One of the worst defects that hits babies is called Spina Bifida. It's hard for both newborns and parents who have to cope with this defect.
What is Spina Bifida?Spina bifida is a neural tube defect, which can be opened or closed. It occurs when spinal cord does not close properly which happens during the first month of pregnancy, thus this condition can cause a a portion of the spinal cord and the surrounding structures to develop outside, instead of inside the body. Baby's spinal cord namely forms few weeks after conception, and then spinal cord arises from baby's neural tube, which is the structure that develops into the baby's brain, the spinal cord and the tissues that enclose them. Therefore spina bifida is often referred to as a neural tube disorder. Also other words are used to describe the condition: myelomeningocele, meningocele, open neural tube defect and closed neural tube defect.
Sometimes infants born with spina bifida have an open lesion on their spine where damage to the nerves and spinal cord has occurred. Despite the fact the spinal opening can be surgically repaired shortly after the birth, which we will discuss later in article,the nerve damage is permanent, and only varies on the degrees of paralysis of the lower limbs, but not only that: most people suffering from spina bifida have some form of learning disability. Spina bifida is also connected to other health problems: it may cause bowel and bladder complications, besides many children with spina bifida have hydrocephalus, which is excessive accumulation of cerebrospinal fluid in the brain.
Types of spina bifidaSpina bifida can be mild to severe depending on the type of defect, how big it is, where it occurs and if there are other problems related.
- Myelomeningocele is the severest form of spina bifida. In this form the spinal cord and its protective covering protrude from an opening in the spine.
- Meningocele is a form of spina bifida in which the spinal cord develops normally but the meninges protrude from a spinal opening.
- Occulta is the mildest form, in which one or more vertebrae are malformed and covered by a layer of skin.
Spina bifida treatmentUnfortunately there is no cure for spina bifida. As said above, spina bifida is neural tube disorder, which means nerves are damaged, and nerve tissue cannot be replaced or repaired. For that reason many individuals with spina bifida need devices such as braces, crutches or wheelchairs.
However, there are treatments that help prevent and manage complications throughout the individual's life. Treatments may include surgery, medication and physiotherapy, and depend on the extent of the condition, child's age, health and age, preferences of parents and expectations for the course of condition.
Most patients with spina bifida occulta require no treatment at all, while children with meningocele typically require surgical removal of the cyst and survive with little, if any, disability.
On the other hand children with myelomeningocele, the severest form of spina bifida, require special care and lifelong treatment. Most of children survive with appropriate treatment starting soon after birth- surgery to close newborn' s spinal opening is performed within 24-48 hours after birth to minimize the risk of infection and to preserve existing function in the spinal cord. The surgery involves closing the opening in the spinal cord and covering it with muscles and skin. The quality of child's life depends on the speed, efficiency, and comprehensiveness with which that treatment is provided, for that reason each person with severe spina bifida requires intensive and complex care by a trained and coordinated team, which includes one or more pediatricians, neurologists, neurosurgeons, orthopedic surgeons, physical medicine specialists, endocrinologists, urologists, physical therapists, orthotics specialists, occupational therapists, psychologists, nurses, dietitians, social workers, and other professionals. The most common complications include tethered spinal cord and hydrocephalus and have very severe consequences (for example progressive tethering can cause loss of muscle function to the legs, bowel or bladder). For that reason treatment with antibiotics is started as soon as the myelomeningocele is recognized, because this sort of treatment prevents infection of the spinal cord, which can be fatal, while on the other hand surgery on the spinal cord may allow the child to regain a normal level of functioning.
Very soon after surgery, actually as soon as possible, a physical therapist teaches parents how to exercise their baby's legs and feet to prepare for walking with leg braces and crutches. These help prevent damage to the joints and help the child walk.
As said before, there is no cure for spina bifida. The goal of treatment for spina bifida is to allow the individual to achieve the highest possible level of function and independence and to develop his or hers potential. Treatment should address any disability, physical, emotional, or educational, that interferes with that person’s potential.
Children with spina bifida must also be seen by urologists to evaluate the bladder: the child is tested for bladder function, and if there are any problems, a small tube is inserted into bladder to drain urine (also known as catheterization).
What is the prognosis of spina bifida?As mentioned several times in the article, the prognosis depends on the severity and number of abnormalities. Prognosis is the poorest for those with complete paralysis, hydrocephalus, and other congenital defects, while with proper care, most children with spina bifida live well into adulthood.
How to prevent spina bifida?There are several researches done, and they aim at finding ways to treat, cure and primary prevent spina bifida.
Recent studies show that the only way to prevent spina bifida (and other neural tube defects) is for the mother to consume during early pregnancy adequate folic acid levels. This prevention does not work in all cases, but studies have shown that even 70% of cases of severe spina bifida could be prevented by adequate folic acid intake.