Neural Tube Defects

Question 1

Is used to describe many distinctly malformations of the neural tube

Answer 1

Neural Tube Defect

Question 2

It is the developing brain & spine od the fetus at 3-4 weeks of gestation

Answer 2

Neural Tube

Question 2

Why is the neural tube susceptible to malformations?

Answer 2

Because NT forms in utero firet as a flat plate and then molds to form the brain & spinal cord.

Question 3

It is the process in which the neural plate bends up and later fuses to form the holloe tube that will eventually differentiate into the brain & the spinal cord of the CNS.

Answer 3

Neurulation

Question 4

Risk Factors of NTDs

Answer 4

• Folic acid deficiency
• Family hx of NTDs
• Maternal age under 20 or over 40
• Maternal educaction
• Low socioeconomic status
• Maternal diabetes
• Maternal obesity
• Certain drugs such as valproic acid - used to treat seizure disorders

Question 5

Two most common NTDs

Answer 5

1. Anencephaly - brain defect
2. Spina Bifida - spinal cord efect

Question 6

When does neural folds fuses?

Answer 6

Around Day 21-28 (3-4 weeks of gestation)

Question 7

Order or sequence of fusion of neural folds

Answer 7

1. Begins midline
2. Cranial
3. Going downward to caudal

Question 8

Two possible outcomes of neural fusion

Answer 8

1. Complete fusion of neural tube
2. Unfused neural tube segment (incomplete)

Question 9

Is the most severe type of NTD in which both the brain and spinal cord remain open

Answer 9

Cranioachischisis

Question 10

Is a condition in which major portions of the brain, skull, and scalp are absent or failed to develop

Answer 10

Anencephaly

Question 11

How is Anencephaly diagnosed?

Answer 11

• Amniocentesis
• Prenatal UTZ
• Elevated MAFP (Maternal Alfa-fetoprotein)

Question 12

Outcomes of anencephaly

Answer 12

An infant with this condition may die in utero or may survive for several days after birth but cannot survive further because they have little or no cerebral function

Question 13

Treatment or cure for anencephaly

Answer 13

No known treatment or cure and no surgical management available

Question 14

What happens if the condition is discovered prenatally?

Answer 14

Parents are offered the option of pregnancy termination

Question 15

Degrees of Spinal Cord Abnormalities

Answer 15

1. Spina Bifida Occulta
2. Meningocele
3. Meningomyelocele

Question 16

It is the mildest form of all NTDs
- a malformation caused by the non-closure or incomplete closure of the posterior portion of the vertebrae

Answer 16

Spina bifida occulta

Question 17

Assessment findings for spina bifida occulta

Answer 17

• May be first noticed as dimpling on the skin at the point of incomplete fusion
• Abnormal tufts of hair or discolored skin may also be present

Question 18

How do nurses help in clarifying the degree of spina bifida occulta to parents?

Answer 18

Explain that this degree simply means a surface of bone is missing and the spinal cord is intact

Question 20

Why do children with spina bifida occulta need no surgical correction?

Answer 20

No tissue protruding from the vertebrae

Question 21

Surgery in children with spina bifida occulta is done in order to?

Answer 21

Prevent vertebral detorioration because of the unbalanced spina column

Question 22

Three layers of meninges

Answer 22

1. Pia mater
2. Arachnoid
3. Dura mater

Question 23

Meninges herniate through an incompletely closed or unformed vertebrae, they will protude as a circular mass called…?

Answer 23

Meningocele

Question 24

Meningocele is accompanied by no sensory or motor deficit unless?

Answer 24

Membrane sac ruptures

Question 25

Why is immediate surgery necessary for meningocele?

Answer 25

To replace the meninges & to close the gap in the skin to prevent infection

Question 26

When is surgery done for meningocele?

Answer 26

**24-48 hours after** birth to prevent infection & trauma to the exposed tissue

Question 27

**Most severe** form of spina bifida - Meninges protrude through the vertebrae & the spinal cord usually ends at the point of protrusion

Answer 27

Meningomyolocele

Question 28

What happens to the nerves function?

Answer 28

Motor & sensory function will be decreased or absent beyond the point of protrusion

Question 29

Why is talipes (club feet) a complication of meningomyelocele

Answer 29

Due to lack of innervation to the feet/ankles

Question 29

Complications associated with meningomyelocele

Answer 29

- Loss of bowel & bladder control - Permanent weakness or paralysis of legs - **Talipes** (club feet) - **Hydrocephalus**

Question 30

Why is hydrocephalus a complication of meningomyelocele?

Answer 30

Due to obstruction of CSF circulation from the spinal deformity - Higher the meningomyelocele occurs on the cord, the more likely it is that hydrocephalus will be present.

Question 31

Therapeutic management for mingomyelocele

Answer 31

- Immediate surgery - **Simultaneous VP shunting** during a primary meningmyelocele repair

Question 32

VP shunting may not be necessary if meningomyelocele repair is done in?

Answer 32

Utero

Question 33

After surgery, the child will continue to have partial or complete paralysis of the lower extremities & loss of bowel & bladder function. why is that?

Answer 33

Lesions on the back can be reparied but the **absence of a lower cord cannot be replaced**

Question 34

How are NTDs diagnosed?

Answer 34

- Prenatal UTZ - Fetoscopy - Screening amniotic fluid for alpha-fetoprotein - analysis of maternal alpha-fetoprotein

Question 35

How can a lesion be closed if the condition is discovered in utero?

Answer 35

Thru **fetoscopic surgery**

Question 36

Why is an infant with NTD can be born via C-section?

Answer 36

To avoid pressure & injury to the spinal cord.

Question 37

Surgical closure of open lesion in an infant with myelomeningocele is usually recommended in the?

Answer 37

First **24 hours** to reduce the incidence of infection & trauma to the exposed tissues

Question 38

Plan of care after deliver of the baby with myelomeningocele is focused on?

Answer 38

Potential for infection

Question 39

What is the baby's position prior to surgery for a myelomeningocele?

Answer 39

Prone position

Question 40

Why is the baby placed in prone position prior to surgery for a myelomeningocele?

Answer 40

To minimize pressure on the sac & reduces potential trauma to the area.

Question 41

Why is maintaing skin integrity necessary in caring for an infant with myelomeningocele?

Answer 41

Because skin problems can develop due to limited movement, muscle weakness, poor sensation, bowel & bladder incontinence