pediatrics
Spina Bifida
Treatment of Spina Bifida
Surgical repair of the spinal lesion Sometimes a ventricular shunt Various measures for orthopedic and urologic complications Without early surgical treatment, neurologic damage can progress in occult spinal dysraphism. Treatment for all spina bifida requires a united effort by specialists from several disciplines; neurosurgical, urologic, orthopedic, pediatric, psychiatric/psychologic, and social service evaluations are important. It is important to assess the type, vertebral segment, and extent of the lesion; the infant’s health status; and associated anomalies. Discussion with the family should ascertain the family’s strengths, desires, and resources and community resources, including availability of ongoing care. Amyelomeningooceleidentified at birth is covered immediately with a sterile dressing. If the myelomeningocele is leaking cerebrospinal fluid, antibiotics are started to prevent meningitis. Neurosurgical repair of a myelomeningocele or an open spine typically is done within the first 72 hours after birth to reduce the risk of meningeal or ventricular infection. If the lesion is large or is in a difficult location, plastic surgeons may be consulted to ensure adequate closure. may require a shunt procedure in the neonatal period (see Treatment ); sometimes a ventricular shunt is inserted when the back is repaired. Kidney function must be monitored closely, and urinary tract infection should be treated promptly. Obstructive uropathy at either the bladder outlet or ureteral level must be treated vigorously to prevent infection. When children are between 2 years and 3 years of age, or at any time if they have elevated pressure in the bladder with vesicoureteral reflux, clean intermittent catheterization is done to empty the bladder on a regular basis. Catheterization increases continence and maintains bladder and kidney health. At around the same time, children are placed on the commode or toilet after meals to encourage fecal continence. Well-balanced diets are encouraged; stool softeners, laxatives, or a combination may be helpful to ensure regular bowel movements and to increase continence (see Treatment ). In older children, an antegrade colonic enema procedure, which is infusion of liquids through a gastrostomy tube, can improve continence. Orthopedic care should begin early. If a Talipes Equinovarus (Clubfoot) and Other Foot Abnormalities is present, a cast is applied; surgery is often necessary after casting. Hip joints are checked for dislocation. Affected children should be monitored for development of scoliosis, pathologic fractures, pressure injuries, and muscle weakness and spasm. 