Medical Presentation

1. Medical Presentation Spina Bifida (SPY-na BIF-i-da) or myelomeningocele (MY-eh-lo-me-NING-oh-seel)

2. Spina bifida is one of the most common birth defects that involve the nervous system and it may affect as many as 1 in 800 infants. Yet the cause of Spina Bifida is still unknown.

3. Defined Spina bifida is a birth defect that involves the incomplete development of the spinal cord or its coverings. The term spina bifida comes from Latin and literally means "split" or "open" spine.

4. When does it start? Week 5 of embryo development: Date updated: February 20, 2008 Content provided by KidsHealth At about the 5th week in the pregnancy the embryo’s distinct shape begins to form. The early stage of the development of the heart is seen, and the neural tube, which will eventually form into the spinal cord and brain, runs from the top to the bottom of the embryo.

5. http://embryology.med.unsw.edu.au/Notes/neuron.htm

6. The neural tube The neural tube is the part of a developing fetus that grows into the spinal cord and brain. Normally, the bones of the skull and spine grow around the brain and spinal cord, and then skin covers the bones, creating the neural tube.

7. Spina bifida occurs when the two sides of the embryo's spine fail to join together, leaving an open area. This is called neural tube defect, or NDT.

8. Neural tube defect (NTD) A neural tube defect (NTD) is a birth defect that occurs when the spine, the brain, or the bone and skin that protect them do not develop properly. Spina bifida is the most common type of neural tube defect. Anencephaly is another type of NTD.

9. Forms of Spina Bifida Occulta : the mildest form of spina bifida (occulta means hidden). Most children with this type of defect never have any health problems. The spinal cord is often unaffected. Manifesta: includes two types of spina bifida, meningocele and myelomeningocele.

10. Spina bifida manifesta, two types: Meningocele and myelomeningocele • Meningoceleinvolves the meninges, the membranes responsible for covering and protecting the brain and spinal cord. If the meninges push through the hole in the vertebrae (the small, ring-like bones that make up the spinal column), the sac is called a meningocele. • Myelomeningocele is the most severe form of spina bifida. It occurs when the meninges push through the hole in the back, and the spinal cord also pushes though. Most babies who are born with this type of spina bifida also have hydrocephalus, an accumulation of fluid in and around the brain.

11. Because of the abnormal development of and damage to the spinal cord, a child with the myelomeningocele form of spina bifida typically has some paralysis. The degree of paralysis largely depends on where the opening occurs in the spine. The higher the opening is on the back, the more severe the paralysis tends to be.

12. Detection of Spina Bifida • Neural tube defects can be detected with prenatal tests, such as ultrasound and amniocentesis • Amniocentesis: Transabdominal puncture of the amniotic sac using a needle and syringe in order to remove amniotic fluid to be studied for any disorders.

13. . Treatment • In spina bifida, treatment depends on the severity. • Children with spina bifida occulta usually need no treatment. • In cases of spina bifida manifesta, the treatment largely depends on the type of spina bifida a child has and how severe it is. • A child with the meningocele form of the disease usually has an operation during infancy in which doctors push the meninges back and close the hole in the vertebrae. Many children with this type of spina bifida have no other health problems down the road, unless there is nerve tissue involved with the sac.

14. Treatment cont. • Babies born with the myelomeningocele form typically have surgery within the first 1 to 2 days of their lives. • During this first surgery, doctors typically push the spine back into the vertebrae and close the hole to prevent infection and protect the spine. • A baby who also has hydrocephalus will need an operation to place a shunt in the brain. The shunt is a thin tube that helps to relieve pressure on the brain by draining fluid.

15. Treatment cont. • In addition, some children need surgeries to manage problems with the feet, hips, or spine. • The location of the gap in the back often dictates what kind of adaptive aids or equipment that a child with myelomeningocele will need down the line. Children with a gap high on the spinal column and more extensive paralysis will often need to use a wheelchair to move around, whereas those with a gap lower on the back may be able to use crutches, leg braces, or walkers. People with spina bifida most likely also have to deal with incontinence.

16. How to help prevent neural tube defects: • Adequate intake of certain nutrients, such as folic acid, protein, calcium, and iron is essential prenatal nourishment for the baby. • Based on past studies, the lack of folic acid has been determined to be a primary cause for the birth defect of Spina Bifida. • In 1992, the FDA recommended fortifying the nation’s food supply with folic acid, a strategy that has worked well in the past with other beneficial substances including iodine (in salt), vitamin D (in milk), and thiamin (in flour and bread). Folic acid began being added to breads and other grain products in January of 1998.

17. What is folic acid? Folateis a B vitamin which is found naturally in leafy vegetables, citrus fruits, beans, and whole grains. Folate and folic acid are interchangeable terms; folic acid is the synthetic form of folate. Scientists are in general agreement that folic acid reduces the risk of neural tube defects.

18. “Maternal folic acid deficiency has also been linked to spina bifida, and researchersbelieve that many cases of spina bifida could be prevented if women of childbearing age consume 0.4 milligrams (400 micrograms) of folic acidevery day, and continue to take it throughout the first trimester. • Good sources of folic acid include eggs, orange juice, and dark green leafy vegetables. Many multivitamins contain the recommended dose of folic acid as well.” • Michael A. Alexander, MD, KidsHealth

19. According to an article from HealthDay News “Men with relatively low levels of folate had increased risks for sperm containing either too few or too many chromosomes, according to researchers at the University of California, Berkeley. These types of deficiencies can cause birth defects and miscarriages, the experts noted.”

20. Doernbecher Children's HospitalHere in Oregon…………….Spina Bifida ClinicClinic activities include prevention through case finding, diagnosis, and evaluation. The team makes recommendations to primary care physicians regarding intervention, long term management, and coordination of care.The program primarily serves children and young adults from birth through age 21. However, people with neural tube defects may be referred to the program at any age. The program counsels families who have had a prenatal diagnosis of neural tube defect to help prepare the family for delivery, infant care, and ongoing management.

22. Famous People & Spina Bifida Jean Driscoll, Olympian Hank Williams Jr. John Cougar Mellencamp Just to name a few.

23. Conclusion There is support right now for people with Spina Bifida, and a future for them, because of the research going on that is trying to solve the handicap issues they face. Go to the following web site to find out more information. W W W . S B A A . O R G

24. References http://www.kidshealth.org/kid/health_problems/bone/spina_bifida.html http://www.healthday.com http://www.righthealth.com/Health/Spina_Bifida_Photos/-od-images_4-s http://www.waisman.wisc.edu/~rowley/sb-kids/ Paramedic Care, Principles & Practice, 2nd Edition, vol.3 & 5