Wesleyan University –Philippines

Cabanatuan City
College of Nursing

NCM 109- Care of Mother and Child at

Risk or with Problems
(Acute and Chronic)-LECTURE
MIDTERM PERIOD
WEEK 10
NURSING CARE OF THE CHILD BORN WITH A
PHYSICAL OR DEVELOPMENTAL DIFFERENCE
 The pediatric provider or neonatologist typically provides
the parents with medical information regarding the health
status of their newborn
 And also the team will cater all the parents questions for
information or clarification
 The nurse can provide support to the family by keeping
them informed of their newborn’s health status and
facilitating their interaction with the health care team
PHYSICAL AND DEVELOPMENTAL DISORDERS OF THE
SKELETAL SYSTEM

ABSENT OR MALFORMED EXTREMITIES

 Congenital skeletal disorders can result from reasons such
as idiopathic congenital, maternal drug or alcohol
ingestion, maternal malnutrition, teratogenic medication,
virus invasion and amniotic band formation in utero.
 Causes: unknown
 Children born without an extremity or with a malformed
extremity can be fitted with prosthesis early in life at
about 6 months, so that the infant can learn to stand at
the normal time or handle and explore objects readily.
 Pediatric occupational or physical therapist- for gait
training
FINGER AND TOE CONDITIONS
 occur in 1:20 children who are born with
hand related birth defects
 POLYDACTYLY- is the presence of one or
more additional fingers or toes
 SUPERNUMERARY DIGIT- extra finger or toe is
formed and can be amputated in early age
 SYNDACTYLY- two fingers or toes are fused
magkadikit

 THERAPEUTIC MANAGEMENT: separation of

digits into two functional
 Upset on the parents part
 Develop self esteem to the kids
CHEST DEVIATION
PECTUS EXCAVATUM
 FUNNEL CHEST- an indentation of the lower portion of the
sternum
 Most common congenital deformity of the anterior chest 1:500
live births more on female than male
 Seen in school age or adolescent
 Result in decrease lung capacity and the heart may be
displaced to the left
 Can be repaired for cosmetic reasons or physiologic reasons to
expand the lung volume
TORTICOLLIS (WRY NECK)
 tortus means twisted and collum means neck
 A congenital anomaly when the sternocleidomastoid muscle is
injured and bleeds during birth
 The infants holds the head tilted to the same side as the muscle
that is involved; the chin rotates to the opposite side
 There is a thick mass over the muscle when palpating
 Management: program of passive stretching exercises and
therapy
 Laying the infant on a flat surface and rotating the head through
a full range of motion
 Encourage the infant to look in the direction of the affected
muscle
 Manual stretching is begun early and performed consistently by
parents
 Surgical correction followed by neck immobilizer
CRANIOSYNOSTOSIS
 Is the premature closure of the sutures of the skull
 Reasons:
 1.rickets or irregularities of calcium or phosphate
metabolism
 2. dominant inherited trait more on males
 Measuring the infant heads circumference early
detection
 Causes: fontanelle closure, fused skull close,
compromise brain growth
 Diagnosed by exam and confirmed by X-RAY and
ultrasound
ACHONDROPLASIA
A failure of bone growth inherited
as a dominant trait, which causes
a disorder in cartilage production
in utero.
The epiphyseal plate of the long
bones cannot produce adequate
cartilage for longitudinal bone
growth; results in both arms and
legs becoming stunted.
The bones of the cranium are
membraneous origin, the head
continue to grow normally, causing
the child’s head to appear
unusually large in contrast to their
extremities.
 Sign and symptoms
 Forehead is prominent, bridge of the nose are flattened,
trunk are normal but a thoracic kyphosis( outward curve),
lumbar lordosis (inward curve) of the spine may develop,
gross motor development may be slowed but intelligence is
not affected
 Diagnose: ultrasound in the utero and X-ray at birth
 Females with this condition may have difficulty with
childbearing because of a small pelvis
 Growth hormones in preschool years
 Continue guidance or counselling can help them to
successfully emerge from this period with a positive self-
image.
TALIPES DISORDERS
 The word talipes is formed from the latin talus (ankle) and pes
(foot).
 Ankle foot disorders common called CLUBFOOT
 CLUBFOOT implies permanent disability to many people but now
surgery is done for correction
 1:1000 born common on males, inherited
 Four separate types:
 1. plantar flexion (an equinus or horse foot)
 2. dorsiflexion (heel is lower than the forefoot)
 3. varus deviation (foot turns in)
 4. valgus deviation (foot turns out)
 Some children have a combination of these types.
 Recognized during newborn
assessment
 Pediatric orthopedist
specialist- for treatment or
correction
 Period of cast and braces
adjusted to patient
development
 Pediatric physical therapy
for mobilization
DEVELOPMENTAL DYSPLASIA OF THE HIPS-DDH
 Common referred as congenital hip dysplasia
 Its improper formation and function of the hip socker and is
considered a spectrum of abnormalities affecting the hip
joint.
 Common musculoskeletal condition found in newborn, more
on females than male
 With this disorder, the acetabulum of the pelvis is unusually
flattened or shallow, that prevents the head of the femur
from remaining in the acetabulum and rotating adequately
 Causes: unknown, possibility of polygenic inheritance
pattern
 Factors: Uterine position(breech), 1st pregnancy
 Additional risk factors: oligohydramnios, macrosomic
babies, metatarsus adductus, torticollis
 Infants screened for DDH from birth through 6 to 12 months of
age by performing the ORTALANI and BARLOW MANEUVER.
 Assessing ortalani and barlow signs box. 27.3 page 731
 Signs: affected leg is slightly shorter than the other leg,
unequal number of skin folds
 Diagnostic: hip ultrasonography
 Therapeutic mngt: surgery in early age, therapy, correction by
the use of brace, cast and splints ( von rosen, pavlik, craig
frejka)
PHYSICAL AND DEVELOPMENTAL DISORDERS OF
THE GASTROINTESTINAL SYSTEM

ANKYLOGLOSSIA (TONGUE TIE)

 A n abnormal restriction of the tongue occurring in a small number of
newborns caused by an abnormally tight frenulum
 Frenulum- the membrane attached to the lower anterior tip of the tongue
 Congenital anomaly in which shortened lingual frenulum causes restricted
tongue mobility and impaired tongue function
 Type 1 and 2-classic or anterior ties-75%
 Type 3 and 4-posterior ties-25%
 The hazelbaker Assessment Tool used to evaluate tongue tie.
 Happened to 25% to 60% incidence of breastfeeding
 Frenotomy for treatment
ORALFACIAL CLEFTS:
CLEFT LIP AND CLEFT PALATE
 A Heterogeneous group of disorder affecting the structure of the
face and oral cavity
 CLEFT LIP- most common orofacial cleft, prevalent among males
 Present during weeks 5 to 8 of intrauterine life
 Causes: viral infection, seizure medicines, smoking, drinking
alcohol, hyperthermia, stress, folic acid deficiency and maternal
obesity
 CLEFT PLATE- opening in the palate and occurs when the palatal
process does not close as usual at approximately weeks 9 to 12 of
intrauterine life.
 Incomplete closure usually in the midline and may involve the
anterior hard palate, and the posterior soft palate or both
 Can be detected by sonogram while the infant is in the
utero
 Therapeutic management:
 A plastic surgeon will repair the baby's cleft lip first,
usually when the baby is about 3 months old. This is done
with a surgery called cheiloplasty (KY-lo-plass-tee). It's
done in the hospital while the baby is under general
anesthesia.
 A cleft palate usually is repaired with surgery called
palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 10–
12 months old. The goals of palatoplasty are to: Close
the opening between the nose and mouth.
 Currently, the results of surgical repair are excellent, it is
helpful for the growing child to become normal to its
environment
 Speech therapy is needed after the surgery to make sure
the child will have normal speech.
THE PIERRE ROBIN SEQUENCE
 Also called as PIERRE ROBIN SYNDROME
 A rare triad of micrognathia(small mandible), cleft palate,
and glossoptosis( tongue malpositioned downward)
 Causes severe upper airway obstruction secondary to
respiratory distress
 Associated disorders: congenital glaucoma cataracts, cardiac
disorder, genetic or chromosomal disorders
 Therapeutic management:
 Suctioning secretions, side lying position
 Sometimes, surgery is necessary to help children eat and
breathe more easily while their jaw is still growing. G-tube
placement, mandibular distraction (jaw distraction), tongue
lip adhesion, and rarely tracheostomy are some surgeries that
are performed to treat Pierre Robin sequence.
ESOPHAGEAL ATRESIAS AND
TRACHEOESOPHAGEAL FISTULAS
 They are rare anomalies in neonates between weeks
4 and 8 of intrauterine life
 The laryngotracheal groove in the chest develop
into the larynx , trachea and beginning lung tissue,
the esophageal lumen forms parallel to this.
 Causes by teratogenic factors
 EA- ESOPHAGEAL ATRESIA- incomplete formation of
the esophageal lumen, resulting in the proximal
esophagus forming a blind pouch which then does
not connect to any other structure
 TEF-Tracheosophageal fistula- occurs when an
opening develops between the closed distal
esophagus and the trachea.
 Five usual types of AE that are results: (FIFURE 27.11 PAGE 739)
 1. the esophagus ends in a blind pouch, there is a TEF between the distal part
of the esophagus and the trachea
 2.the esophagus ends in a blind pouch; there is no connection to the trachea
 3. a fistula is present between an otherwise normal esophagus and trachea
 4. the esophagus ends in a blond pouch. A fistula connects the blind pouch of
the proximal esophagus to the trachea.
 5. there is a blind-end portion of the esophagus. Fistula are present between
both widely spaced segments of the esophagus and the trachea.

 Potentially serious disorder because of feeding the baby my result to

aspiration
 Diagnostic: x-ray and bronchial endoscopy to check for fistula
 In most cases of tracheoesophageal fistula and esophageal atresia repair, the
surgeon cuts through the abnormal connection (fistula) between the windpipe
and esophagus and then sews together the two ends of the esophagus. The
windpipe is also repaired.
Abdominal Wall defects

UMBILICAL HERNIAS
 A protrusion of a portion of the intestine through the
umbilical ring, muscle and fascia surrounded by the
umbilical cord.
 An umbilical hernia occurs at the umbilicus (belly button)
when a loop of intestine pushes through the umbilical ring, a
small opening in a fetus' abdominal muscles through which
the umbilical cord—which connects a fetus to its mother
while in the womb—passes.
 During umbilical hernia repair, the surgeon makes a small cut
of about 2 to 3cm at the base of the belly button and pushes
the fatty lump or loop of bowel back into the tummy. The
muscle layers at the weak spot in the abdominal wall where
the hernia came through are stitched together to strengthen
them.
OMPHALOCELES
 Omphalocele, also known as exomphalos, is a birth
defect of the abdominal (belly) wall. The infant's
intestines, liver, or other organs stick outside of the
belly through the belly button. The organs are covered
in a thin, nearly transparent sac that hardly ever is
open or broken.
 Omphalocele occurs very early in pregnancy when the
abdominal wall fails to form normally. During typical
fetal development, the intestines extend outside the
fetal abdomen into the umbilical cord, then return back
into the abdomen by about 11 weeks of gestation.
 Most of the time, surgery can correct omphalocele. How
well your baby does depends on how much damage or
loss of intestine there was, and whether your child has
other birth defects. Some babies have gastroesophageal
reflux after surgery
GASTROCHISIS
 Gastroschisis (pronounced gas-troh-skee-sis) is a birth defect
where there is a hole in the abdominal wall beside the belly
button. The baby's intestines, and sometimes other organs, are
found outside of the baby's body, exiting through the hole.
 Symptoms
 Lump in the abdomen.
 Intestine sticks through the abdominal wall near the umbilical
cord.
 Problems with movement and absorption in the gut due to the
unprotected intestine being exposed to irritating amniotic fluid.
 Most of the time, gastroschisis can be corrected with one or two
surgeries. How well your baby does will depend on how much
damage there was to the intestine. After recovering from surgery,
most children with gastroschisis do very well and live normal
lives.
 CAN BE DETECTED BY ULTRASOUND.
DIFFERENCE BETWEEN
OMPHALOCELE AND
GASTROCHISIS
 Gastroschisis is generally a solitary anomaly
with postnatal outcomes related to the
underlying integrity of the prolapsed bowel. In
contrast, omphalocele is frequently associated
with other structural anomalies or genetic
syndromes that contribute more to postnatal
outcomes than the omphalocele defect itself.
 These conditions differ in some important ways.
But how they present is similar, as are the
treatments. Both conditions are visible at birth,
and both can affect how a newborn digests
food. In both cases, a doctor will perform
surgery to put the intestines and any other
affected organs into their proper locations.
MECONIUM PLUG SYNDROME
 Meconium plug is an extremely hard portion of meconium that
has completely blocked the intestinal lumen.
 Meconium plug syndrome is a condition that predominantly
affects preterm-neonates of low birth weight. It presents with
an inability to pass meconium within the first 24 to 48 hours of
life, and It must be properly differentiated from similar
conditions.
 infants develop abdominal distension and vomiting. The
vomiting can present with bilious emesis.
 Associated with hirschsprung disease, cystic fibrosis,
hypothyroidism, magnesium sulfate toxicity.
 water-soluble contrast enema can be therapeutic by
separating the plug from the intestinal wall and expelling it.
Occasionally, repeated enemas are required. Rarely, surgical
decompression is required.
Meconium ileus
 Meconium ileus is a bowel
obstruction that occurs when
the meconium in your child's
intestine is even thicker and
stickier than normal meconium,
creating a blockage in a part of
the small intestine called the
ileum. Most infants with
meconium ileus have a disease
called cystic fibrosis.
 Diaphragmatic hernias
 A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the
diaphragm. The diaphragm is the muscle between the chest and abdomen that helps you
breathe. The abnormal opening allows part of the organs from the belly to move into the
chest cavity near the lungs.
 Every child may experience symptoms differently, but possible symptoms of a Bochdalek
diaphragmatic hernia may include:
 difficulty breathing.
 fast breathing.
 fast heart rate.
 cyanosis (blue color of the skin)
 abnormal chest development, with one side being larger than the other.
 abdomen that appears caved in.
 The 3 basic types of congenital diaphragmatic hernia include the posterolateral Bochdalek
hernia (occurring at approximately 6 weeks' gestation), the anterior Morgagni hernia, and
the hiatus hernia. The left-sided Bochdalek hernia occurs in approximately 85% of cases.
 It is most common as a congenital phenomenon; however, it can also be acquired. Most commonly, acquired DH
occurs following blunt or penetrating trauma, which results in a rupture of the diaphragm and herniation of
abdominal content.
 Doctors use an ultrasound to create a picture of the diaphragm and lungs to look for abnormalities. In some cases,
ultrasounds during pregnancy do not show the diaphragmatic hernia. However, once the baby is born, doctors may
diagnose the condition after noticing that the baby has trouble breathing.
 diaphragmatic hernia direct repair with a tension-free suture is generally attempted; in case of very large defects
or when a tension-free suture is deemed unfeasible, the use of prosthesis is recommended
 Prognosis: The outcome of surgery depends on how well the baby's lungs have developed. It also depends on
whether there are any other congenital problems. Most often the outlook is good for infants who have a sufficient
amount of working lung tissue and have no other problems.
 Medical advances have made it possible for more than one half of infants with this condition to survive. The babies
that survive will often have ongoing challenges with breathing, feeding, and growth.
AN IMPERFORATED ANUS
 Imperforate anus is a defect in which the opening to the anus is
missing or blocked. The anus is the opening to the rectum through
which stools leave the body. This is present from birth (congenital).
 Imperforate anus may occur in several forms:
 The rectum may end in a pouch that does not connect with the
colon.
 The rectum may have openings to other structures. These may
include the urethra, bladder, base of the penis or scrotum in boys,
or vagina in girls.
 There may be narrowing (stenosis) of the anus or no anus.
 Symptoms of the problem may include:
 Anal opening very near the vagina opening in girls
 First stool is not passed within 24 to 48 hours after birth
 Missing or moved opening to the anus
 Stool passes out of the vagina, base of penis, scrotum, or urethra
 Swollen belly area
 Treatment
 A health care provider can diagnose this condition during
a physical exam. Imaging tests may be ordered.
 The infant should be checked for other problems, such as
abnormalities of the genitals, urinary tract, and spine.
 Surgery to correct the defect is needed. If the rectum
connects with other organs, these organs will also need to
be repaired. A temporary colostomy (connecting the end
of the large intestine to the abdomen wall so that stool
can be collected in a bag) is often needed.
 Contact your provider if a child treated for imperforate
anus has: Abdominal pain, Constipation that is difficult to
manage, and Failure to develop any bowel control by the
age of 3
 There is no known prevention. Parents with a family
history of this defect may seek genetic counseling.
PHYSICAL AND DEVELOPMENTAL
DISORDERS OF THE NERVOUS SYSTEM
HYDROCEPHALUS
 Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF)
builds up within the fluid-containing cavities or ventricles of the brain.
 The term hydrocephalus is derived from the Greek words "hydro" meaning
water and "cephalus" meaning the head. Although it translates as "water on
the brain," the word actually refers to the buildup of cerebrospinal fluid, a
clear organic liquid that surrounds the brain and spinal cord.
 CSF is in constant circulation within the ventricles of the brain and serves
many crucial functions:
 1) it acts as a "shock absorber" for the brain and spinal cord;
 2) it acts as a vehicle for delivering nutrients to the brain and removing
waste from it; and
 3) it flows between the cranium and spine to regulate changes in pressure.
 When CSF builds up around the brain, it can create harmful pressures on
the tissues of the brain confined within the skull.
 The accumulation of CSF occurs due to either an increase in production of
the fluid, a decrease in its rate of absorption or from a condition that
blocks its normal flow through the ventricular system.
 Hydrocephalus can occur at any age, but is most common in infants and
adults age 60 and older.
 Some cases of hydrocephalus are present at birth, while others develop in
childhood or adulthood.
 Hydrocephalus can be inherited genetically, may be associated with
developmental disorders, like spina bifida or encephalocele, or occur as a
result of brain tumors, head injuries, hemorrhage or diseases such as
meningitis.
 The symptoms of hydrocephalus tend to vary greatly from person to
person and across different age groups. Infants and young children are
more susceptible to symptoms from increased intracranial pressure like
vomiting and adults can experience loss of function like walking or
thinking.
 Infants
 Unusually large head size
 Rapidly increasing head circumference
 Bulging and tense fontanelle or soft spot
 Prominent scalp veins
 Downward deviation of eyes or sunset sign
 Vomiting
 Sleepiness
 Irritability
 Seizures
 Children and Adolescents
 Nausea and vomiting
 Swelling of the optic disc or papilledema
 Blurred or double vision
 Balance and gait abnormalities
 Slowing or loss of developmental progress
 Changes in personality
 Inability to concentrate
 Seizures
 Poor appetite
 Urinary incontinence
 Adults
 Headache
 Nausea and vomiting
 Difficulty walking or gait disturbances
 Loss of balance or coordination
 Lethargy
 Bladder incontinence
 Impaired vision
 Impaired cognitive skills
 Memory loss
 Mild dementia
 testing and Diagnosis
 Computed tomography scan (CT or CAT scan)
 Magnetic resonance imaging (MRI)
 Lumbar puncture (spinal tap)
 Intracranial pressure monitoring
 Isotope cisternography
 Treatment
 Hydrocephalus can be treated in a variety of ways. Based on the underlying
etiology, the condition may be treated directly by removing the cause of CSF
obstruction or indirectly by diverting the excess fluid.
 Hydrocephalus is most commonly treated indirectly by implanting a device
known as a “shunt” to divert the excess CSF away from the brain. The shunt is a
flexible tube which, along with a catheter and a valve, is placed under the skin
to drain excess CSF from a ventricle inside the brain to another body cavity such
as the peritoneal cavity (the area surrounding the abdominal organs).
 Once inserted, the shunt system usually remains in place for the duration of a
patient's life (although additional operations to revise the shunt system are
sometimes needed). The shunt system continuously performs its function of
diverting the CSF away from the brain, thereby keeping the intracranial
pressure within normal limits. In some cases, two procedures are performed,
the first to divert the CSF and another at a later stage to remove the cause of
obstruction
 A limited number of patients can be treated with an alternative operation
called endoscopic third ventriculostomy. In this procedure, a surgeon utilizes
a tiny camera (endoscope) with fiber optics to visualize the ventricles and
create a new pathway through which CSF can flow.
NEURAL TUBE DEFECTS
 Neural tube defects (NTDs) are birth defects
(congenital conditions) of the brain, spine or spinal
cord. They happen to developing fetuses within the
first month of pregnancy — often before you even
know you're pregnant. The two most common neural
tube defects are spina bifida and anencephaly.
 Neural tube defects, also known as spinal
dysraphisms, are a category of neurological
disorders related to malformations of the spinal
cord, such as spina bifida, anencephaly,
meningocele, myelomeningocele and tethered spinal
cord syndrome.
 The cause is not clear but may be related to
genetics, maternal nutrition (including folic acid
deficiency) during pregnancy or other factors.
 You're at greater risk of having an infant with a
neural tube defect if you:
 Have obesity
 Have poorly controlled diabetes
 Take certain antiseizure medicines
ANENCEPHALY
 Anencephaly is a serious birth defect in which a baby is born without
parts of the brain and skull.
 Because the neural tube fails to close properly, the developing brain
and spinal cord are exposed to the amniotic fluid that surrounds the
fetus in the womb. This exposure causes the nervous system tissue to
break down (degenerate).
 Because these nervous system abnormalities are so severe, almost all
babies with anencephaly die before birth or within a few hours or
days after birth.
 CAUSES: Anencephaly is a complex condition that is likely caused by
the interaction of multiple genetic and environmental factors. Some
of these factors have been identified, but many remain unknown.
MICROCEPHALY
 Microcephaly is a condition where a baby’s head is much smaller than expected.
During pregnancy, a baby’s head grows because the baby’s brain grows.
 Microcephaly can occur because a baby’s brain has not developed properly during
pregnancy or has stopped growing after birth, which results in a smaller head
size.
 Microcephaly can be an isolated condition, meaning that it can occur with no
other major birth defects, or it can occur in combination with other major birth
defects.
 CAN BE LINKED TO OTHER DISORDERS:
 Seizures
 Developmental delay, such as problems with speech or other developmental
milestones (like sitting, standing, and walking)
 Intellectual disability (decreased ability to learn and function in daily life)
 Problems with movement and balance
 Feeding problems, such as difficulty swallowing
 Hearing loss
 Vision problems
 Causes and Risk Factors
 The causes of microcephaly in most babies are unknown. Some babies have
microcephaly because of changes in their genes. Other causes of microcephaly,
including severe microcephaly, can include the following exposures during pregnancy:
 Certain infections during pregnancy, such as rubella, toxoplasmosis, or
cytomegalovirus
 Severe malnutrition, meaning a lack of nutrients or not getting enough food
 Exposure to harmful substances, such as alcohol, certain drugs, or toxic chemicals
 Interruption of the blood supply to the baby’s brain during development
 DIAGNOSTIC: During pregnancy, microcephaly can sometimes be diagnosed with an
ultrasound test (which creates pictures of the body). To see microcephaly during
pregnancy, the ultrasound test should be done late in the 2nd trimester or early in
the third trimester.
 Microcephaly is a lifelong condition.
 There is no known cure or standard treatment for microcephaly. Because
microcephaly can range from mild to severe, treatment options can range as well.
Babies with mild microcephaly often don’t experience any other problems besides
small head size. These babies will need routine check-ups to monitor their growth
and development.
 SPINA BIFIDA OCCULTA
 Spina bifida occulta is the mildest type of spina bifida.
 It is sometimes called “hidden” spina bifida. With it, there is a small
gap in the spine, but no opening or sac on the back. The spinal cord
and the nerves usually are normal.
 Many times, spina bifida occulta is not discovered until late
childhood or adulthood.
 Occurs most commonly in the 5th lumbar or 1st sacral level along the
spinal canal.
 Typically has no symptoms
 sign are first noticed as a dimpling at the point of poor fusion , with
abnormal tufts of hair or discolored skin.
 There is no cure for SBO. Most people never receive treatment
because they never have symptoms or even know they have the
condition. When symptoms do arise, they are generally treated
individually. For example, pain can be managed with medications or
physical therapy.
 Spina bifida occulta can affect anyone. Some people are at a higher risk of having
a child with spina bifida occulta if:
 A parent has a lack of folic acid (vitamin B9) during pregnancy. Folic acid is a
vitamin (B9) found in leafy vegetables, beans, whole grains and several other
foods.
 You have a history of spina bifida in your family (genetic).
 Parents who become pregnant have conditions like diabetes or obesity.
 Your baby has a genetic condition like Down syndrome, Edwards syndrome or
Patau’s syndrome.
 A parent is taking antiseizure medicines like valproate or carbamazepine.
 Imaging tests, like an X-ray, MRI or CT scan, diagnose spina bifida occulta.
 Most cases of spina bifida occulta don’t need treatment. If symptoms occur,
treatment focuses on reducing the amount of tension on your spinal cord.
Treatments could include:
 Surgery to close the gap between the vertebrae of your backbone.
 Physical or occupational therapy to improve muscle strength.
 Using mobility equipment like a back brace, walker or wheelchair.
 Taking medicine to treat bladder or bowel problems.
MENINGOCELE
 A meningocele is a birth defect where there is a sac protruding from the spinal
column.
 The sac often is visible from the outside of the back.
 The defect is commonly located in the lumbosacral region.
 Meningoceles are often covered with skin, and the bony abnormality rarely
involves more than two or three vertebrae. The sac of the meningocele
consists of both arachnoid and dural meninges and contains cerebrospinal
fluid. Most meningoceles also contain neural elements.
 Meningomyelocele
 Myelomeningocele is the most common open neural tube defect. It is
characterized by failure of the neural tube to close in the lumbosacral region
during embryonic development (fourth-week post-fertilization), leading to the
herniation of the meninges and spinal cord through a vertebral defect.
 The meninges protrude through the vertebrae and the spinal cord usually ends
at the point of protrusion.
 Motor and sensory function will be decreased or absent
 Timely diagnosis allows for prenatal counseling and informed management
choices, including termination of pregnancy, fetal surgery, or postnatal surgery.
 After delivery, a baby born with a myelomeningocele will need: surgery to close
the skin over the myelomeningocele (usually within 3 days) testing for Chiari
malformation and hydrocephalus with an ultrasound, CT scan, or MRI. regular
checks of head size to see if hydrocephalus develops.
 Care must be taken to protect the exposed meninges in the spinal lesion until
surgical closure can be performed. The infant must be nursed prone and not
dressed to prevent injury to the lesion. Use an incubator or radiant warmer.
Immediately after delivery the lesion must be covered with a sterile dressing.
DEGREES OF SPINAL CORD ANOMALIES
End….