Spina Bifida

Spina Bifida

Spina Bifida is a type of birth defect where there is an incomplete closing of the backbone and membranes around the neural tube of the fetus. The neural tube is what eventually develops into the brain and spinal cord. In most cases, the neural tube closes by the 28th day after conception, but in babies with spina bifida, a portion of the neural tube doesn’t get properly enclosed leading to spinal cord defects. This defect varies in severity, with the mildest being known as occulta which can be seen as a small dimple, dark spot or a hairy patch or small swelling in the lower back. Rarely does spina bifida occur in the middle back or neck regions. A more severe form known as meningocele appears as a sac of fluid present in the gap of the spine that pushes against the skin, creating a bulge. The most severe is the myelomeningocele, also known as open spina bifida where part of the malformed and defective spinal nerves push out of the spinal canal. It also presents as a bulge, but in some babies, the skin may be open leaving the nerves exposed.

This birth defect is believed to be linked to genes and the environment; women with one child with spina bifida are likely to have another child with the same defect. Other linked factors include poorly-controlled diabetes, obesity and a history of anti-seizure medications. Sufficient folate intake before and during pregnancy however play a major role in prevention.

As far as symptoms are concerned, they vary with severity of the defect; those with occulta and meningocele hardly ever have any symptoms, but those with myelomeningocele often have serious spine and brain issues. These may include a curve in their spine (scoliosis), bladder and bowel problems, fluid build-up in the brain (hydrocephalus) and little or no feelings in the legs and arms along with an associated inability to move these limbs.

Treatment for spina bifida varies with the severity of the defect. Most cases with occulta and meningocele types require surgery to prevent infection and prevent any further damage. Children with the most severe type usually need surgery for living a somewhat normal life, however the outcome is generally not good due to the fact that the nerves are malformed at birth itself. In cases where the baby has been diagnosed while still in the womb, the surgery can be completed before its birth. Children with hydrocephalus will need surgery for draining out the excess fluid to relieve pressure on the brain and further damage.

Such children need to start working with physical and occupational therapists from a very young age and may need a brace, wheelchair or other aids to keep upright and mobile. They will also need active management to manage urinary complications and prevent kidney damage. As they grow, other treatments and surgeries will be needed to manage the problems that arise. Parents will need to be very vigilant in their care of such children, but the most important factor here is prevention; regular scans during pregnancy, healthy habits and sufficient folate intakes go a long way in preventing such defects.

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