Spina bifida in a newborn child: symptoms, treatment

Causes of spina bifida in newborns

Why manifestations of spina bifida may occur in newborns has not been well studied. Therefore, we can only name the factors that can influence the development of pathology, based on the opinion of leading professors of medical sciences. Risk factors include:

• Lack of sufficient amounts of folic acid, also known as vitamin B9, and other vitamins in a pregnant woman's body is now recognized as the main cause of spina bifida in infants;
• intoxication of the body of a pregnant woman;
• early pregnancy;
• hereditary factor.

The formation of the neural tube occurs before the eighth week of gestation, and it is at this time that one or more of the listed factors can trigger the occurrence of pathology. As a result of this phenomenon, one or more vertebral bodies are separated in the region of the spinous process. The membranes of the spinal cord, fluid and even nerve endings can exit into such a gap.

Prevention of spina bifida

Since spina bifida is a congenital developmental anomaly, the prevention of this disease is the elimination of its causes even before conception. The primary measure is to provide the unborn child with all the necessary microelements and vitamins. Even if the pregnancy is unplanned, the use of medications and appropriate foods can be started after conception - the sooner the better. In the specific case of preventing spinal cord herniation, the emphasis is on vitamin B9 (folic acid). It is interesting that this substance can enter the fetus’s body not only from the mother, but also from the future father, since it is transmitted through the seminal fluid, having a significant effect.

Any expectant mother should contact a gynecologist and consult about diseases that develop during the fetal development stage. The doctor should talk about ways to ensure a favorable pregnancy. To begin, stop taking most pharmaceutical drugs for at least the first eight weeks while the neural tube forms in the embryo. Also, don’t get carried away with cosmetics; the same goes for any household chemicals.

Author of the article:

Volkov Dmitry Sergeevich |
Ph.D. surgeon, phlebologist Education: Moscow State Medical and Dental University (1996). In 2003, he received a diploma from the educational and scientific medical center for the administration of the President of the Russian Federation. Our authors

Forms of spina bifida in newborns

Spina bifida in a child can be divided according to location and structural features. Where the protrusion is located is very important, since further treatment, the complexity of the symptoms and its elimination will depend on this factor. The mildest type is hidden cleft, when one vertebra is slightly deformed, which will not cause severe discomfort to the child. If the defect is more serious, a hernial split occurs, when a clearly noticeable protrusion is revealed, which is visible under the skin. In severe cases, the spinal cord itself emerges into this protrusion. If we talk about where the spina bifida is located in a child, we can highlight:

• cervical - the rarest, concerns the upper parts of the spinal cord, innervation can occur in the neck and face, accordingly, coordination is impaired, and malfunctions in the functioning of the lungs and heart also occur;
• thoracic - occurs more often in the cervical, but much less frequently in the lumbar, and the pathology can affect the functioning of the arms and legs, lungs, heart, stomach, spleen, liver, etc.;
• lumbosacral – occurs most often, affects the functioning of the pelvic organs, kidneys and lower extremities.

Whatever the protrusion, the severity of the condition will be determined depending on its size.

Spina bifida at GMS Clinic

The Center for Congenital Pathology at the GMS Clinic has been observing children with spina bifida for many years.
Previously, these were consultations and consultations with specialists. In 2021, a special program for the management of such children was developed: a team of doctors from different specialties was selected who examined the child in the best possible way and together made decisions on further tactics for his treatment and observation. This program is supervised by GMS Clinic pediatrician Emilia Gavrilova. In this material, she talks about the essence of the disease: where certain of its manifestations come from, how they are related to each other, what possible complications are possible, what tests need to be done and what symptoms should alert you.

Symptoms of spina bifida in newborns

Photos of spina bifida in newborns are often found on the Internet, and almost every pregnant woman fears this pathology. To determine if your newborn has this condition, look for symptoms of a hernia. These include:

• paralysis of the limbs, nutritional disorders, paresis;
• malfunction of the pelvic organs, bowel incontinence;
• disruptions in the functioning of the heart, lungs, gastrointestinal tract and endocrine system.

All these symptoms may be accompanied by secondary complications, which include muscle atrophy, swelling, trophic ulcers and lack of skin thermoregulation, etc.

Cystic hygroma of the neck

Hygroma on the fetal neck (lymphangioma) is a benign tumor that is formed as a result of disruption of the formation of the lymph system in the area of ​​the cervical vertebrae during embryonic development. If the lymph flow is disrupted at the junction of the jugular sac with the jugular vein, a cyst or several cysts filled with fibroserous fluid are formed. The tumor is localized near the cervical vertebrae, affecting the development of the fetus.

Pathology on ultrasound can be seen already at the 1st screening for a period of 11-12 weeks. The main indicator will be an increase in the thickness of the collar space. Neck hygroma in the fetus occurs both as a result of chromosomal abnormalities and under the influence of external causes - mechanical intrauterine trauma, smoking and alcohol consumption by the mother, infections suffered during pregnancy.

At the 2nd screening, the hygroma is visualized as an asymmetric neoplasm with a dense shell, sometimes with septa inside, located in the projection of the cervical spine. The tumor itself does not pose a threat to the life of the fetus.

In the early stages, a chorionic villus biopsy is performed to identify chromosomal abnormalities. If they are confirmed, the woman will be offered to terminate the pregnancy. In the absence of genetic abnormalities, doctors take a wait-and-see approach. very often, by 18-20 weeks of pregnancy, the hygroma resolves on its own.

If this does not happen, then after birth the baby is likely to have the following abnormalities:

• paresis of the facial nerve - immobilization of the facial muscles due to prolonged compression of the nerve fiber by the hygroma;
• spinal deformity (the most common is torticollis - curvature of the cervical spine due to an inflammatory process in the neck muscles due to overexertion of the constant pressure of the tumor);
• deformation of the occipital bone and jaw;
• swallowing dysfunction;
• obstruction of the respiratory tract (obstruction of the respiratory canal due to blockage of the trachea by hygroma).

Hygroma is treated conservatively after the birth of the child. If the cause of the pathology is not chromosomal abnormalities, the prognosis for the baby is favorable.

Diagnostics

To determine the presence of the disease, the doctor collects the history of the small patient and also conducts a full examination. If there were no abnormalities during pregnancy, the doctor

will determine the child’s health status taking into account his age. He will check how well the muscles are developed, whether there is weakness, difficulty in muscle activity, etc. In addition, to determine the presence of the disease and the consequences of spina bifida in newborns, you will need:

1. Visit a neurologist
   .
2. Conduct a light scan called transillumination, which will identify the obstructed protrusion.
3. Myelography with contrast - allows you to determine damage to the spinal cord.
4. MRI or CT.
5. Visit a neurosurgeon who will determine the need for surgical intervention and give a prognosis.

Timely detection of the disease will increase the chances of successfully curing the baby from the disease.

Intestinal dysfunction

Due to a violation of the innervation of the intestine, its peristalsis is insufficient, a person does not feel the urge to defecate, and the anal sphincter does not close feces well. This leads to the development of persistent constipation, often in combination with incontinence: that is, liquid or, conversely, solid feces are released uncontrollably, but not all. The examination is usually limited to only an ultrasound of the abdominal organs. If there is a suspicion of some disease not related to spina bifida, additional studies may be prescribed and a consultation with a gastroenterologist will be required.

A pediatrician deals with intestinal problems: he can prescribe medication, perform enemas, adjust nutrition, and tell you how to make incontinence less noticeable to others.

Treatment

The disease usually needs to be treated with surgery. It can be performed both before and after birth.

Perinatal surgery

It can be prescribed at 19-26 weeks of pregnancy and is considered the most effective method of ridding a child of a hernia. The operation will close the anatomical abnormality in the spinal column, as a result of which the spinal cord returns to its place and is protected from influences. Among the reasons for the appearance of spina bifida in newborns in this case there may be a natural birth, so after the operation the woman will be delivered by cesarean section. This method allows you to ensure the most normal life for your child. Among the disadvantages of the method is that such operations, like operations on premature babies, are performed only abroad. There are currently only a few specialists capable of performing such an operation in Russia.

Postpartum surgery

This type of treatment is possible in the first few days after birth, after which it makes no sense. Surgery will remove the growth, but there will be significant developmental problems and additional surgery may be required. Life expectancy is affected not only by the type of hernia, but also by the presence of hydrocephalus.

Postoperative therapy

To undergo such an operation, any baby will require a long rehabilitation period. A newborn needs careful care, maintaining impeccable hygiene, therapeutic massages, physiotherapy, gymnastics and prevention of constipation. The list of conservative measures also includes the prevention of bedsores, training of the sphincters of the bladder and anus, treatment of spinal deformities and correction with support corsets.

Typically, recovery from spina bifida occurs in one of two ways:

• After removal of the meningocele and all required rehabilitation procedures, the child’s development continues normally. In most cases, such children grow up capable of leading an active lifestyle.
• Repairing hernia meningomyelocele, meningoradiculocele and meningocystocele can cause certain difficulties, both during and after surgery. Proper compliance with the requirements of the rehabilitation period helps to avoid disturbances in the motor activity of the limbs, but one cannot expect the same from the functions of the pelvic organs. Urinary and fecal incontinence may persist much longer than in normal children. In adulthood, even with the preservation of external signs of health, infertility is found in women, and erectile dysfunction in men.

Read more: Erectile dysfunction in men

Leg and back problems

Violation of the innervation of the legs leads to their weakness. Its degree can vary: some children walk even without support, others only in orthoses or devices, with walkers or crutches, and still others move in wheelchairs because they cannot lean on their legs at all.

Children with spina bifida often have deformed feet and dislocations in the hip joints.

Dislocation of the left hip joint: the head of the femur is not in the socket, but above.
The spine may be curved. Due to the fact that the joints are not fully used, and the muscles of some groups are weaker than others, contractures often form (when movement in the joints is limited): for example, a child is not able to straighten his knees. All these manifestations can further interfere with walking and maintaining balance. Due to sensory impairment, people with spina bifida are prone to developing long-healing pressure sores—pressure ulcers. Therefore, it is very important to carefully monitor the condition of the skin, the quality of shoes and orthoses.

An orthopedist deals with problems of bones and joints, as well as bedsores. To clarify the nature and severity of manifestations, he may recommend conducting studies: x-rays of the hip joints, feet, knees, spine and others. Even in the presence of severe orthopedic problems, operations are not always indicated. An orthopedist is often faced with a difficult task: to determine whether operations will be more beneficial or harmful (and the harm can be significant, because due to impaired innervation, bones and sutures take a long time to heal), at what age they are best performed and in what order.

In order to teach a child maximum independence and independence, a rehabilitation specialist must work with him. The selection of special means to help move is carried out by an orthotist.

Other manifestations of spina bifida

As mentioned earlier, with spina bifida it is not at all necessary, but the intrauterine anlage of not only the spine, but also the skull may be disrupted - then there will initially be less space in it than necessary. If the child develops hydrocephalus, the situation gets worse. Compression of the brain may become significant. At the same time, the range of possible manifestations is very wide - they depend on which parts of the brain suffer more from compression: one child will have strabismus, another will have a hoarse voice, etc. But this is an uncommon situation. In controversial cases, in addition to the neurologist, the child is consulted by an ophthalmologist, an ENT doctor and other specialists.

The intelligence of children with spina bifida is rarely affected. Usually, the most that parents encounter is reduced attention and memory in the child. Only a small percentage of children study not in a regular school, but according to a special curriculum.

There is one more potential problem worth mentioning. Children with spina bifida usually gain less weight in the first months and years of life, so relatives are inclined to overfeed them. But subsequently, due to decreased physical activity, excess weight gain begins. Excess weight is also harmful for children without spina bifida. And in children with altered hip joints and a curved spine, it contributes to the progression of disorders. In addition, if a child weighs a lot, it is harder for him to move.

Fractures

People with spina bifida are more likely than others to have fractures. Firstly, because they move less - for this reason, their bone density decreases (osteoporosis develops). And secondly, due to the fact that they go outside less often and are exposed to the sun, which is necessary for the formation of vitamin D in the body.

Therefore, periodically, people with spina bifida need to determine the level of 25-OH vitamin D in the blood and undergo densitometry - determination of bone density. The evaluation criteria of conventional densitometry for spina bifida are not suitable. Because if you do densitometry of the lumbar spine, the result will be underestimated due to clefts in the vertebrae. And if you do densitometry of the whole body, the result may be overestimated by contractures or metal elements in the body (if any) or underestimated by skeletal defects. So densitometry should be carried out in a place where they are familiar with the characteristics of people with spina bifida. Based on the results of the examination, the pediatrician decides on the required dose of vitamin D and may recommend a drip with a drug that increases bone density.