Can spina bifida be eliminated? Here is the truth,,,

Spina bifida

A birth defect in which a developing baby’s spinal cord fails to develop properly.It occurs when a developing baby’s spinal cord fails to develop or close properly while in the womb.

Because spina bifida occurs early in pregnancy, doctors recommend that women who are planning to have a baby start taking 400 micrograms of folic acid every day for at least three months before trying to become pregnant.

Women should continue to take folic acid daily throughout pregnancy.Spina bifida occurs when there is an opening in the spinal column where the spinal cord sticks out and is exposed.

Spinal cords are usually protected by the spinal column and skin. When they are open in the womb, this can lead to spinal cord damage. As a result, children with Spina Bifida have higher chances for various health issues.

However, advances in healthcare have greatly improved outcomes for these medical conditions.

Types of spina bifida:

There are several different types of spina bifida, including;

myelomeningocele – the most severe type of spina bifida; the baby’s spinal canal remains open along several vertebrae in the back, allowing the spinal cord and protective membranes around it to push out and form a sac in the baby’s back.

meningocele – another serious type of spina bifida where the protective membranes around the spinal cord (meninges) push out through the spine; the spinal cord usually develops normally so surgery can often be used to remove the membranes without damaging the nerves.

spina bifida occulta – the most common and mildest type of spina bifida; one or more vertebrae does not form properly, but the gap in the spine is very small; spina bifida occulta does not usually cause any problems and most people are unaware they have it.

Symptoms of spina bifida:

Most people with spina bifida are able to have surgery to close the opening in the spine.But the nervous system will usually already have been damaged, which can lead to problems such as:weakness or total paralysis of the legs.bowel incontinence and urinary incontinence.loss of skin sensation in the legs and around the bottom – the child is unable to feel hot or cold, which can lead to accidental injury.Many babies will have or develop hydrocephalus (a build-up of fluid on the brain), which can further damage the brain.Most people with spina bifida have normal intelligence, but some have learning difficulties.SPINA BIFIDA IN STUDENTS MANAGEMENT:Spina bifida can affect the part of the brain that controls executive functioning, so some students may find it difficult to plan, organize and recall details. To support students to remain focused and on task, break tasks into small manageable chunks and check for understanding before moving onto the next activity. Additionally, providing a checklist or a tick box, may assist the student to remember what they need to do for that lesson. Build breaks into your daily routine that involve age-appropriate movement – for example, rocking, rolling or marching for younger students and mindfulness practices for the older students.Writing can be challenging for students with spina bifida as the condition may affect fine motor skills. Allowing students more time to complete a task when the focus is on handwriting is one adjustment. Further adjustments include the use of assistive technology. When writing is not the core skill being learnt, modify the work so that the student with spina bifida is required to do less handwriting but is provided with an alternative way to demonstrate their learning. These may include tasks that can be completed via a computer, an app, or another alternative technology. The development of a student’s fine motor skills may also be supported through creative pursuits that are age appropriate such as sewing, knitting or threading.Adjust the physical space in the classroom, in consultation with an OT, to suit the mobility needs of the student with spina bifida – whether they are using an electric wheelchair or other mobility aides. Ensure there’s easy access in and out of the room and building. Inside the classroom, make sure surfaces are flat, there are no trip hazards, and provide the student with a height adjustable desk to accommodate their wheelchair as needed.Students with spina bifida are at risk of developing injuries as they may not have full sensation in their lower body. Reduce the risk of students being harmed by doing a risk assessment of the different environments in which the student learns, particularly during outdoor activities, by ensuring they always wear shoes and socks. Remind students to avoid sitting on hot surfaces such as metal seats, which may cause burns.Causes of spina bifida:The cause of spina bifida is unknown, but a number of factors can increase the risk of a baby developing the condition.These include: low folic acid intake during pregnancy.having a family history of spina bifida.medicines – taking certain medicines such as valproic acid (used to prevent seizures) during pregnancy has been linked to an increased risk of having a baby with spina bifida.DiagnosisTests before the birth of a baby, known as prenatal screening, can check for spina bifida and other conditions. The tests aren’t perfect. Some people who have positive blood tests have babies without spina bifida. Even if the results are negative, there’s still a small chance that spina bifida is present. Talk with your healthcare professional about prenatal testing, its risks and what the results mean.Spina bifida can be screened with blood tests during pregnancy, but typically the diagnosis is made with an ultrasound exam.Maternal serum alpha-fetoprotein (MSAFP) test; For the MSAFP test, a sample of blood is drawn and tested for alpha-fetoprotein (AFP). This is a protein produced by the baby. It’s typical for a small amount of AFP to cross the placenta and enter the pregnant parent’s bloodstream. But high levels of AFP suggest that the baby may have a neural tube defect such as spina bifida. However, high levels of AFP don’t always occur in spina bifida.Test to confirm high AFP levels. Varying levels of AFP can be caused by other factors such as a wrong estimate of the unborn baby’s age or the presence of multiple babies. You may need a follow-up blood test to confirm the results. If levels of AFP are still high, you need further evaluation, including an ultrasound exam.Other blood tests; Your healthcare professional may perform the MSAFP test with two or three other blood tests. These tests screen for other conditions, such as trisomy 21 syndrome, also known as Down syndrome. They are commonly done with the MSAFP test.An ultrasound is the most accurate way to diagnose spina bifida in your baby before delivery. During pregnancy, an ultrasound may be done in the first 11 to 14 weeks of pregnancy, known as the first trimester. Or it may be done at 18 to 22 weeks, known as the second trimester. Spina bifida can be more accurately diagnosed during the second trimester ultrasound exam. This exam is crucial to identify and rule out conditions that may be present at birth.An advanced ultrasound can detect symptoms of spina bifida, such as an open spine or features in the baby’s brain. Sometimes ultrasound also can help your healthcare professional see how serious spina bifida is.If the prenatal ultrasound confirms the diagnosis of spina bifida, your healthcare professional may request a test called amniocentesis. During this test, a needle is used to remove a sample of fluid from the amniotic sac that surrounds the baby. This exam may be important to rule out genetic diseases.Explaining the diagnosis:The medical professionals involved in providing prenatal testing and explaining the diagnosis might include any of the following: obstetricians, neonatologists, midwives, maternal-fetal medicine specialists, genetics doctors, or genetic counselors. In some areas, family medicine providers, pediatricians, neurologists, nurses, or physician assistants may also be involved. The specialists who can give the most detailed information are pediatric neurosurgeons (brain and spine surgeons) and Spina Bifida clinic staff.Receiving a diagnosis is an important time for families, and each family may have a range of emotions and questions. Some families ask what causes Spina Bifida, and, at this time, no one knows for sure. Doctors and researchers think that most cases are due to a mix of genes and environment that prevent the spine from closing. Research does show that taking folic acid can reduce chances for Spina Bifida. However, Spina Bifida can still occur even when taking folic acid. Once a family has a baby with Spina Bifida, they can meet with specialists to talk about their chances of having another child with this condition. They can discuss what might be done in future pregnancies. For example, people with a family history need an even higher dose of folic acid than found in prenatal vitamins to reduce their chances for Spina Bifida to occur again. There are still many unknowns. What is known is that Spina Bifida is usually not caused by something a parent did or did not do.Surgery before birthNerve function in babies with spina bifida can get worse if it’s not treated. Prenatal surgery for spina bifida, also known as fetal surgery, takes place before the 26th week of pregnancy. Surgeons open the pregnant person’s stomach and then the womb, also known as the uterus. The unborn baby’s spinal cord is repaired. Then the surgeon closes the uterus and stomach. Sometimes this procedure can be done less invasively with a special surgical tool called a fetoscope. Instruments are inserted into the uterus through tiny ports to perform surgery on the unborn baby.Research suggests that children with spina bifida who have fetal surgery may have less disability and be less likely to need crutches or other walking devices. Fetal surgery also may lower the risk of hydrocephalus. Ask your healthcare professional whether this procedure may be right for you. Ask about the potential benefits. Also ask about the risks to you and your baby, such as premature delivery and other complications.It’s important to have a comprehensive evaluation to determine whether fetal surgery can be done. This specialized surgery should only be done at a healthcare facility with experienced fetal surgery experts, a multi-specialty team and neonatal intensive care. Typically, the team includes a fetal surgeon, a pediatric neurosurgeon, a maternal-fetal medicine specialist, a fetal cardiologist and a neonatologist.Cesarean birthMany babies with myelomeningocele tend to be in a feet-first position, known as breech. Cesarean birth may be a safer way to deliver if your baby is breech or has a large cyst or sac.Surgery after birthMyelomeningocele requires surgery to close the opening in the baby’s back within 72 hours of birth. Early surgery can help lower the risk of infection associated with the exposed nerves. It also may help protect the spinal cord from more trauma.During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the baby’s body and covers them with muscle and skin. At the same time, the neurosurgeon may place a shunt in the baby’s brain to control hydrocephalus. Treatment for complicationsIn babies with myelomeningocele, nerve damage that can’t be repaired has likely already occurred in the uterus. Ongoing care from a multi-specialty team of surgeons, physicians and therapists usually is needed. Babies with myelomeningocele may need more surgery for complications. Complications can include weak legs, bladder and bowel issues, or hydrocephalus. Treatment typically begins soon after birth.Treatment options may include:Walking and mobility aids. Some babies may start exercises to prepare their legs for walking with braces or crutches when the babies are older. Some children may need walkers or a wheelchair. Mobility aids, along with regular physical therapy, can help a child become independent. Even children who need a wheelchair can learn to function well and become self-sufficient.Bowel and bladder management. Routine bowel and bladder evaluations and management help reduce the risk of organ damage and illness. Evaluations include X-rays, kidney scans, ultrasounds, blood tests and bladder function studies. These evaluations are more frequent in the first few years of life and are done less often as children grow. A specialist in pediatric urology with experience in performing surgery on children with spina bifida may offer the most effective management options.Surgery for hydrocephalus. Most babies with myelomeningocele need surgery to place a tube that allows fluid in the brain to drain into another part of the body. The tube is called a ventricular shunt. It may be placed just after birth, during the surgery to close the sac on the back. Or it may be placed later as fluid builds up.Children with spina bifida often need treatment and ongoing care from healthcare professionals with expertise in:Physical medicine and rehabilitation.Neurology.Neurosurgery.Urology.Orthopedics.Physical therapy.Occupational therapy.Special education.Social work.Nutrition.Prenatal and Postnatal Treatment:Babies with Spina Bifida need surgery to close the exposed spinal cord and skin. Surgery can be done before or after the baby is born. There are many factors to consider when deciding on the timing of surgery, and there is no right or wrong answer. There are potential risks and benefits for both options.11Postnatal SurgeryWhen a baby is born with Spina Bifida, their back closure needs to be done within a few days of birth. Given the need for early surgery, most babies are delivered in a medical center that specializes in Spina Bifida or are transferred to such centers right after birth. Babies with Spina Bifida often spend some time in the newborn intensive care unit (NICU) to assess and treat health issues.Fetal Surgery:In the past, a baby with open Spina Bifida would almost always undergo surgery soon after birth to close the spinal cord. However, prenatal surgery to close the spine while in the womb is now also an option. This can be offered if the mother and baby are seen by specialists and found to be good candidates for prenatal surgery.Fetal surgery is done during a pregnancy when the baby is still inside the womb. If the parents and the medical team choose this treatment, fetal surgery is most often done before 26 weeks of pregnancy. In addition, it must be done at a medical center that specializes in fetal surgery for Spina Bifida. A specialty medical center can look at your case and let you know if you and your baby qualify for fetal surgery and the details involved.Fetal surgery offers benefits and also poses some risks for baby and a low risk for the mother and future pregnancies. Many babies who undergo surgery in utero will be born preterm and may have complications related to their early birth. Hence, it is not appropriate for everyone. However, an NIH study showed that, more often than not, the surgery lessens the need for hydrocephalus treatment, such as shunts. It can also improve leg strength.14,15Care After Birth:A common treatment for hydrocephalus is the placement of a ventriculo-peritoneal (VP) shunt. A VP shunt is a small tube that drains the excess fluid from the brain (ventricle) to the belly (peritoneum). Once a shunt is placed, providers watch for symptoms to avoid or treat infections and blockages.10Instead of a shunt, the pediatric neurosurgeon may recommend a different procedure known as ETV/CPC (endoscopic third ventriculostomy with choroid plexus cauterization). An ETV is when a small brain scope is used to make an opening, or new pathway, for the brain fluid while the CPC helps decrease the amount of fluid produced. Your baby’s neurosurgeon will discuss each of these options and help you choose the best management for your child.16Most infants with Spina Bifida are monitored in the hospital for a few days to weeks after birth. The infant is then followed by medical and surgical specialists through a Spina Bifida clinic. Infants often have many doctor and therapy appointments in the first year of life, but these tend to lessen as the child ages. The life expectancy and quality of life for those people living with Spina Bifida continues to improve with medical advances.Treating spina bifida 2:Treatments for the symptoms or conditions associated with spina bifida include:surgery soon after birth to close the opening in the spine and treat hydrocephalustherapies to help make day-to-day life easier and improve independence, such as physiotherapy and occupational therapyassistive devices and mobility equipment, such as a wheelchair, or walking aidstreatments for bowel and urinary problemsWith the right treatment and support, many children with spina bifida survive well into adulthood.It can be a challenging condition to live with, but many adults with spina bifida are able to lead independent and fulfilling lives.Preventing spina bifida with folic acid:The best way to prevent spina bifida is to take folic acid supplements before and during pregnancy.Folic acid recommendationsYou should take a 400 microgram folic acid tablet every day while you’re trying to get pregnant and until you’re 12 weeks pregnant.If you did not take folic acid before you conceived, you should start as soon as you find out you’re pregnant.Recommendations for women at higher risk of spina bifida:Women thought to be at higher risk of having a child with spina bifida need to be prescribed a higher (5 milligram) dose of folic acid by a GP.Women at higher risk include those:with a family history of neural tube defects.with a partner with a family history of neural tube defects.who have had a previous pregnancy affected by a neural tube defect.with diabetes.Conclusion:Expectant parents who learn about a prenatal Spina Bifida diagnosis should receive accurate and up-to-date information about Spina Bifida, including real-life experiences, common medical issues, available social services, and expected development. Parents should also receive reliable information about testing, treatment options, and pregnancy management. Together, obstetric medical providers, pediatricians, genetic counselors, neurosurgeons, other health care providers with expertise in Spina Bifida, and Spina Bifida organizations can provide a breadth of information to give patients a well-rounded understanding of Spina Bifida. Discussion TAKE AWAYSWhy is it crucial to remind a student with spina bifida to have scheduled bathroom breaks?What steps can I take to support limited executive functioning in students with spina bifida?What physical adjustments do I need to make in the environment to support the mobility of a student with spina bifida?Why is it important to carefully consider the seating arrangement of a student with spina bifida?How can I adjust my lesson to support a student with spina bifida who is experiencing difficulty with tasks requiring fine motor skills?