Spina bifida in children: what is it, treatment, consequences
Spina bifida is a violation of fetal development at which the split spine (meningocele). In the hole can fall out spinal cord and nerves (myelomeningocele). On the back of the newborn characterized by large skin education only if the pathology does not develop hidden. This clinical picture leads at best to neurological and motor disorders, at worst to severe disability, intellectual disability, paralysis and death.
So as soon as possible to begin to deal with the deformation, the doctors in detail following the development of the fetus. As soon as the baby is born, the surgery, helping to avoid complications. The main preventive recommendation is the intake of folic acid from the moment you started to plan pregnancy until the end of her first trimester.
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What is spina bifida?
Spina bifida is a deformity of the spinal column, in utero developed a crack in the spine.
Doctors think this occurs most often because of a lack of folate during pregnancy. In early pregnancy begins to develop a nervous system, and when spina bifida is some division of the spinal cord stops in development. The disease has several levels of severity. With the help of ultrasound spina bifida is detected during the intrauterine development. Any evidence that there is such a pathology, a pregnant woman usually feels. Doctors may suspect a spina bifida, based on the results of blood tests and noticed the lack of certain substances in the mother's body.
After the birth of a baby with spina bifida, a violation is evident. Treated only by surgery and in these cases the life of the baby can often be saved. Sometimes the deformity is hidden, and then we can see it only for the treatment of dermatological symptoms – fistulas, hair clusters, strong pigmentation.
In the worst cases, the spine is open entirely. Here the most serious symptoms, which in most cases leads to death. Cystic spina bifida in children can manifest in output from the natural position of the spinal cord or its membranes. If the skin in this case does not protect the protrusion, may occur their break, begin sepsis. Children with spina bifida are born in 1-2 cases out of thousands. Quite often after the first child with this pathology in the second there is a similar disease, because there is a genetic moment. Another risk factor become late delivery.
Maybe you searched for: spina bifida in children and adults.
Reasons
The most common cause deformation becomes a lack of folic acid (vitamin B9). It leads to other dangerous disorders of fetal development.
If the fetus has already developed in the womb with such a deformation, increases the likelihood of relapse during new attempts to conceive a healthy child. Almost certainly spina bifida will develop, if this happened twice. In cases where there are relatives, giving birth to children with spina bifida, the likelihood also increases.
Diabetes mellitus in pregnant women increases the likelihood of a lack of folic acid and as a consequence spina bifida. Another risk factor is obesity, before pregnancy or during it. Some medicines usually are contraindicated during pregnancy, can block the flow of folate and interfere with normal nervous system function.
Another cause of spina bifida – a high body temperature of the mother in the first months of intrauterine life of the fetus.
Symptoms
If there is a hidden form of spina bifida symptoms in children may not be obvious. Below the deformed portion of the spinal cord of a child paralyzes, totally or partially. The muscle thus has no connection with the nervous system that can lead to problems with internal organs, especially the intestines. After birth can also be observed dislocation of the joints of the pelvis and hips, clubfoot condition. Curvature of the spine, because of which it is impossible to put the baby on the back. Deteriorates the function of urination, the urea is thrown back, which is severely affecting kidney work.
Complications
Such a pathological process as spina bifida, can cause not only physical disability, butproblems of children in intellectual development. How serious will be the consequences and how comforting is the forecast affected by the size and scope of spinal cord lesions, dermatological disorders. The result is spina bifida in children may develop hydrocephalus of the brain. In such a situation, an urgent need to drain excess moisture from the head to the abdomen. This operation can be performed in the first days of life.
The child does not control defecation and urination, fully or partially not able to control and feel with the feet. In many cases it is necessary to resort to orthopedic devices, crutches, wheelchairs.
Other complications may be:
- Learning disabilities;
- Problematic reading and speech;
- Reduced alertness;
- The inability to count;
- Dermatological diseases;
- Impaired function of the gastrointestinal tract;
- Individual intolerance of latex;
- Inflammation of the urinary system;
- Low emotional background.
Diagnosis
Now the doctors early enough may find that spina bifida develops in children. Help biochemical methods, ultrasound. So there may be preventive measures and research. The roots of the problem is complex, often install them just does not work. But you can make the risk and to understand whether a specific patient. So take some time and planning to have a baby, visit the office of a specialist in genetics. This will help you understand if you need to monitor the level of folic acid in the body.
Each month of pregnancy go to full examination by specialists in gynecology, urology. During the second trimester of pregnancy must blood tests for the level of chemical compounds. If there is pathology of the growth of the spinal cord, it is necessary to consider the possibility to terminate the pregnancy.
If the risk of spina bifida in the fetus are high, the need to tightly control the level of folic acid, more frequent ultrasound to detect defects in development. Can be scheduled for MRI.
If the violations of the development of the spinal cord confirmed, doctors often advised to terminate the pregnancy. But even now medicine is not always all disorders during pregnancy. Sometimes it turns out to only learn about the presence of pathology, but not on the extent to which she was struck by the fruit. So, if the spine in children are just not fully closed, the possibility of successful therapy, the normal life of a child in the future. But if through the opening left by the spinal cord, even surgery will not give a person to develop normally, possibly fatal, at least – severe disabilities. That is why doctors often talk about abortion, if such violation is diagnosed.
The situation is worse for the mother, if she's been trying to get pregnant and do it again will be difficult or impossible. It is in these cases usually use MRI to see how severe the situation is. Then the doctors tell the mother what the consequences and complications are possible if there are children with spina bifida.
Treatment of the newborn
Therapy ideally begins even before the child was born. Even at this stage can be a surgical procedure to repair hernias and other defects of the spine. This operation is carried out rarely, but it does give the nerves to become deformed, retains the ability to develop normally, both physically and mentally. At the moment in the Russian Federation such interventions have not been conducted.
If you were able to detect the violation before the birth, to exclude the natural ancestral process in favor of Cesarean Section. This is necessary to prevent further deformation of the spinal cord and its nerve structures.
In most cases, the surgeons begin to work almost immediately after the baby was born and it turned out that his diagnosis is spina bifida. Doctors eliminate the deformation of the bone tissue of the spine, in order not to disrupt further the work of the nervous system. Revealed herniated section cavity that has gone out of its limits, the nerves are placed back as close as possible to its natural localization. Cut cavity is sutured. It helps to relieve patients from newborns visual protrusions, but those nerves that have already been damaged, it is impossible to rehabilitate.
The priority goal of treatment is to allow the person in the future to move normally. After surgery use prosthetics, physiotherapy, physiotherapy. In many cases, compulsory several operations – for example, if in the first there is an outpouring of cerebrospinal fluid, the fluid of the spinal canal. And later the spinal cord might be like "glued" to the bones, and again will require the work of a surgeon.
If the back is justsplit and the spinal cord came out through the hole, and allow the patient to move normally, to form a whole person. If the spinal cord out through the hole, and damaged a large number of nerves, can be fatal. Or if therapy will be the most successful, the patient will have to live with a large number of incurable complications.
Treatment of older children
Often paralytic symptoms cure becomes impossible. But children with spina bifida and hurts another problem is urological. Need to stabilize urination, artificially taking the urea from the bladder. For this purpose catheters. Approximately nine years the child can already perform this procedure.
Need to provide patients with catheters, urine receivers, special sheets. Sometimes you have to use catheters permanently. The stimulations of the bladder by electricity.
Modern medicine is progressing, and there are more people that have experienced the most severe manifestations of the illness and to live a normal life in society, work and learn. But this pathology in any case requires constant medical supervision, numerous operations.
Prevention
To prevent the development of fetal disorders such as spina bifida, it is necessary first and foremost to ensure the receipt and absorption of a sufficient amount of folic acid. And to take it in prescribed quantities is necessary before conception. Still accepting until the end of the first trimester of pregnancy – it was at this time formed a future spinal cord and its nerve structures.
In the Scandinavian countries, England, Italy and France, at the state level are recommended to take folic acid to prevent the spina bifida children. This substance is issued in Italy on health insurance mandatory.
In the Russian Federation this practice is not yet common. Therefore, to your children were born healthy, eat more fruits and vegetables, whole grains, greens, berries.