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Neural tube defects

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11 views33 pages

Neural tube defects

Uploaded by

Jayalakshmi JR
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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NEURAL TUBE DEFECTS

NEURAL TUBE DEFECTS

Neural tube defects are congenital malformations


of the CNS resulting from defective closure of neural
tube during early embryogenesis between 3rd and 4th
week of intrauterine life. It involves defect in skull,
vertebral column , the spinal cord and other portion of
CNS.
SPINA BIFIDA – ANENCEPHALY
• Neural tube defects are birth defects of the brain,
spine, or spinal cord.
• It happens in the first month of pregnancy, often
before a woman even knows that she is pregnant.
• The two most common neural tube defects are spina
bifida and anencephaly.
• In spina bifida, the fetal spinal column doesn't close
completely.
• In anencephaly defect in brain development occur.
TYPES OF NEURAL TUBE DEFECTS
• Spina Bifida characterized by incomplete closure of
neural tube and vertebrae.
• Encephalocele which is formed when the bones of
the skull fail to develop.
• Anencephaly where there is absence of cranial vault
and no cerebral hemisphere can be seen.
SPINA BIFIDA

• Spina bifida meaning open spine or split spine.


• Medically it refers to a neural tube defect characterized by
incomplete closure of neural tube and vertebrae.
• It occurs in about 1.5 per 1000 live births.
CAUSES

• Multifactorial inheritance: 1 to 5 per 1000 live births.


• Risk for second sibling is high.
• Maternal factor : zinc and folate deficiency, exposure to alcohol and
radiation, insulin dependent diabetes mellitus and certain drugs
during pregnancy.
TYPES

• SPINA BIFIDA OCCULTA


• SPINA BIFIDA CYSTICA
Meningocele
Meningomyelocele
Spina bifida occulta

This occurs between L5 and S1 vertebra with


failure of the vertebra to completely fuse. Here,
the meninges and the spinal cord are normal.
Spina bifida cystica

This is the incomplete closure of like protrusion in


the lumber or sacral area with or without nervous
involvement. This is further subdivided to meningocele
& meningomyelocele.
Meningocele: it is a sac like protrusion
contain-ing CSF and meninges.
Meningomyelocele: it is the protrusion of
meninges and spinal cord in which the cyst
contains meninges, cerebrospinal fluid, nerve
roots and part of the spinal cord. This is the
most serious type of spina bifida.
BI LOBULATED OCCIPITAL MENINGOCELE
MENINGOMYELOCELE
DIFFERENCE BETWEEN :
MENINGOCELE MYELOMENINGOCELE
 Sac contains neural tissue along with
 Sac contains Meninges and CSF.
CSF and meninges
 Sac may be covered by a
 Sac may be covered by transparent
transparent membrane of skin. membrane of skin but an opening in
 When the sac is transilluminated the sac may be present causing risk of
light can be seen through it. infection.
 When the sac is transilluminated light
 As spinal cord is not involved no
cannot be seen through it.
neurological deficit occurs.
 As spinal cord protrudes out,
 Bladder and bowel control may
neurological deficit occurs.
not be affected.
 Bladder and bowel control are affected.
CLINICAL FEATURES
• Spina bifida occulta: the split in the bone of the spine is small
and the spinal cord and main nerves cannot bulge out and so
little or no damage is done. The only feature seen on the back
may be a dimple, tuft of hair, or a port wine navus. It is usually
asymptomatic.

• Meningocele: A fluid-filled sac is protruded in the back. Usually


nerve supply is not affected. Degree of disability depends on the
position of the defect, but less severe than meningomyelocele
Meningomyelocele: along with the protruded
sac, neurological deficits occur due to nerve
involvement. Neurological deficit includes flaccid
paralysis, sensory deficit in the trunk and the legs
corresponding to the involved segment of spinal cord.
Involvement of bladder and bowel causes urinary and
fecal incontinence.
DIAGNOSIS

Prenatal diagnosis by elevated alfa feto protein level in


maternal blood at 14-16 weeks of gestation
 Ultrasound of head
 x-ray chest and spine
CT scan and myelography
MANAGEMENT

Medical care the child should be positioned in the prone


position to prevent pressure on the defect.
 The newborn with an open NTD should be kept warm and the
defect covered with a sterile wet saline dressing.
 Intravenous antibiotic should be initiated.
TREATMENT

• Surgical intervention is necessary which include closure of the


defect.
• Open cysts with drainage of csf needs repair within 24 hrs.
• Closed sacs can be operated within 48 hrs.
• Surgery is not done if severe paraplegia, gross hydrocephalus with
associated gross congenital anomalies are present.
• VP shunt is done if hydrocephalus is present.
COMPLICATIONS

• HYDROCEPHALUS
PREVENTION OF NEURAL TUBE DEFECT
 It is recommend that all women of childbearing age
take a daily supplement of 400 micrograms (mcg) of
folic acid.
 Educate mothers regarding intake of folic acid
especially in periconception period and in first trimester
as well.
 Women already had first pregnancy with NTD should
take a daily 4mg tablet of folic acid for at least one
month before conception and then throughout the first
NURSING MANAGEMENT

ASSESSMENT

 Assess for degree of defect by doing neurological examination.

 Assess for bowel and bladder function.

 Identify sensory disturbances by doing a pin prick over lower trunk


or legs.
NURSING DIAGNOSIS

 Risk for injury related to the presence of fluid-filled sac on back.

 Risk for infection related to the open sac and operative procedure.

 Risk for impaired skin integrity related to neurologic motor deficits.

 Impaired physical mobility related to neuromuscular deficit as evidenced


by paraplegia.
NURSING DIAGNOSIS
 Impaired urinary elimination related to bladder dysfunction as evidenced by
incontinence of urine.

 Impaired bowel elimination related to loss of bowel sphincter control as


evidenced by fecal incontinence or constipation.

 Sensory deprivation related to neurological deficit as evidenced by not


responding to sensory stimulation.

 Deficient knowledge related to care of the child, prognosis of the disease.


PREVENTING INFECTION AND INJURY TO THE SAC

 Place the infant under warmer without clothing.

 Position the infant on abdomen to avoid pressure on the sac

 Gently cleanse the sac with sterile normal saline hydrogen


peroxide solution.

 Apply a sterile moist normal saline or antibiotic dressing.


PREVENTING INFECTION AND INJURY TO THE SAC

 Change the dressing every 2-4 hourly to prevent drying.

 Assess for opening in the sac with csf leakage.

 Keep the area clean of urine, feces to prevent contamination.

 Do not apply diaper if the defect is in the lower portion of the


spine. Apply meningomyelocele apron to prevent contamination
in such cases.

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