Spina bifida- Treatment and caring for your child after surgical repairSSpina bifida- Treatment and caring for your child after surgical repairSpina bifida: Treatment and caring for your child after surgical repairEnglishNeurologyNewborn (0-28 days)SpineSpinal CordProceduresCaregivers Adult (19+)NA2017-11-07T05:00:00ZPatricia Rowe, RN(EC), MN, NP-Pediatrics;Sara Breitbart, RN(EC), MN, NP-Pediatrics;Peter Dirks, MD, PhD, FRCSC;James Drake, BSE, MB, BCh, MSc, FRCSC8.9000000000000059.80000000000001845.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how your baby's spina bifida is repaired with surgery either before or after they are born. Also learn what happens after surgery and how to take care of your baby at home.</p><h2>What is spina bifida?</h2><p>Spina bifida means that the bones that protect the spinal cord have not formed completely while a baby is developing in the mother’s womb. This happens very early in pregnancy.</p><p>Spina bifida can happen anywhere along a baby’s back between the head and the hips. It happens most often in the lower back. This area is called the lumbar or lumbosacral spine.</p><p>Children with spina bifida may have health problems because of this condition. They may experience changes or loss of feeling in their legs, have decreased movement of their legs or not be able to move their legs at all. They may also have problems with their bladder and bowel function.</p><p>About 2.6 in every 10,000 babies are born with some form of spina bifida.</p><p>There are four common types of spina bifida: Myelomeningocele, meningocele, lipomyelomeningocele and spina bifida occulta.</p><p>Babies with myelomeningocele or meningocele are both treated with surgery. Older infants and young children with lipomyelomeningocele may require surgery if they develop symptoms. Spina bifida occulta does not usually require treatment. </p><p>To learn more about the different types of spina bifida, how it is diagnosed and the complications associated with it please read: <a href="/Article?contentid=848&language=English">Spina bifida</a>.</p><h2>Key points</h2><ul><li>Spina bifida means that the bones that protect the spinal cord have not formed completely. </li><li>In babies with spina bifida, the CSF, the nerves and the lining of the spinal cord often bulge out through a defect in the baby’s back. </li><li>Two types of spina bifida, meningocele and myelomeningocele, are usually repaired with surgery</li><li>Surgery will be done either before your baby is born, before the 26 week of pregnancy, or within two to three days after they are born. </li></ul><h2>Complication after surgery</h2><h3>Incision healing</h3><p>After surgery the incision is monitored closely for signs of the wound reopening or any leakage of CSF. Depending on the size of your baby and the size of the defect, closure of the opening may have been difficult. The incision is fragile and there could possibly be issues with healing. The incision will need to be watched closely and may need some additional care such as special dressings. </p><h3>Infection</h3><p>Infection is possible with any surgery. Because your baby’s CSF and spinal cord is involved your baby will be closely monitored for any signs of infection. If infection is suspected the team will explain to you what treatment your baby will need. </p><h3>Hydrocephalus</h3><p>After their back surgery to close the defect, babies with spina bifida often have extra CSF around their brain and spinal cord. This is called <a href="/Article?contentid=858&language=English">hydrocephalus</a>. About 80 percent of baby’s with spina bifida, primarily those with myelomeningoceles, develop hydrocephalus. Hydrocephalus is treated with an operation that puts a tube called a shunt into the ventricles of the brain. This tube helps to drain CSF from your baby's head into an area where the CSF is better absorbed, such as the lining of the abdomen (tummy). </p><p>To watch for hydrocephalus your baby's head circumference will be measured often and they will also have ultrasound imaging done of their brain. </p><h3>Chiari Malformation</h3><p>Some babies will have issues because they have a <a href="/Article?contentid=853&language=English">Chiari malformation</a>. They may have feeding difficulties, breathing troubles and some weakness of their arms. Some babies may require other health-care team members to assist with these issues. For example, they may require an occupational therapist to help with position or type of nipple for feeding, or a respiratory doctor because they need oxygen support. Some babies may require surgery to decrease the pressure on the lower part of the brain caused by the Chiari malformation. </p><h2>When to see a doctor</h2><p>If you see any signs of infection or any leakage of fluid from the incision then your baby needs to be assessed and should be brought to a local emergency department. Please be sure to notify your neurosurgical team of any concerns. </p><p>If your baby has <a href="/Article?contentid=858&language=English">hydrocephalus</a> and/or a <a href="/Article?contentid=853&language=English">Chiari malformation</a> type 2 please refer to those pages for when to seek medical attention. </p><h2>Meningocele and myelomeningocele are usually repaired with surgery</h2><h3>Surgery before your baby is born</h3><p>Sometimes when a baby is diagnosed with spina bifida, specifically with myelomeningocele, surgery may be possible before the 26 week of pregnancy. This is done by opening the mother’s uterus and repairing the baby’s spinal cord defect while they are still in the womb. There are some studies that suggest this type of surgery stops damage to the spinal cord from getting any worse and decreases the possibility of needing treatment for hydrocephalus. Your neurosurgeon and obstetrician will tell you if this is an option for you and your baby.</p><h3>Surgery after your baby is born</h3><p>If your baby has been diagnosed with spina bifida during pregnancy, you may need to deliver at a high-risk pregnancy centre. Your obstetrician will tell you if this is needed. After delivery, the sac cannot stay outside of the body for a long time. It may tear or get infected, or it may already be ruptured exposing its delicate contents. Your baby will have surgery to repair the sac within two or three days of birth. A neurosurgeon will do the operation. A neurosurgeon is a doctor who operates on the brain and spinal cord. </p><p>Your baby may need an MRI before their operation to help the surgeons to better see the spinal cord. An MRI is a scan that takes special pictures of the inside of the body. An MRI scan requires a person to be still while the pictures are being taken. Some children may need medicine to help them keep still during the tests. </p><p>The purpose of the operation is to: </p><ul><li>close the skin over the sac</li><li>prevent infection and further damage to the spinal cord</li></ul><p>If your baby’s legs and feet are paralyzed or have decreased movement, the operation will not return movement and feeling to the baby’s legs and feet. </p><h2>What happens after the surgery?</h2><p>The surgery takes about four hours. After the operation, your baby will spend three to four hours in the Post Anaesthetic Care Unit (PACU) to recover from the anaesthetic (sleep medicine). Then your baby may go back to the neurosurgical unit, or they may be monitored in the NICU (neonatal intensive care unit). </p><p>Your child will have a bandage on their back for a number of days, depending on how the incision is healing. The nurse will check the bandage often. The nurse will also check your child’s temperature, heart rate, blood pressure, breathing, leg movements and level of pain. </p><p>Your child will also have a thin tube in their arm. This is called an intravenous (IV) tube. It lets your child receive fluids and medicines directly into their bloodstream. Your child will have this IV in place until they are feeding well and no longer requiring medication through it. </p><p>For the first three to five days after surgery, your child needs to lie flat in bed usually on their stomach. This is to prevent fluid around the spinal cord from leaking out through the incision. Do not get your baby up until you are given the go ahead. The team can assist you with holding and cuddling your baby for feeding and providing comfort. Once the incision is healed your baby will be able to be positioned normally. </p><p>Your baby may feel pain at the site of their operation. They will receive medicine to control the pain. If it does not control the pain, speak to your child’s nurse or a member of their health-care team. </p><p>When your baby is stable and alert after their surgery they will be able to feed. The team will be able to help support you with breastfeeding if that is your feeding method of choice. </p><p>To ensure that your baby empties their bladder, a catheter will be put into their bladder through their urethra every few hours. How often this happens may be decreased over time depending on your baby’s ability to pee on their own. </p><p>Babies with spina bifida that require surgery nearly always have a Chiari Malformation type 2. Because of this, they will be monitored for any issues with feeding or breathing. </p><h2>At SickKids</h2><p>The Neurosurgery clinic is located on 6D in the Atrium or you can call them at 416-813-5222.</p><h2>Resources</h2><p>There are many resources available to help you and your baby cope with spina bifida. </p><p>Spina Bifida and Hydrocephalus Association of Ontario<br> <a href="http://www.sbhao.on.ca/" target="_blank">http://www.sbhao.on.ca/</a></p><p>Holland Bloorview Kids Rehabilitation Hospital<br> <a href="http://www.hollandbloorview.ca/" target="_blank">http://www.hollandbloorview.ca/</a></p><p>Public Health Agency of Canada. (2013). <em>Congenital Anomalies In Canada 2013: A Perinatal Health Surveillance Report</em>. Retrieved from <a href="http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf">http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf</a>.</p>
Spina-bifida : traitement et soin de votre enfant après une intervention chirurgicaleSSpina-bifida : traitement et soin de votre enfant après une intervention chirurgicaleSpina bifida: Treatment and caring for your child after surgical repairFrenchNeurologyNewborn (0-28 days)SpineSpinal CordProceduresAdult (19+) CaregiversNA2017-11-07T05:00:00ZPatricia Rowe, RN(EC), MN, NP-Pediatrics;Sara Breitbart, RN(EC), MN, NP-Pediatrics;Peter Dirks, MD, PhD, FRCSC;James Drake, BSE, MB, BCh, MSc, FRCSCHealth (A-Z) - ProcedureHealth A-Z<p>Apprenez comment le spina bifida de votre bébé est corrigé par une chirurgie avant ou après sa naissance. Apprenez aussi ce qui se passe après la chirurgie et comment prendre soin de votre bébé à la maison.</p><h2>Qu’est-ce que le spina bifida?</h2><p>Le spina-bifida désigne un trouble dans lequel les os qui protègent la moelle épinière du fœtus ne se forment pas complètement aux premiers stades dela grossesse.</p><p>Le spina bifida peut affecter n’importe quel endroit le long du dos d’un bébé, entre la tête et les hanches, mais le plus souvent, c’est le bas du dos qui est atteint, la région appelée colonne vertébrale lombaire ou lombo-sacrée.</p><p>Les enfants atteints de spina-bifida peuvent présenter des problèmes de santé. Ils peuvent éprouver des changements ou une perte de sensation dans leurs jambes, avoir une diminution des mouvements de leurs jambes ou ne pas être en mesure de bouger leurs jambes du tout. Ils peuvent également avoir des problèmes avec leurs fonctions vésicale et intestinale.</p><p>Environ 2,6 bébés sur 10 000 naissent avec une forme de spina-bifida.</p><p>Il existe quatre principaux types de spina-bifida : le myéloméningocèle, le méningocèle, le lipomyéloméningocèle et le spina-bifida occulta.</p><p>Les bébés atteints de myéloméningocèle ou de méningocèle sont traités par chirurgie. Les nourrissons plus âgés et les jeunes enfants atteints de lipomyéloméningocèle peuvent nécessiter une intervention chirurgicale s’ils développent des symptômes. Le spina-bifida occulta ne nécessite généralement pas de traitement.</p><p>Pour en savoir plus sur les différents types de spina-bifida, comment il est diagnostiqué et les complications qui y sont liées, nous vous invitons à lire : <a href="/Article?contentid=848&language=French">Spina-bifida</a>.</p><h2>À retenir</h2><ul><li>Le spina-bifida signifie que les os ayant pour fonction de protéger la moelle épinière ne sont pas complètement formés.</li><li>Chez les bébés atteints de spina-bifida, le LCR, les nerfs et la membrane qui enveloppe la moelle épinière forment souvent une protubérance qui fait saillie dans le dos du bébé.</li><li>Deux types de spina-bifida, méningocèle et myéloméningocèle, sont habituellement corrigés au moyen de la chirurgie.</li><li>La chirurgie peut être effectuée avant la naissance de votre bébé, avant la26e semainede grossesse ou dans les deux à trois jours qui suivent sa naissance.</li></ul><h2>Complications après la chirurgie</h2><h3>Cicatrisation de l’incision</h3><p>Après la chirurgie, l’incision est étroitement surveillée pour les signes de réouverture de la plaie ou de fuite de LCR. Selon la taille de votre bébé et celle de la malformation, la cicatrisation peut se révéler lente. L’incision est fragile et il pourrait y avoir des obstacles à la guérison. L’incision devra être surveillée de près et nécessitera des soins supplémentaires tels que des pansements spéciaux.</p><h3>Infection</h3><p>L’infection est possible avec n’importe quelle chirurgie. Comme le LCR et la moelle épinière de votre bébé sont en cause, votre bébé sera surveillé pour déceler tout signe d’infection à ces endroits. Si une infection est suspectée, l’équipe vous expliquera le traitement dont votre bébé aura besoin.</p><h3>Hydrocéphalie</h3><p>À la suite d’une chirurgie pour corriger leur problème, les bébés atteints de spina-bifida présentent souvent trop de LCR autour du cerveau et de la moelle épinière. C’est ce qu’on appelle l’<a href="/Article?contentid=858&language=French">hydrocéphalie</a>. Environ 80 % des bébés atteints de spina-bifida, principalement ceux atteints de myéloméningocèles, développent une hydrocéphalie. L’hydrocéphalie est traitée avec une opération par laquelle un tube appelé « dérivation » est inséré dans le cerveau. Ce tube permet d’évacuer le LCR de la tête de votre bébé dans une zone où le LCR est mieux absorbé, comme la paroi de l’abdomen (ventre).</p><p>Pour surveiller l’hydrocéphalie, la circonférence de la tête de votre bébé sera mesurée régulièrement et une imagerie par ultrasons sera également effectuée sur son cerveau.</p><h3>Malformation de Chiari</h3><p>Certains problèmes sont prévisibles chez les bébés souffrant d’une <a href="/Article?contentid=853&language=French">malformation de Chiari</a>. Ils peuvent, par exemple, avoir de la difficulté à se nourrir, présenter des troubles respiratoires et une certaine faiblesse des bras. Certains bébés peuvent nécessiter l’aide de membres de l’équipe de soins de santé. Par exemple, qu’un ergothérapeute les aide à s’alimenter avec le positionnement ou le type de tétine, ou qu’un inhalothérapeute les aide à respirer en facilitant l’apport en oxygène. Dans d’autres cas, une intervention chirurgicale peut être requise pour diminuer la pression sur le cerveau du bébé causée par la malformation de Chiari.</p><h2>Quand consulter un médecin?</h2><p>Si vous voyez des signes d’infection ou une fuite de liquide de l’incision, votre bébé doit être évalué et amené à un service d’urgence local. Assurez-vous d’informer votre équipe neurochirurgicale de toute préoccupation à cet égard.</p><p>Si votre bébé présente une <a href="/Article?contentid=858&language=French">hydrocéphalie</a> ou une <a href="/Article?contentid=853&language=French">malformation de Chiari</a> de type 2, veuillez consulter les pages pertinentes pour savoir quand consulter un médecin.</p><h2>Le méningocèle et le myéloméningocèle sont habituellement corrigés par une chirurgie</h2><h3>Chirurgie avant la naissance de votre bébé</h3><p>Parfois, lorsqu’un bébé reçoit un diagnostic de spina-bifida, plus particulièrement de myéloméningocèle, la chirurgie peut être possible avant la 26e semaine de grossesse. Elle est pratiquée en ouvrant l’utérus de la mère et en réparant la malformation à la moelle épinière du bébé pendant qu’il est encore dans l’utérus. Certaines études suggèrent que ce type d’intervention prévient l’aggravation des lésions de la moelle épinière et diminue la possibilité d’avoir besoin d’un traitement pour l’hydrocéphalie. Votre neurochirurgien et votre obstétricien vous diront si cette option est envisageable pour vous et votre bébé.</p><h3>Chirurgie après la naissance de votre bébé</h3><p>Si votre bébé a reçu un diagnostic de spina-bifida pendant la grossesse, vous devrez peut-être accoucher dans un centre de grossesse à haut risque. Votre obstétricien vous dira si cela est nécessaire. Après l’accouchement, le sac ne peut pas rester à l’extérieur du corps pendant une longue période. Il peut se déchirer ou s’infecter, ou il peut déjà être rompu, exposant son contenu délicat. Votre bébé sera opéré pour réparer le sac dans les deux ou trois jours suivant la naissance. Un neurochirurgien pratiquera l’opération. Un neurochirurgien est un médecin qui pratique des opérations dans le cerveau et la moelle épinière.</p><p>Votre bébé pourrait avoir besoin de passer une imagerie par résonnance magnétique (IRM) avant l’opération pour aider les chirurgiens à mieux voir la moelle épinière. Une IRM est un examen qui permet de prendre des photos spéciales à l’intérieur du corps. Pour passer une IRM, le patient doit demeurer immobile pendant que les photos sont prises. Certains enfants peuvent avoir besoin de sédatifs pour les aider à rester immobiles pendant l’examen.</p><p>L’opération vise deux choses :</p><ul><li>refermer la peau par-dessus le sac</li><li>éviter des infections et tout autre dommage à la moelle épinière</li></ul><p>Si votre bébé bouge moins ses jambes et ses pieds ou qu’il n’est pas en mesure de les bouger du tout, l’opération ne redonnera pas le mouvement et la sensibilité aux jambes et aux pieds du bébé.</p><h2>Que se passera-t-il après l’opération?</h2><p>L’opération dure environ quatre heures. Après l’opération, votre bébé passera entre trois et quatre heures à l’Unité de soins post-anesthésique pour se remettre de l’anesthésie (médicaments pour dormir). Ensuite, votre bébé peut retourner à l’unité de neurochirurgie, ou il peut être suivi un certain temps à l’unité néonatale de soins intensifs (UNSI).</p><p>Votre enfant aura un pansement sur le dos pendant plusieurs jours pour protéger le site de l’incision tant qu’elle ne sera pas guérie. L’infirmière examinera souvent le pansement. L’infirmière vérifiera également la température, la fréquence cardiaque, la pression artérielle, la respiration, les mouvements des jambes de votre enfant et s’il est souffrant.</p><p>Votre enfant aura également un mince tube dans le bras, appelé une intraveineuse (IV). Il permet d’administrer des liquides et des médicaments directement dans le sang de votre enfant. Votre enfant conservera l’IV en place jusqu’à ce qu’il s’alimente bien et qu’il n’ait plus besoin de médicaments.</p><p>Pendant les trois à cinq premiers jours qui suivent l’opération, votre enfant devra rester allongé dans son lit, généralement sur le ventre. Ceci empêchera le liquide de s’échapper de l’incision. Ne levez pas votre enfant jusqu’à ce que le médecin vous donne son accord pour le faire. L’équipe de soins de santé peut vous aider à tenir et à caresser votre bébé pour le nourrir et le réconforter. Une fois l’incision guérie, votre bébé pourra être tenu de manière normale.</p><p>Votre bébé pourra ressentir de la douleur au site de son opération. Il recevra des médicaments pour contrôler la douleur. Si cela ne suffit pas pour contrôler la douleur, parlez-en à l’infirmière de votre enfant ou à un membre de son équipe de soins de santé.</p><p>Lorsque votre bébé est stable et alerte après son opération, il sera en mesure de se nourrir. L’équipe pourra vous aider à allaiter si c’est la méthode que vous privilégiez pour nourrir le bébé.</p><p>Pour s’assurer que votre bébé se vide la vessie, un cathéter sera placé dans sa vessie par l’urètre à toutes les heures. La fréquence à laquelle cela se produit peut diminuer avec le temps en fonction de la capacité de votre bébé à uriner tout seul.</p><p>Les bébés atteints de spina-bifida qui nécessitent une intervention chirurgicale ont presque toujours une malformation de Chiari de type 2. Pour cette raison, ils seront surveillés pour tout problème d’alimentation ou de respiration.</p><h2>À l’hôpital SickKids</h2><p>La clinique de neurochirurgie est située à l’étage 6D dans l’Atrium ou vous pouvez appeler au 416 813-5222.</p><h2>Ressources</h2><p>Spina Bifida and Hydrocephalus Association of Ontario</p><p><a href="http://www.sbhao.on.ca/">http://www.sbhao.on.ca/</a></p><p>Holland Bloorview Kids Rehabilitation Hospital</p><p><a href="http://www.hollandbloorview.ca/">http://www.hollandbloorview.ca/</a></p><p>Public Health Agency of Canada. (2013). <em>Congenital Anomalies In Canada 2013: A Perinatal Health Surveillance Report</em>. Retrieved from <a href="http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf">http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf</a>.</p>

 

 

Spina bifida- Treatment and caring for your child after surgical repair2532.00000000000Spina bifida- Treatment and caring for your child after surgical repairSpina bifida: Treatment and caring for your child after surgical repairSEnglishNeurologyNewborn (0-28 days)SpineSpinal CordProceduresCaregivers Adult (19+)NA2017-11-07T05:00:00ZPatricia Rowe, RN(EC), MN, NP-Pediatrics;Sara Breitbart, RN(EC), MN, NP-Pediatrics;Peter Dirks, MD, PhD, FRCSC;James Drake, BSE, MB, BCh, MSc, FRCSC8.9000000000000059.80000000000001845.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn how your baby's spina bifida is repaired with surgery either before or after they are born. Also learn what happens after surgery and how to take care of your baby at home.</p><h2>What is spina bifida?</h2><p>Spina bifida means that the bones that protect the spinal cord have not formed completely while a baby is developing in the mother’s womb. This happens very early in pregnancy.</p><p>Spina bifida can happen anywhere along a baby’s back between the head and the hips. It happens most often in the lower back. This area is called the lumbar or lumbosacral spine.</p><p>Children with spina bifida may have health problems because of this condition. They may experience changes or loss of feeling in their legs, have decreased movement of their legs or not be able to move their legs at all. They may also have problems with their bladder and bowel function.</p><p>About 2.6 in every 10,000 babies are born with some form of spina bifida.</p><p>There are four common types of spina bifida: Myelomeningocele, meningocele, lipomyelomeningocele and spina bifida occulta.</p><p>Babies with myelomeningocele or meningocele are both treated with surgery. Older infants and young children with lipomyelomeningocele may require surgery if they develop symptoms. Spina bifida occulta does not usually require treatment. </p><p>To learn more about the different types of spina bifida, how it is diagnosed and the complications associated with it please read: <a href="/Article?contentid=848&language=English">Spina bifida</a>.</p><h2>Many people will help look after your baby</h2><p>There is a big team of people who will be caring for your baby: </p><ul><li>a neurosurgeon, who will do your baby’s surgery</li><li>a paediatrician, a doctor who will give healthy baby care</li><li>a urologist, a doctor who will care for your baby’s kidneys and bladder</li><li>an orthopaedic surgeon, who will care for your baby’s bones</li><li>a nurse, who will care for your baby day to day</li><li>a nurse practitioner, who will help to co-ordinate care and services </li><li>a physiotherapist, who will give your baby exercises to strengthen the legs and feet</li><li>an occupational therapist, who will help with feeding and your baby’s development</li><li>a social worker, who will help you cope with hospitalization and being a new parent</li></ul><h2>Key points</h2><ul><li>Spina bifida means that the bones that protect the spinal cord have not formed completely. </li><li>In babies with spina bifida, the CSF, the nerves and the lining of the spinal cord often bulge out through a defect in the baby’s back. </li><li>Two types of spina bifida, meningocele and myelomeningocele, are usually repaired with surgery</li><li>Surgery will be done either before your baby is born, before the 26 week of pregnancy, or within two to three days after they are born. </li></ul><h2>Complication after surgery</h2><h3>Incision healing</h3><p>After surgery the incision is monitored closely for signs of the wound reopening or any leakage of CSF. Depending on the size of your baby and the size of the defect, closure of the opening may have been difficult. The incision is fragile and there could possibly be issues with healing. The incision will need to be watched closely and may need some additional care such as special dressings. </p><h3>Infection</h3><p>Infection is possible with any surgery. Because your baby’s CSF and spinal cord is involved your baby will be closely monitored for any signs of infection. If infection is suspected the team will explain to you what treatment your baby will need. </p><h3>Hydrocephalus</h3><p>After their back surgery to close the defect, babies with spina bifida often have extra CSF around their brain and spinal cord. This is called <a href="/Article?contentid=858&language=English">hydrocephalus</a>. About 80 percent of baby’s with spina bifida, primarily those with myelomeningoceles, develop hydrocephalus. Hydrocephalus is treated with an operation that puts a tube called a shunt into the ventricles of the brain. This tube helps to drain CSF from your baby's head into an area where the CSF is better absorbed, such as the lining of the abdomen (tummy). </p><p>To watch for hydrocephalus your baby's head circumference will be measured often and they will also have ultrasound imaging done of their brain. </p><h3>Chiari Malformation</h3><p>Some babies will have issues because they have a <a href="/Article?contentid=853&language=English">Chiari malformation</a>. They may have feeding difficulties, breathing troubles and some weakness of their arms. Some babies may require other health-care team members to assist with these issues. For example, they may require an occupational therapist to help with position or type of nipple for feeding, or a respiratory doctor because they need oxygen support. Some babies may require surgery to decrease the pressure on the lower part of the brain caused by the Chiari malformation. </p><h2>Going home</h2><p>Before you take your baby home, your health-care team will explain how to take care of your baby at home. The instructions will include: </p><ul><li>how to take care of your baby’s incision</li><li>what to do with your baby’s stitches </li><li>how to tell if your baby’s incision becomes infected </li><li>other things to watch for </li><li>what activities your baby is able to do</li><li>who your contact is if you have any questions or concerns</li></ul><h3>Taking care of your baby’s incision</h3><p>Watch your baby’s incision to make sure it is healing well. Your health-care team will discuss with you how long to wait before your baby can have a bath. It is OK to let the incision get wet once your baby is ready for bathing. </p><h3>Taking care of your baby’s stitches</h3><p>Your baby might have stitches or surgical glue to close their incision. Your health-care team will tell you what type of stitches were used. </p><p>Your neurosurgery or plastic surgery team member will remove any stitches that need to be taken out. </p><ul><li>If your baby has stitches that need to be removed, you will be given an appointment for when you should return to have them removed</li><li>If your child has stitches that dissolve on their own, the stitches will not need to be removed. You can still see your family doctor to have the incision line checked. </li></ul><h3>Watching for signs of infection</h3><p>Tell your child’s doctor if you notice any of the following signs of infection: </p><ul><li>fluid leaking from the incision </li><li>fluid collection (bulging) at the incision </li><li>redness </li><li>swelling </li><li>smelly discharge from the incision </li><li>fever</li></ul><h2>When to see a doctor</h2><p>If you see any signs of infection or any leakage of fluid from the incision then your baby needs to be assessed and should be brought to a local emergency department. Please be sure to notify your neurosurgical team of any concerns. </p><p>If your baby has <a href="/Article?contentid=858&language=English">hydrocephalus</a> and/or a <a href="/Article?contentid=853&language=English">Chiari malformation</a> type 2 please refer to those pages for when to seek medical attention. </p><h2>Following up after the operation</h2><p>The surgeon will see your child in a follow-up clinic visit four to six weeks after your child goes home after surgery. The appointment may be made for you when your child is discharged. Your child may need to visit sooner if stitches need to be removed or if the incision needs to be followed more closely.</p><h2>Meningocele and myelomeningocele are usually repaired with surgery</h2><h3>Surgery before your baby is born</h3><p>Sometimes when a baby is diagnosed with spina bifida, specifically with myelomeningocele, surgery may be possible before the 26 week of pregnancy. This is done by opening the mother’s uterus and repairing the baby’s spinal cord defect while they are still in the womb. There are some studies that suggest this type of surgery stops damage to the spinal cord from getting any worse and decreases the possibility of needing treatment for hydrocephalus. Your neurosurgeon and obstetrician will tell you if this is an option for you and your baby.</p><h3>Surgery after your baby is born</h3><p>If your baby has been diagnosed with spina bifida during pregnancy, you may need to deliver at a high-risk pregnancy centre. Your obstetrician will tell you if this is needed. After delivery, the sac cannot stay outside of the body for a long time. It may tear or get infected, or it may already be ruptured exposing its delicate contents. Your baby will have surgery to repair the sac within two or three days of birth. A neurosurgeon will do the operation. A neurosurgeon is a doctor who operates on the brain and spinal cord. </p><p>Your baby may need an MRI before their operation to help the surgeons to better see the spinal cord. An MRI is a scan that takes special pictures of the inside of the body. An MRI scan requires a person to be still while the pictures are being taken. Some children may need medicine to help them keep still during the tests. </p><p>The purpose of the operation is to: </p><ul><li>close the skin over the sac</li><li>prevent infection and further damage to the spinal cord</li></ul><p>If your baby’s legs and feet are paralyzed or have decreased movement, the operation will not return movement and feeling to the baby’s legs and feet. </p><h2>What happens after the surgery?</h2><p>The surgery takes about four hours. After the operation, your baby will spend three to four hours in the Post Anaesthetic Care Unit (PACU) to recover from the anaesthetic (sleep medicine). Then your baby may go back to the neurosurgical unit, or they may be monitored in the NICU (neonatal intensive care unit). </p><p>Your child will have a bandage on their back for a number of days, depending on how the incision is healing. The nurse will check the bandage often. The nurse will also check your child’s temperature, heart rate, blood pressure, breathing, leg movements and level of pain. </p><p>Your child will also have a thin tube in their arm. This is called an intravenous (IV) tube. It lets your child receive fluids and medicines directly into their bloodstream. Your child will have this IV in place until they are feeding well and no longer requiring medication through it. </p><p>For the first three to five days after surgery, your child needs to lie flat in bed usually on their stomach. This is to prevent fluid around the spinal cord from leaking out through the incision. Do not get your baby up until you are given the go ahead. The team can assist you with holding and cuddling your baby for feeding and providing comfort. Once the incision is healed your baby will be able to be positioned normally. </p><p>Your baby may feel pain at the site of their operation. They will receive medicine to control the pain. If it does not control the pain, speak to your child’s nurse or a member of their health-care team. </p><p>When your baby is stable and alert after their surgery they will be able to feed. The team will be able to help support you with breastfeeding if that is your feeding method of choice. </p><p>To ensure that your baby empties their bladder, a catheter will be put into their bladder through their urethra every few hours. How often this happens may be decreased over time depending on your baby’s ability to pee on their own. </p><p>Babies with spina bifida that require surgery nearly always have a Chiari Malformation type 2. Because of this, they will be monitored for any issues with feeding or breathing. </p><h2>At SickKids</h2><p>The Neurosurgery clinic is located on 6D in the Atrium or you can call them at 416-813-5222.</p><h2>Resources</h2><p>There are many resources available to help you and your baby cope with spina bifida. </p><p>Spina Bifida and Hydrocephalus Association of Ontario<br> <a href="http://www.sbhao.on.ca/" target="_blank">http://www.sbhao.on.ca/</a></p><p>Holland Bloorview Kids Rehabilitation Hospital<br> <a href="http://www.hollandbloorview.ca/" target="_blank">http://www.hollandbloorview.ca/</a></p><p>Public Health Agency of Canada. (2013). <em>Congenital Anomalies In Canada 2013: A Perinatal Health Surveillance Report</em>. Retrieved from <a href="http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf">http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf</a>.</p>Spina bifida- Treatment and caring for your child after surgical repairFalse

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