L2: NTDs Flashcards
Neural Tube Development
Types of Neural Tube Defects
- Spina Bifida Occulta
- Tethered Cord
- Meningocele
- Myelomeningocele
Incidence of Spina Bifida Occulta
Very mild but Common
Spinal Cord Affection in Spina Bifida Occulta
Very rarely causes disability
How to detect Spina Bifida Occulta?
- x-ray
- investigating a back injury.
Spinal Cord affection in Tethered Cord
The spinal cord could be caught against the vertebrae (Normal cord ends at lower end of L1)
CP of Tethered Cord
- Motor weakness of lower limbs
- Sphincteric problems such as inefficient bladder control.
Incidence of Meningocele
Least common form
Spinal Cord affection in Meningocele
- The nerves are not badly damaged and able to function normally.
- Limited disability is present.
CP of Meningocele
Incidence of Myelomeningocele
Most serious and common
Spinal Cord Affection in Myelomeningocele
- The spinal cord is damaged or not properly developed resulting in motor and sensory deficit.
CP of Myelomeningocele
- The cyst not only contains meninges and CSF but also the nerves and spinal cord.
- Majority have bowel and bladder problems
High Cost of NTDs
Dx of NTDs
- MSAFP
- US
- Amniocentesis
Senseitivity of AFP in detection of NTDs
91% sensitivity in spina bifida
AFP in detection of NTDs
- Normal
AFP in detection of NTDs
- What is Diagnostic Level?
High maternal serum AFP > 2 multiples of median for appropriate week of gestation.
US in detection of NTDs
US in detection of NTDs
- Advantages
- Diffrentiate NTD fron non-neurological causes of elevated AFP e.g. omphalocele
Amniocentesis in detection of NTDs
Amniocentesis in detection of NTDs
- Uses
- Show elevated AFP between 12-15 week earlier than serum AFP
Amniocentesis in detection of NTDs
- Disadvantages
Carries 6% risk of abortion and fetal loss
Amniocentesis in detection of NTDs
- Indications
- Pregnancies subsequent to NTD
- Elevated AFP with Normal US
Factors associated with Increased Risk of NTDs
The only most significant risk factor associated with NTDs is
Folic Acid
Prophylaxis against NTDs
Nursing Care in NTDs
TTT aspects of NTDs
- Nursing Care
- General Assessment
- Neurological Pre-operative Assessment
Nursing Care in NTDs
- Ex & INVx
Like any other neonate with congenital anomalies efforts should be towards careful Ex and INVx to rule out other anomalies.
Nursing Care in NTDs
- Position
Nursed in Trendlenburg position aiming to & pressure & keep it away from cystic lesion.
Nursing Care in NTDs
- Precautions
- Much care not to disturb intact membrane (high incidence of infection & urgent surgery).
- Cover lesion with Gauze ring soaked with normal saline or Ringer solution to prevent dryness
- Avoid antiseptics e.g. betadine as it is Neurotoxic affecting functioning roots in placode
- Avoid mechanical trauma to placode
- No need for ultra frequent dressing
General Assessment in NTDs
General Assessment in NTDs
- Ruptured or not?
- Ruptured lesions start prophylactic antibiotic & Urgent surgery
General Assessment in NTDs
- Site & Site of Defect
For proper planning for closure
General Assessment in NTDs
- Neonatologist
- Other anomalies (average 2-2.5% additional anomalies)
- Condition oppose with surgery e.g. lung immaturity
General Assessment in NTDs
- Bladder
- Start with on regular urinery catheterization
- Urological consultation
General Assessment in NTDs
- Orthopedic
For sever kyphotic or scoliotic deformities and hip, knee and foot deformities
Neurological Pre-Operative Assessment in NTDs
Neurological Pre-Operative Assessment in NTDs
- Spontaneous Movement of LL
Which associated with better outcome.
Neurological Pre-Operative Assessment in NTDs
- Lowest Level of Neurological Function
- Response to painful stimuli
- Differentiate () voluntary movement from reflex movement→ which is stereotyped and not persist after stimulus
Neurological Pre-Operative Assessment in NTDs
- Other Neurological Assossiations
Check Mamdouh Notes
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