Spina Bifida
Spina Bifida - Definition
Spina Bifida is a birth defect where there is an incomplete closing of the backbone and tissue around the spinal cord. Spina Bifida is one of the most widely recognized birth defects which impact the spinal cord.
Spina Bifida starts in the womb when the tissues that overlap to frame the backbone don not close or do not close or develop properly. This causes an opening in the vertebrae, which encloses and surrounds the spinal cord. This happens within the first 30 days after inception—more often than not before the woman realizes that she is pregnant. There are 3 types of Spina Bifida.
- Spina Bifida Occulta: Spina Bifida Occulta means "a hidden spot on the spine." Spina Bifida Occulta is normally found inadvertently when the individual has an X-ray or MRI for some other reason. The pervasiveness of Occulta is not known, but unfortunately, it is the most widely recognized cause of Spina Bifida.
- Meningocele: This is the least common type of Spina Bifida. The membrane that surrounds the spinal cord protrudes through the opening causing a lump or sac on the back.This severe type of Sina Bifida can be surgically repaired with little to no nerve damage.
- Spina Bifida Cystica (Myelomeningocele): This is the most severe form of Spina Bifida. Spina Bifida Cystica, for the most part, includes neurological issues that can be intense or even fatal. A portion of the spinal cord and the nerves that surround it are protruding and are not covered by skin.
Surgery is a successful treatment for most children with Spina Bifida. Most newborns with an open spine or Myelomeningocele experience surgery within the initial 48 hours of life to close the deformity. Anti-infection medicines are given to prevent infections of the uncovered spinal cord and nerves until the point that this defect can be corrected by surgery.
Prevalence
Spina Bifida affects approximately 1 out of every 2,500 newborns in the world. It is less common in African-Americans than in Hispanics and Caucasians in the United States. Spina Bifida occurs more often in children of parents who have the condition, but there is not a known genetic defect associated with the condition.
Causes
The precise reason for this birth deformity isn't known. For instance, women who have had one child with Spina Bifida may not have another child with the illness. Women who are overweight or who have diabetes are additionally more at risk to have a child Spina Bifida.
Risk Factors
In spite of the fact that specialists and analysts don't know the exact cause of Spina Bifida, they have recognized a couple of risk factors:
- Race: Spina Bifida is more typical among Caucasians and Hispanics.
- Sex: Females are impacted more frequently.
- Family history: Couples who have had one child with Spina Bifida have a somewhat higher possibility of having another child with a similar birth defect. That risk increases if two past children have been influenced by the condition.
- Folate insufficiency: A lack of folate in the diet is a theory on what causes Spina Bifida
- A few meds: Reactions to seizure prescriptions, for example, valproic acid (Depakene), appear to cause neural tube deformities when taken amid pregnancy by interfering with the body's capacity to process folate and folic acid.
- Diabetes: Diabetes is another probable cause of Spina Bifida in women. Women with diabetes who do not control their glucose may have a higher risk of having a child with Spina Bifida.
Complications
The outcome of Spina Bifida depends on the severity of the condition. Some patients live completely independent lives and others who have a severe injury to the spinal cord require life-long care. The infant mortality rate for Spina Bifida has improved with advancements in neonatal medicine.
Symptoms of Spina Bifida
Children with Spina Bifida may not have any symptoms of Spina Bifida. In this case, the lamina arch has not completely closed, but the spinal cord is not damaged and is in its correct position.
In others with Spina Bifida, a fatty tissue mass protrudes through the opening in the spinal column. This is called a Lipomeningocele.
In more severe cases of Spina Bifida, the spinal cord or the tissues that protect it come through the opening in the arch. This is called a Myelomeningocele. The symptoms of Spina Bifida in these cases might include a decrease in the size of the muscles of the legs, muscle weakness and loss of bladder function.
A child will show symptoms of Spina Bifida dependent upon how extreme the defect. Most of the children with the less severe form of Spina Bifida don't have any issues with it. Much of the time, children with Meningocele don't have any symptoms of Spina Bifida.
Children with the most extreme type of Spina Bifida, Spina Bifida Cystica (Myelomeningocele), have very dramatic symptoms including:
- Little to no feeling and control in their legs, feet, or arms.
- Extremely impaired bladder and bowel functions.
- Hydrocephalus
- Scoliosis
Diagnostic Procedures
Blood test and Ultrasounds can offer early indications or symptoms of Spina Bifida as well as other issues. In the event that test comes out positive for a birth defect, you can elect to have an Amniocentesis. This test can help affirm if the infant has Spina Bifida.
After birth, a specialist can normally tell if an infant has symptoms of Spina Bifida. In the event that Spina Bifida is suspected, the specialist may do an X-ray, an MRI, or a CT scan to check whether the defect is mild or extreme.
Regardless of the possibility that the results are negative, there's is still a slight chance that Spina Bifida is present. Consult your specialist about pre-birth testing, its dangers, and the full scope of Spina Bifida.
Blood tests
Your specialist will check for Spina Bifida by first doing the following:
- Maternal Serum Alpha-Fetoprotein (MSAFP) test.
A typical test used to check for Myelomeningocele is the Maternal Serum Alpha-Fetoprotein (MSAFP) test. In order to perform this test, your specialist draws a blood test and sends it to a research facility, where it's tested for Alpha-Feto Protein (AFP) — a protein that is created by the infant.
It's typical for a small measure of AFP to cross the placenta and enter the mother's circulatory system, yet strangely elevated amounts of AFP recommend that the infant has a neural tube deformity, most normally Spina Bifida or Anencephaly, an undeveloped and skull.
Some Spina Bifida cases don't deliver an abnormal state of AFP. Then again, when an abnormal state of AFP is discovered, a neural tube deformity is present in just a small percentage.
Fluctuating levels of AFP can be caused by different variables — including an error determining an exact fetal age — so your specialist may arrange a subsequent blood test for confirmation. In the event that the results are still high, you'll require additional assessment, including an ultrasound examination.
Ultrasound
Numerous obstetricians depend on ultrasonography to screen for Spina Bifida. In the event that blood tests show high AFP levels, your specialist will recommend an ultrasound exam to help decide why. The most widely recognized ultrasound exams ricochet high-recurring sound waves off tissues in your body to frame highly contrasting pictures on a video screen.
The data these pictures give can reveal whether there's more than one child and can help confirm gestational age, two factors that can influence AFP levels. An ultrasound can also distinguish indications of Spina Bifida, for example, an open spine or specific components in your child's brain that demonstrate spina bifida.
Amniocentesis
If the blood test shows abnormal amounts of AFP in your blood yet the ultrasound is normal, your specialist may offer amniocentesis. With amniocentesis, your specialist uses a needle to expel a sample of the liquid from the amniotic sac that surrounds the child.
When an open neural tube deformity is present, the amniotic fluid contains a raised measure of AFP if the skin surrounding the infant's spine is gone and AFP spills into the amniotic sac.
Spina Bifida - Treatment
When a child with Spina Bifida is born, a referral is usually made to a neurologist who can consult with other specialists as needed. Children with Spina Bifida are at risk for other conditions such as clubfoot. Spina Bifida treatment for this typically involves stretching, casting and bracing. If these are not successful, surgery may be necessary.
A child with Spina Bifida usually is monitored throughout life for complications related to their condition. It's especially important to monitor the skin so pressure ulcers do not develop.
Most children with the mild type of Spina Bifida do not need Spina Bifida treatment. Children with Meningocele may not require treatment as well. However, children with the most extreme form of Spina Bifida ordinarily require extensive treatment including surgery.
A child who has Hydrocephalus will require Spina Bifida treatment surgery to insert a shunt. It diminishes pressure on the cerebrum by depleting the overabundant fluid into the belly. This reduces the swelling from doing more harm to the brain.
Is surgery necessary for spina bifida?
Several types of surgeries may be necessary for Spina Bifida treatment depending on the severity of the condition. If a child has clubfoot, lengthening of certain tendons may be recommended or the realignment of bones may also be necessary. Spine surgery may be needed if the child has significant spinal curvature, loss of balance or has trouble sitting.
Spina Bifida treatment relies on the seriousness of the condition. Spina Bifida Occulta frequently doesn't require Spina Bifida treatment at all, however different types of Spina Bifida will require surgery.
Surgery
Meningocele includes Spina Bifida treatment surgery to set the meninges back and close the opening in the vertebrae. Myelomeningocele additionally requires surgery, typically within 24 to 48 hours after birth.
Planning out the Spina Bifida treatment early can help limit the danger of the disease that is related to the uncovered nerves and may likewise help shield the spinal cord from extra injury.
During the surgery, a neurosurgeon returns the spinal cord and uncovered tissue inside the infant's body and covers them with muscle and skin. Occasionally a shunt is inserted to control hydrocephalus in the child's brain during the surgery.
Pre-birth Surgery
In this method — which happens before the 26th week of pregnancy — specialists open the uterus and repair the infant's spinal cord.
The proponents of fetal surgery trust that the nerve function in babies with Spina Bifida appears to intensify quickly after birth, so it might be better option to repair Spina Bifida defects while the infant is still in the uterus.
Children who got the fetal surgery require fewer shunts and are less inclined to require braces or other walking devices. There are several risks with the operation since it poses dangers to the mother and significantly increases the danger of unexpected labor.
Continuous Care
Spina Bifida treatment doesn't end with surgery. In babies with Myelomeningocele, irreparable nerve damage has occurred and continuous care from a multidisciplinary group of specialists, doctors, and advisors is typically required. Infants with Myelomeningocele may require numerous operations for a variety of complications.
Loss of motion and bladder issues regularly remain, and treatment for these conditions ordinarily starts not long after birth. Infants with Myelomeningocele may also begin therapy and exercises that will develop their legs for walking with braces or bolsters when they are older.
Many have a fastened spinal cord — a condition in which the spinal cord is bound to the closure scar and is less ready to appropriately develop in terms of length as the child develops. This dynamic "tying" can cause loss of muscle work in the legs, gut or bladder. Surgery can decrease the level of inability and may also reestablish some of its capacity.
Cesarean birth
Cesarean birth can be one of the Spina Bifida treatments. Many children with Myelomeningocele have a tendency to be in a feet-first (breech) position. On the off chance that your child is in this position or if your specialist has identified an expansive growth, cesarean birth might be a more secure approach to deliver your infant.
Useful Advice
There are numerous ways you can continually support your child with Spina Bifida:
- Make sure to attend all scheduled doctor's appointments.
- Encourage your child to be dynamic, and urge him or her to be as free as can be expected under the circumstances.
- Urge your child to drink a lot of water and eat foods that are high in fiber, for example, fruits and grains. These counteract blockage.
- Check your child's skin every day for cuts, wounds, and bruises. Children who have practically no feeling in their legs and feet may get hurt and not know it. What's more, this could prompt an infection.
- Make sure to get your child's vision checked consistently. Children with Spina Bifida frequently have weak eye muscles.
- Look for learning disorders and converse with your child's specialist or educator if you have any worries.
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