Spina bifida is the most common birth defect in the United States. It is a type of neural tube defect (NTD). The neural tube is a narrow channel that folds and closes during the third and fourth weeks of pregnancy to form the brain and spinal cord. Spina bifida happens if the portion of the neural tube that forms the spinal cord does not close completely during the first month of pregnancy.
Spina bifida includes two types of spina bifida:
- Meningocele :- involves 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.
- Spina bifida occulta : - a mild form of spina bifida in which the spinal cord and the surrounding structures remain inside the baby, but the back bones in the lower back area fail to form normally. There may be a hairy patch, dimple, or birthmark over the area of the defect. Other times, there may be no abnormalities in the area.
- Meningocele : - a moderate form of spina bifida in which a fluid-filled sac is visible outside of the back area. The sac does not contain the spinal cord or nerves.
- Myelomeningocele : - a severe form of spina bifida in which the spinal cord and nerves develop outside of the body and are contained in a fluid-filled sac that is visible outside of the back area. These babies typically have weakness and loss of sensation below the defect. Problems with bowel and bladder function are also common. A majority of babies with myelomeningocele will also have hydrocephalus, a condition that causes the fluid inside of the head to build up, causing pressure inside of the head to increase and the skull bones to expand to a larger than normal size.
Approximately 85 percent of defects are found in the lower back area. The remaining 15 percent of the defects are located in the back of the neck or upper back areas.
What causes spina bifida?
While the cause of spina bifida is unknown, scientists believe that many factors are involved. We at CDC work with many other researchers to study risk factors that can increase the chance of having a baby with spina bifida.
Following are examples of what our research has found:
Hispanic babies are at an increased risk for spina bifida.
Mothers who are obese before they become pregnant are at a higher risk than mothers who are of average weight for having a baby with spina bifida.
There has been a 24% decline in babies born with spina bifida since the United States began fortifying grains with folic acid
How is spina bifida diagnosed ?
Diagnostic tests can be performed during pregnancy to evaluate the fetus for spina bifida. The tests include the following : -
• Blood tests : -
The American College of Obstetrics and Gynecology (ACOG) recommends that a blood test be offered between 15 to 20 weeks to all women who are pregnant who have not previously had a child with an ONTD and who do not have a family history of ONTD.
This blood test measures alpha-fetoprotein (AFP) levels and other biochemical markers in the mother's blood to determine whether her pregnancy is at increased risk for an ONTD. AFP is a protein normally produced by the fetus that crosses the placenta into the mother's blood. Generally, if a fetus has an ONTD, the alpha-fetoprotein level in the mother's blood will be increased. Although this test does not tell for certain whether a fetus has an ONTD, it will determine which pregnancies are at greater risk, so that additional testing may be performed.
Prenatal ultrasound (Also called sonography.) : -
a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Prenatal ultrasound may be able to detect an ONTD, and may be used to examine other organs and body systems of the fetus.
• Amniocentesis : -
a procedure that involves inserting a long, thin needle through the mother's abdomen into the amniotic sac to withdraw a small sample of the amniotic fluid for examination. The fluid is then tested to determine the presence or absence of an open neural tube defect. Small or closed defects may not be picked up by this test.
What problems do people with spina bifida have?
Spina bifida can cause physical, as well as learning disabilities. The severity of the problem depends on the size and location of the defect, whether skin covers the affected area(s), and whether spinal nerves come out of the affected area.
Physical problems might include the following:
- Difficulty controlling bowel and bladder functions.
- Partial or complete loss of strength of the legs (paralysis).
- People with spina bifida might need crutches, braces, or wheelchairs to help them get around, depending on the size of the opening and the care received after birth.
- Babies born with spina bifida might experience buildup of fluid in the brain, a condition known as hydrocephalus.
- Some babies might develop meningitis, an infection in the tissues surrounding the brain. Meningitis can cause brain injury and can be life-threatening.
Long-term outcomes for children with spina bifida are poorest for those with complete paralysis, hydrocephalus, and additional birth defects. With proper care, most children with spina bifida live well into adulthood.
Still, children with spina bifida might have learning disabilities later in life, including:
Difficulty paying attention.
Problems with language and reading.
Trouble learning math.
Symptoms of Spina Bifida
What are the symptoms of spina bifida ?
The following are the most common symptoms of spina bifida. However, each baby may experience symptoms differently :
Symptoms may include : -
• Abnormal appearance of the baby's back, varying from a small, hairy patch or a dimple or birthmark, to a sac-like protrusion that is found along the back bone area.
• Bowel and bladder problems (i.e., constipation, incontinence).
• Loss of feeling below the area of the lesion, especially in babies born with a meningocele or myelomeningocele.
• Inability to move the lower legs (paralysis).
The baby may also have other problems related to spina bifida that include the following : -
Hydrocephalus (increased fluid and pressure in the head area; occurs in about 80 to 90 percent of cases).
Orthopedic (bone) problems.
Subtle learning problems.
Babies with myelomeningocele also have a sac-like mass that bulges from the back, but a layer of skin may not always cover it. In some cases, the nerves of the spinal cord may be exposed. A baby who also has hydrocephalus will have an enlarged head, the result of excess fluid and pressure inside the skull.
Treatment Of Spina Bifida
In cases of spina bifida manifesta, treatment depends on the type of spina bifida and its severity.
meningocele usually have an operation during infancy in which doctors push the meninges back and close the hole in the vertebrae. Many will have no other health problems later unless there is nerve tissue involved with the sac.
myelomeningocele need more immediate attention and often have surgery within the first 1 to 2 days after birth. During this first surgery, doctors push the spine back into the vertebrae and close the hole to prevent infection and protect the spine.
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 and diverting extra fluid. In addition, some children need subsequent surgeries to manage problems with their feet, hips, or spine.
The location of the gap in the back often dictates what kind of adaptive aids or equipment a child with myelomeningocele will need. Those with a gap high on the spinal column and more extensive paralysis often need to use a wheelchair, while those with a gap lower on the back may be able to use crutches, leg braces, or walkers.
Can Spina Bifida Be Prevented ?
Currently, there is no known way to prevent spina bifida, although steps can be taken to lower the risk. Recent studies have shown that the addition of a B vitamin called folic acid to the diet of women who might become pregnant can greatly reduce the number of babies born with neural tube defects. CDC recommends that all women of childbearing age consume 400 micrograms of folic acid daily. A single daily serving of most multivitamins and fortified cereals contain 400 micrograms of folic acid.
In addition, mothers can take steps before and during pregnancy to be healthy, including not smoking and not drinking alcohol during pregnancy.
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