulcers prevented?

1. Diaper open to air (infant & child) 2. Change of position frequently 3. Daily assessments of sacral area 4. Daily washing of perineal area and good skin care

What causes neural tube defects?

1. Exact cause is unclear 2. May occur as a result of genetic defect 3. May occur as a result after fetal exposure to teratogenic drugs 4. May occur by a combination of both. 5. Factors thought to contribute to the development of NTD: poor nutrition folate deficiency maternal age, pregnancy history, birth order, SES

What is the care for post surgical neurogenic bladder?

1. Intermittent catheterization 2. Recognition of UTI (odorous, cloudy urine, pain on urination, irritability, & hematuria) 3. High fluid intake 4. Surgical urinary diversion (if reflux is severe)

What is the bowel program post surgery?

1. Plan bowel evacuation following meal 2. Well balanced diet, high in fiber 3. Knee‑chest position for evacuation 5. Rectal Suppository 6. Good fluid intake

What is the preoperative care for surgical closure of the sac?

1. Position child on his abdomen (prone position) 2. If prone, place a cloth roll under hips to allow for proper alignment of hips & downward flow of urine & stool 2. Sterile, saline‑soaked dressing to sac 3. Q. 1 hr assessment of dressing & application of saline as needed 4. Dressing is not removed. 5. Administration of a broad spectrum antibiotic 6. Q. 2 hour Vital signs 7. Intermittent urinary catheterization 8. Assessment for signs & symptoms of meningitis: irritability, fever, feeding intolerance, seizures)

What are the immediate nursing care interventions in the immediate post operative period for neural tube defect surgery?

1. Prone position for 3 ‑4 days 2. Adequate nutrition 3. Fontanel assessment & daily head circumference measurement 4. Assessment of dressings (back & VP shunt exit sites) 5. Vital signs (esp. Temp & respiratory assessment) 6. Strict infection control measures (meticulous care after urination or bowel movement)

What does spina bifida surgery look like?

1. The surgery is to free up the tethered or tied up spinal cord and close the opening (dissection of exposed sac & closure of the dura mater & skin over the preserved neural tissue) 2. Goal is to stop progressive deterioration & function of the affected extremities 3. Placement of a ventriculo‑peritoneal shunt for hydrocephalus

What are the long term consequences of neural tube defect surgery?

All long‑term consequences are related to the degree of nerve damage that is determined by location of defect. The higher the location on the spinal column the more or greater the degree of nerve damage and the more deficits experienced.

Why is it important to evaluate the sac?

Because the kids are at risk of meningitis

What is Chiari Malformation?

Brain defect involving posterior fossa contents (hind brain) in which there is herniation of parts of the hind brain through the foramen magnum into the cervical spinal canal.

What is Myelomeningocele?

Develops in 1st 28 days of pregnancy Detected prenatally or @ birth Accounts for 90% of spinal cord lesions May be located @ any point along the spinal column Largest number found in the lumbar or lumbosacral area Location &magnitude=nature & extent of neurological impairment Below the 2nd vertebra the nerves are involved flaccid, paralysis of lower extremities, varying degree of sensory deficit This occurs before many people even know they are pregnant.

What is a long term consideration after nueral tube defect surgery?

Fecal incontinence & constipation due to loss of parasympathetic innervation to colon & pelvic floor

How are neural tube defects prevented?

Neural Tube Defects are very preventable. Folic Acid is important in the diet to prevent this. Fortified Foods: breads, cereals, grains, orange juice. When should you be taking folic acid? It's to late to take it after you find out that you are pregnant.

What is the difference between Spina Bifida (Myelomeningocele) and myelodysplasia?

Neural tube defects occur as a result in the failure of neural tube closure that produces defects of varying degrees. can occur along the entire length of the spinal column or can be restricted to a small area in the spinal column. Myelodysplasia refers to a malformation of the spinal cord and spinal canal and spina bifida refers to a defect in one or more vertebrae through which spinal cord content can protrude (B & B 1328). When you have spina bifida it is intrusion and usually visible. When you have myelodysplasia it may not be visible at all

Does fetal surgery work for neural tube defects?

Since 1997 more than 200 in utero closures of myelomeningoceles Preliminary clinical evidence suggests that hs procedure reduces the incidence of shunt-dependent hydrocephalus & restores the cerebellum & brainstem to a more normal configuration

What are the clinical manifestations of neural tube defects?

The lower the defect the better. The higher the defect the more impact. Don't need to memorize all of the levels. Thoracic or lumbar 1-2 level: paralysis of the legs weakness and sensory loss in the trunk and lower body Lumbar 3 level: child can flex hips, extend the knees, ankle and toe paralysis Lumbar 4-5 level: can flex hips, extend knew, weak or absent ankle extension, toe flexion, and hip extension Sacral level: mild weakness in the ankles and toes, bladder and bowel function may be involved.

What is Spina bifida cystica?

Visible defect Sac like protrusion Meningocele meninges,& spinal fluid Myelomeningocele Meninges,spinal fluid & nerves

Where do neural tube defects occur?

occur anywhere in the brain or spinal cord

How are neural tube defects detected?

via a ultra sound