Neural tube defects are the most common congenital abnormality in India which can be easily prevented with due information and better nursing practices. Neural Tube Defects can be prevented with intake of folic acid.
2. INTRODUCTION
The most common birth defect in India is Neural Tube
Defect.
The presentation of Neural Tube Defect may vary
from Anencepaly, spina bifida occulta and spina bifida
cystica.
In Year 2015 the birth prevalence of neural tube
defects in India was 4.5 per 1000 total birth.
3. Neural tube defects are birth defects of the brain,
spine, or spinal cord. It happens in the first month of
pregnancy, often before a woman even knows that she
is pregnant.
The two most common neural tube defects are
SPINA BIFIDA AND ANENCEPHALY.
In Spina bifida, the fetal spinal column doesn't close
completely.
In Anencephaly defect in brain development occur.
4. ETIOLOGY
The exact causes of neural tube defects are not known.
Genetic
Nutritional Factors
Environmental factors.
Poor intake of folic -acid (also known as folate)
Obese Women
Intake of anti epileptic medications during pregnancy
5. PATHOPHYSIOLOGY
THE NEURAL PLATE APPEARS ON THE 17TH DAY OF GESTATION
AS A THICKENING OF THE EMBRYONIC ECTODERM
.
ON DAY 18, THE NEURAL PLATE FOLDS ALONG THE MIDLINE
BY THE END OF THE THIRD GESTATIONAL WEEK, THE NEURAL
FOLDS FUSE TO FORM NEURAL TUBE.
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6. FUSION BEGINS AT THE HINDBRAIN-CERVICAL JUNCTION FIRST
PROCEEDS ROSTRALLY AND THEN CAUDALLY
THEN, THE ANTERIOR AND POSTERIOR ENDS (NEUROPORES)
CLOSES TO FORM SPINAL CORD
DEPENDING ON THE POINT OF INTERUPPTION IN NEURAL TUBE
FORMATION DEVELOPS NTDS MAY AFFECT THE BRAIN
(ANENCEPHALY)OR SPINAL CORD (SPINA BIFIDA).
7. TYPES OF NEURAL TUBE DEFECTS
A Spinal cord defects
SPINA
OCCULTA
MENINGOCELE
A
9. COMMON TYPES OF SPINA BIFIDA
Spina bifida occulta which is the mildest form where
there is a small gap in the spine but the opening
cannot be seen in the back. Brain and spinal cord
functions are normal and there is no disabilities.
Meningocele is a sac of fluid not involving the spinal
cord that comes out through an opening in the back
and involve meninges also.
10. CONT……………
Myelomeningocele is one of the most common and
most severe form of spina bifida .
In this the unfused portion of the spinal column allows
the spinal cord to protrude through an opening,
forming a sac enclosing the spinal elements, such as
meninges, cerebrospinal fluid, and parts of the spinal
cord and nerve roots.
12. SIGN AND SYMPTOMS
Loss of bladder or bowel control
Partial or complete lack of sensation
Partial or complete paralysis of the legs
Weakness of the hips, legs, or feet of a newborn
Other symptoms may include:
Abnormal feet or legs, such as clubfoot
Build up of fluid inside the skull (hydrocephalus)
Hair present at sacral region
Dimpling of the sacral area
13. Brain Defects
Anencephaly is the absence of a major portion of
the brain, skull and scalp that occurs
during embryonic development. Infants with this
disorder do not survive longer than a few hours or
possibly days after their birth.
14. CONTD……
Encephalocele, sometimes known as cranium
bifidum, is a neural tube defect characterized by sac-
like protrusions of the brain and the membranes .
Symptoms may include
Neurologic problems
Hydrocephalus
Spastic quadriplegia
Microcephaly
15. DIAGNOSTIC TESTS
Ultrasound
Maternal serum Alpha feto protein at 16-20 weeks.
Aminiotic Alpha feto protein
Aminiotic acetyl cholineterase
16. MANAGEMENT
Medical Care
The patient should be positioned in the prone position
to prevent pressure on the defect.
The newborn with an open NTD should be kept warm
and the defect covered with a sterile wet saline
dressing.
Intravenous antibiotic should be initiated.
17. SURGICAL MANAGEMENT
Neurosurgical repair of the defect is considered the
mainstay of treatment for open spina bifida.
Closed spina bifida does not usually warrant any
immediate surgery.
The cele closure is typically performed within 1 to 3
days of delivery.
Neonates born with severe hydrocephalus should have
ventriculoperitoneal shunt placed concurrently.
18. NURSING MANAGEMENT
ASSESSMENT
Depends on the spinal involvement.
Visible spinal defect
Flaccid paralysis of legs.
Altered bowel and bladder pattern.
Perform neurological assessment
19. NURSING INTERVENTIONS
Evaluate the sac and measure lesion .
Monitor for increased ICP
Measure head circumfrence.
Protect sac with non adherent moist dressing
Place child in prone position
Use aseptic techniques
Monitor for early signs of infection
Administer Antibiotic.
Prepare Family for surgery
20. PREVENTION OF NEURAL TUBE
DEFECT
Experts recommend that all women of childbearing
age take a daily supplement of 400 micrograms (mcg)
of folic acid.
Educate mothers regarding intake of folic acid
especially in periconception period and in first
trimester as well.
Women already had first pregnancy with NTD should
take a daily 4mg tablet of folic acid for at least one
month before conception and then throughout the
first 12 weeks of pregnancy.
Genetic Counseling or screening.
