Overview Of Birth Defect – Myelomeningocele
Birth defect – myelomeningocele is a type of spina bifida. Spina bifida is a birth defect where the backbone and spinal canal do not fully close. Myelomeningocele is one such type of defect. Cleft spine and neural tube defect (NTD) are other names myelomeningocele.
During the first month of pregnancy, the fetus’ vertebrae fuse together to cover the spinal cord, and meninges (the tissues covering the spinal cord and brain). Myelomeningocele is a defect in which the vertebrae do not completely form, resulting in an incomplete spinal canal and protrusion of the spinal cord and meninges from the child’s back.
Causes Of Birth Defect – Myelomeningocele
As yet, the cause of myelomeningocele is unknown. However, one culprit is low levels of folic acid in the mother’s body before and during early pregnancy. Folate, or folic acid, is important for the development of the brain and spinal cord.
While many cases have no hereditary or familial connection, future babies born into a family with a spina bifida sibling have a higher risk of also having the condition. This is likely due to the same conditions that influenced the first child, such as diabetes, low folic acid, the use of anti-seizure medicines, and obesity in the mother.
Myelomeningocele affects roughly 1 in 4,000 infants.
Other ‘common’ types of spina bifida include:
- Meningoceles – the spinal cord remains in place, though the meninges protrude from the spinal defect.
- Spina bifida occulta – the spinal cord and meninges remain in place, and skin usually covers the defect.
Other disorders may also be present, such as:
- Syringomyelia (a fluid-filled cyst within the spinal cord)
- Hip dislocation
- Abnormal feet or legs, such as clubfoot
- A buildup of fluid inside the skull (hydrocephalus)
A infant with this type of birth defect will have an open area or a fluid-filled sac along the mid to lower back.
Symptoms may include:
- Weakness of the lower body
- Partial or complete lack of sensation in the lower body
- Partial or complete paralysis of the lower body
- Incontinence, or loss of bladder and bowel control
Exams & Tests
Prenatal screening helps detect this condition in utero. A blood test, the quadruple screen, is done to test for myelomeningocele, Down syndrome, and other congenital diseases in the fetus. Women carrying a baby with spina bifida will have an increased level of maternal alpha fetoprotein (AFP).
Following a positive quadruple screen additional testing, such as a pregnancy ultrasound, or an amniocentesis, may be .
Myelomeningocele is rather obvious once the child is born. A neurologic examination can reveal if the infant has any loss of nerve-related functions below the defect. For example, watching how the baby responds to pinpricks can indicate where the baby can feel sensation. Tests will be done after birth, such as x-rays, and CAT or MRI imaging of the spine.
Treatment Of Birth Defect – Myelomeningocele
Surgeons operate within days of birth. This is to repair, or finish repairing, the defect. In some cases, intrauterine surgery can begin repairing the myelomeningocele. This can reduce risk of later complications. In addition, children with hydrocephaly may also need a ventriculo-peritoneal shunt placed. This is to drain extra fluid from the brain to the peritoneal cavity in the abdomen.
Carers take special precautions with handling, feeding, and bathing the newborn. Doctors prescribe antibiotics to treat or prevent infections, such as meningitis or urinary tract infections.
Children with spina bifida defects will need lifelong treatment due to problems resulting from damage to the spinal cord and spinal nerves. Treatments include:
- Orthopedic or physical therapy to help musculoskeletal symptoms. Many people with myelomeningocele use a wheelchair. A brace is all that is necessary for some individuals.
- Gentle massage or downward pressure over the bladder to help drain it. A catheter can also help.
- Bowel training programs and a high fiber diet to improve bowel function.
These children will also need life-long evaluation. This allows for early treatment for any issues arising from the myelomeningocele, such as developmental, physical, intellectual, or neurologic problems. Parents need support too. In-home health care, support groups, social services, and other local agencies can provide emotional and mental support, and assist with the care of a child with myelomeningocele who has significant problems or limitations.