Myelomeningocele is a very severe form of spina bifida among fetus. It is a condition where the spinal cord fails, making it a very delicate procedure during surgery of a fetus. This is in the sense that it can impact the nervous system, kidneys, bladder, muscles and bones. The only safe and recommended way of treating myelomeningocele is carrying out a surgery on the fetus after birth (Mitchell, et. al., 2004). During delivery of the fetus, the safest and recommended way of carrying out a cesarean section delivery on a pregnant woman is through open fetal surgery, that involves making a small opening on the uterus, this is then followed by closing the spinal cord of the fetus immediately after birth. The operation should be carried out within 19 to 26 weeks of the pregnancy.
Myelomeningocele is an advanced stage of spina bifida, a spinal cord malformation among fetus that has a varying degree of severity among different fetus diagnosed with the dysfunction. It is a defect of the neural tube where the embryonic development grows on the fetus and results to affect the structure and development of the brain and the spinal cord. This limits the fetus morbidity and may result to bladder and bowel dysfunction as well as mental retardation and orthopedic disabilities (Oakeshott & Hunt, 2003).
The major difference between myelomeningocele and meningocele is the fact that myelomeningocele affects the backbone resulting to swelling wound, whereas meningocele that affects the skull, more so the brain surrounding of the meninges leading to an abnormal opening. In lay man’s language, myelomeningocele is a very common and extremely severe form of the spina bifida, and may result to irreversible defects on an infant. Meningocele on the other hand is a less severe and very rare type of spina bifida whose defects are very rare (Copp, Stanier, & Greene, 2013).
d. This is an abnormal reaction from a parent of a child born with a very visible physical defect.
c. No reaction when pulse oximeter is placed on right foot
e. Pulses 2+ and capillary refill time less than 2 to 3 seconds
g. Bilateral clubfeet
h. Sac in sacral region covered with sterile gauze that is moistened with saline.
6. True
7. Open warmer- To regulate the body temperature of an infant
Place in prone position- For heat trapping
Use appropriate positioning alds such as diaper rolls, pads, pressure- reducing mattress- So as not to apply unnecessary pressure on the infant’s spinal cord
Maintain sterile gauze with normal saline (NS) to sac and monitorq2-4h-
Place peripheral IV with D10 W at 15 mL/hr – to prevent dehydration and hemodynamic
Administer IV antibiotics as ordered – in order to stabilize the WBC that fights foreign harmful bodies
NPO- to withhold fluids and oral foods in the infant
Keep clean padding under diaper area; check frequently – To prevent infections on the infant’s excretion area
Assess for urine output every 2 to 4 hours; if none, assess for retention- To determine bladder volume
Clean intermittent catheterization (CIC) as needed – This happens when the child is unable to empty bladder by themselves.
Measure FOC every shift – For controlling an infant’s eating behavior
PT- The therapy ensures that the parents are kept on check in regards to taking care of the infant and ensure that the child has a regular check- up.
Orthopedic consultation – To ensure that the bones and muscles are functional
Maintain latex free environment – to prevent infections to the infant as he is very sensitive at this stage
8. 1.5 mL
9. I will check for deep breathe and incentive spirometer on the infant. This involves routine check- up of the lungs and the air system. I will therefore ensure that the oxygen in the incubator is increased as well as carry out a neurovascular check. While doing this I will inform the doctor so that the infant can be booked for surgery to seal the suture.
10. I will assure them that the problem has been rectified all they need to do is be tender as holding the baby cannot result to suture opening
11. True. This is in the fact that 5th to 95th percentiles on infants are considered normal.
12. Specialized feeding techniques
Positioning
Skin care and wound care
Appropriate stimulation such as sitting in an infant seat or swing.
ROM exercises as appropriate per PT
Comfort measures and pain control
Signs and symptoms of when to call a physician.
References:
Copp AJ, Stanier P, Greene ND. Neural tube defects: recent advances, unsolved questions, and controversies. Lancet Neurol 2013;12(8):799-810.
Mitchell LE, Adzick NS, Melchionne J, Pasquariello PS, Sutton LN, Whitehead AS. Spina bifida. Lancet. 2004;364:1885–95
Oakeshott P, Hunt GM. Long-term outcome in open spina bifida. Br J Gen Pract. 2003;53:632–6
