Spina bifidaSSpina bifidaSpina bifidaEnglishNeurologyNewborn (0-28 days)SpineSpinal CordConditions and diseasesCaregivers 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, FRCSC9.4000000000000056.70000000000002007.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Spina bifida occurs when a baby’s spine and spinal cord do not develop properly in the womb, leaving an opening in the spine. Learn about the four different types of spina bifida, their causes and how it is diagnosed.</p><h2>What is spina bifida?</h2><p>The spinal cord is a thick bundle of nerves that carries messages between the brain and the rest of the body. It floats in a liquid called cerebrospinal fluid (CSF). This liquid nourishes and protects the brain and spinal cord. The CSF is covered by a lining made of three thin layers called the meninges. This lining is normally protected by the bones of the back (the vertebrae).</p><p>In people with spina bifida, the bones that protect the spinal cord have not formed completely while the baby is developing in the mother’s womb. This leaves the lining, the CSF, and the spinal cord unprotected. 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><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 cerebrospinal fluid (CSF), the nerves and the lining of the spinal cord can bulge out through a defect in the baby’s back.</li><li>There are four common types of spina bifida: Myelomeningocele, meningocele, lipomyelomeningocele and spina bifida occulta.</li><li>What causes spina bifida is unknown but spina bifida and other neural tube defects are less likely to occur when women get enough folic acid.</li></ul><h2>Causes of spina bifida</h2><p>All of the causes of spina bifida are not known but there are genetic, environmental and nutritional risks linked to spina bifida.</p><ul><li>Some spina bifida is found in families, meaning there may be a genetic link.</li><li>What you eat during pregnancy may have an impact on healthy growth of the spinal cord.</li><li>Some medications that interfere with the body’s ability to use folate and folic acid could increase risk.</li><li>Women with diabetes whose blood sugars are not well controlled have a higher risk.</li><li>Increased body temperature (for example from using a sauna or hot tub) in early weeks of pregnancy may increase risk.</li></ul><p>Spina bifida and other neural tube defects are less likely to occur when women get enough folic acid. These defects occur in early pregnancy, often before many women even know they are pregnant. If there is any possibility of becoming pregnant, it is important to have a well-balanced diet rich in folic acid. If you are planning to become pregnant, it is essential that you begin taking folic acid daily, at least three or four months before you start trying to conceive. Talk with your doctor about the right dosage for you. The usual recommended dose is 400 micrograms (mcg) of folic acid a day. Often this can be found in a prenatal vitamin. If you have had a pregnancy affected by spina bifida, or a family history of spina bifida or are taking certain medications, you may require a higher dose of folic acid.</p><h2>Diagnosis of spina bifida</h2><p>Spina bifida can be diagnosed during pregnancy or after the baby is born.</p><h3>During pregnancy</h3><p>There are tests that can be done during pregnancy that can indicate if the baby has a high chance of having spina bifida.</p><ul><li>Alpha-fetoprotein (AFP) blood test – AFP is a protein made by unborn babies. AFP crosses from the baby through the placenta to the mother. A test is done that measures AFP levels in the mother's blood. If there are high levels of AFP in the mother's blood this might mean that the baby has spina bifida.</li><li>Ultrasound – this is a common test during pregnancy that allows health-care providers to see images of the unborn baby. In some cases an ultrasound can show if the baby has spina bifida.</li><li>Amniocentesis – this is a test that takes a small sample of amniotic fluid from the mother’s womb. If this fluid has a higher than average level of AFP then the baby might have spina bifida.</li><li>Fetal MRI – if initial tests suggest there is a high chance of spina bifida then a fetal MRI can be done. This is an MRI that is done on the pregnant mother to assess the unborn baby.</li></ul><p>Spina bifida occulta may not be diagnosed until late childhood, adulthood or may not be diagnosed at all.</p><h2>Treatment of spina bifida</h2><p>Meningocele where only the meninges are pushed through the opening and myelomeningocele where the meninges and spinal cord are pushed out through the opening 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 treatment of spina bifida please read <a href="/Article?contentid=2532&language=English">Spina bifida: Treatment and caring for your child after surgical repair</a>.</p><h2>Health problems linked to or caused by spina bifida</h2><p>Every child with spina bifida is different with their own medical, mobility and learning challenges. Some children may only be mildly affected while others may have more severe disabilities. Being born with spina bifida brings life-long challenges. Your child’s health-care team will work together with you to help your child achieve their greatest potential.</p><p>The following health issues are common for children with spina bifida.</p><h3>Hydrocephalus</h3><p>About 80 percent of babies born with spina bifida, primarily those with myelomeningocele, will also have <a href="/Article?contentid=858&language=English">hydrocephalus</a>. Hydrocephalus is an abnormal build-up of CSF in the ventricles inside the brain.</p><h3>Chiari malformation</h3><p>Nearly all babies born with myelomeningocele have a <a href="/Article?contentid=853&language=English">Chiari malformation</a> type 2. This is when the lower part of the brain (the brainstem) sits too low in your child’s upper spine area. Some children with Chiari malformation type 2 may have feeding problems (for example, weak suck when feeding, gagging, choking, trouble swallowing), breathing trouble and some may have weakness of the arms. Surgery may be required to decrease the pressure on the lower part of the brain.</p><h3>Leg function (movement) and sensation (feeling)</h3><p>In children with spina bifida, the nerves in the spinal canal are often damaged or improperly formed, and therefore they may not able to control the muscles properly or sometimes feel properly. Some children may be paralyzed, not able to move their legs at all, while others can stand and walk to some extent.</p><h3>Muscles and bones</h3><p>Muscles and bones may also be affected by spina bifida. A baby with spina bifida may be born with <a href="/Article?contentid=1192&language=English">clubfoot</a>, this is when the baby's feet are turned in at the ankle.</p><p>The baby's hips may also be affected as different muscles may be stronger than others interfering with how the hips move and function. This can cause dislocation of the hip.</p><p>Muscles around the spine may also be affected. Any difference in muscle strength can affect the position of the spine and cause an abnormal curve.</p><p>If your child has clubfoot or any leg bone issues an orthopaedic surgeon will speak to you about options for correcting this in the future.</p><h3>Bladder problems</h3><p>With spina bifida, the nerves that tell the bladder to empty and release urine (pee) are often weak or not working. This means you may have to help your baby to pee and empty their bladder. When your baby is born, a tube or catheter will be put inside their bladder through the urethra every few hours to see if they can pee on their own and empty their bladder. The urethra is the tube inside the body that carries urine from the bladder to the outside of the body. If your baby is unable to fully empty their bladder, they are at risk for an infection and possibly damage to their kidneys. You may need to learn how to empty your baby’s bladder using a catheter before you can take them home. Instructions for <a href="/Article?contentid=978&language=English">boys</a> and <a href="/Article?contentid=979&language=English">girls</a> are slightly different. A member of the urology team will talk to you about this.</p><h3>Bowel problems</h3><p>Sometimes the nerves that make the bowels move are weak or not working. The nurse will be assessing how well your baby’s bowels move. The nurse can teach you how to help your baby’s bowels move better and how to protect your baby’s skin around their anus.</p><h3>Latex allergies/sensitivity</h3><p>Babies with spina bifida have a high risk of developing a latex sensitivity or allergy. It is important to make sure that products such as gloves, catheters and soothers do not contain latex.</p><h3>Tethered cord</h3><p>In children with spina bifida, sometimes the spinal cord gets stuck at the site where the vertebrae have not closed completely. This is called a <a href="/Article?contentid=861&language=English">tethered cord</a>.</p><h2>Resources</h2><p>There are many resources available to help you learn more about spina bifida.</p><p>Spina Bifida and Hydrocepahlus 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 http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf.</p>
Spina-bifidaSSpina-bifidaSpina bifidaFrenchNeurologyNewborn (0-28 days)SpineSpinal CordConditions and diseasesAdult (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) - ConditionsHealth A-Z<p>Le spina-bifida est une malformation provoquée par le mauvais développement de la colonne vertébrale et de la moelle épinière dans l’utérus, laissant une ouverture dans la colonne vertébrale. Renseignez-vous sur les quatre différents types de spina-bifida, leurs causes et comment il est diagnostiqué.</p><h2>Qu’est-ce que le spina-bifida?</h2><p>La moelle épinière est un faisceau épais de nerfs qui transporte des messages entre le cerveau et le reste du corps. Il flotte dans un liquide appelé liquide céphalorachidien (LCR). Ce liquide nourrit et protège le cerveau et la moelle épinière. Le LCR est recouvert d’une doublure faite de trois couches minces appelées méninges. Cette doublure est normalement protégée par les os du dos (les vertèbres).</p><p>Chez les personnes atteintes de spina bifida, les os qui protègent la moelle épinière du bébé ne sont pas complètement formés pendant la grossesse. La doublure, le LCR et la moelle épinière sont laissés sans protection, ce qui survient très tôt au cours de la croissance du bébé.</p><p>Le spina-bifida peut affecter n’importe quelle partie du dos d’un bébé, entre la tête et les hanches, mais le plus souvent dans le bas du dos. Cette région est appelée la colonne vertébrale lombaire ou lombo-sacrée.</p><p>Les enfants atteints de spina-bifida peuvent avoir des problèmes de santé liés à ce trouble.Ils peuvent éprouver une perte de sensation de leurs jambes, présenter une capacité réduite à les bouger, voire être paralysés. 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><h2>À retenir</h2><ul><li>Le spina bifida signifie que les os qui protègent la moelle épinière ne sont pas entièrement formés.</li><li>Chez les bébés atteints de spina-bifida, le liquide céphalorachidien (LCR), les nerfs et la membrane qui enveloppe la moelle épinière forment une protubérance qui fait saillie dans le dos du bébé.</li><li>Il existe quatre types courants de spina-bifida : le myéloméningocèle, le méningocèle, le lipomyéloméningocèle et le spina-bifida occulta.</li><li>Les causes du spina bifida sont inconnues, mais le spina bifida et d’autres anomalies du tube neural sont moins susceptibles de survenir lorsque les femmes reçoivent suffisamment d’acide folique.</li></ul><h2>Les causes de spina-bifida</h2><p>Toutes les causes du spina-bifida ne sont pas connues mais il existe des risques génétiques, environnementaux et nutritionnels liés au spina-bifida.</p><ul><li>Certaines formes de spina-bifida sont présentes dans certaines familles, ce qui signifie qu’il peut y avoir un lien génétique.</li><li>L’alimentation de la mère pendant la grossesse peut avoir un impact sur la croissance saine de la moelle épinière.</li><li>Certains médicaments qui nuisent à la capacité du corps à utiliser le folate et l’acide folique pourraient augmenter le risque.</li><li>Les femmes diabétiques dont la glycémien’est pas bien contrôléee courent un risque plus élevé.</li><li>L’augmentation de la température corporelle (p. ex. utilisation d’un sauna ou d’un bain à remous) dans les premières semaines de la grossesse peut augmenter le risque.</li></ul><p>Le spina-bifida et d’autres anomalies du tube neural sont moins susceptibles de se produire lorsque les femmes reçoivent suffisamment d’acide folique. Ces malformations se produisent au début de la grossesse, souvent avant même que de nombreuses femmes ne sachent qu’elles sont enceintes. S’il y a une possibilité de tomber enceinte, il est important d’avoir une alimentation équilibrée et riche en acide folique. Si vous envisager de devenir enceinte, il est essentiel que vous commenciez à prendre de l’acide folique quotidiennement, au moins trois ou quatre mois avant d’essayer de concevoir. Vérifiez auprès de votre médecin le dosage qui vous convient. La dose habituelle recommandée est de 400 microgrammes (mcg) d’acide folique par jour. Une vitamine prénatale pourra souvent convenir. Si vous avez déjà eu une grossesse affectée par le spina-bifida, ou si vous avez des antécédents familiaux de spina-bifida ou si vous prenez certains médicaments, vous pourriez avoir besoin d’une dose plus élevée d’acide folique.</p><h2>Diagnostic du spina-bifida</h2><p>Le spina-bifida peut être diagnostiqué pendant la grossesse ou après la naissance du bébé.</p><h3>Pendant la grossesse</h3><p>Des tests effectués pendant la grossesse peuvent indiquer que le bébé a de fortes chances d’être atteint de spina-bifida.</p><ul><li>Test sanguin alpha-fœtoprotéine (AFP) - L’AFP est une protéine produite par les bébés à naître. L’AFP traverse le placenta jusqu’à la mère. Un test permet de mesurer les niveaux d’AFP dans le sang de la mère. S’ils sont élevés, cela peut signifier que le bébé est atteint de spina-bifida.</li><li>Échographie - Il s’agit d’un test courant pendant la grossesse qui permet aux professionnels de la santé de voir des images du bébé à naître. Dans certains cas, une échographie peut montrer que le bébé a le spina-bifida.</li><li>Amniocentèse - Il s’agit d’un petit échantillon de liquide amniotique provenant de l’utérus de la mère. Si ce liquide a un taux d’AFP supérieur à la moyenne, alors le bébé pourrait avoir le spina-bifida.</li><li>Imagerie par raisonnace magnétique (IRM) fœtale – si les premiers tests suggèrent qu’il y a une forte probabilité de spina-bifida, une IRM fœtale peut être réalisée. L’IRM pratiquée dans ce cas sur la mère enceinte permet d’évaluer le bébé à naître.</li></ul><p>Le spina-bifida occulta peut n’être diagnostiqué que vers la fin de l’enfance, à l’âge adulte ou ne pas être diagnostiqué du tout.</p><h2>Traitement du spina-bifida</h2><p>Le méningocèle où seules les méninges sont poussées à travers l’ouverture et le myéloméningocèle où les méninges et la moelle épinière sont forcées à travers l’ouverture sont tous deux 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 plus de renseignements sur le traitement du spina-bifida, veuillez consulter <a href="/Article?contentid=2532&language=French">Spina-bifida : traitement et soin de votre enfant après une réparation chirurgicale</a>.</p> <h2>Les problèmes de santé associés ou causés par le spina-bifida</h2><p>Chaque enfant souffrant de spina-bifida est différent avec ses propres problèmes médicaux, de mobilité et d’apprentissage. Certains enfants peuvent seulement être légèrement affectés alors que d’autres peuvent avoir des handicaps plus graves. Le fait de naître avec le spina-bifida apporte des défis pour la vie. L’équipe de soins de santé de votre enfant collaborera avec vous pour aider votre enfant à réaliser son plus grand potentiel.</p><p>Les problèmes de santé suivants sont fréquents chez les enfants atteints de spina-bifida.</p><h3>Hydrocéphalie</h3><p>Environ 80 % des bébés nés avec le spina-bifida, principalement ceux atteints de myéloméningocèle, présenteront également une <a href="/Article?contentid=858&language=French">hydrocéphalie</a>. L’hydrocéphalie est caractérisée par l’accumulation anormale de LCR dans les ventricules à l’intérieur du cerveau.</p><h3>Malformation de Chiari</h3><p>Presque tous les bébés nés avec le myéloméningocèle ont une <a href="/Article?contentid=853&language=French">malformation de Chiari</a> de type 2. C’est quand la partie inférieure du cerveau (le tronc cérébral) se trouve trop bas dans la zone supérieure de la colonne vertébrale de votre enfant. Certains enfants atteints d’une malformation de Chiari de type 2 peuvent avoir des problèmes d’alimentation (par ex. faible succion lorsqu’ils se nourrissent, bâillonnement, étouffement, difficulté à avaler), des problèmes respiratoires et certains peuvent avoir une faiblesse au niveau des bras. La chirurgie peut être nécessaire pour diminuer la pression sur la partie inférieure du cerveau.</p><h3>Fonction physiologique des jambes (mobilité) et sensation </h3><p>Chez les enfants atteints de spina-bifida, les nerfs du canal neural sont souvent endommagés ou mal formés; ils peuvent donc avoir du mal à contrôler correctement leurs muscles ou à éprouver des sensations. Certains enfants peuvent être paralysés, incapables de bouger leurs jambes, tandis que d’autres peuvent se tenir debout et faire des pas.</p><h3>Muscles et os</h3><p>Les muscles et les os peuvent également être affectés par le spina-bifida. Un bébé atteint de spina-bifida peut naître avec un <a href="/Article?contentid=1192&language=French">pied bot</a>, c’est-à-dire lorsque les pieds du bébé sont tournés au niveau de la cheville.</p><p>Les hanches du bébé peuvent également être affectées en raison de la force qui varie dans différents muscles, interférant ainsi avec le mouvement et la fonction des hanches. Cela peut provoquer une luxation de la hanche.</p><p>Les muscles autour de la colonne vertébrale peuvent également être affectés. Toute différence de force musculaire peut affecter la colonne vertébrale et provoquer une courbe anormale.</p><p>Si votre enfant a des problèmes de pied bot ou souffre un trouble osseux dans la jambe, un chirurgien orthopédique vous parlera des options pour corriger cette situation.</p><h3>Problèmes de vessie</h3><p>Dans le cas du spina-bifida, les nerfs qui informent la vessie qu’elle doit se vider et libérer l’urine (pipi) sont souvent faibles ou ne fonctionnent pas. Cela signifie que vous devrez peut-être aider votre bébé à uriner et à vider sa vessie. Lorsque votre bébé naîtra, une sonde ou un cathéter sera placé à l’intérieur de sa vessie par l’urètre à intervalles de quelques heures pour constater s’il peut uriner lui-même et vider sa vessie. L’urètre est le tube qui transporte l’urine de la vessie à l’extérieur du corps. Si votre bébé est incapable de vider complétement sa vessie, il risque de contracter une infection qui endommagera ses reins. Vous devrez peut-être apprendre à vider la vessie de votre bébé à l’aide d’un cathéter avant de pouvoir le ramener à la maison. Les instructions pour les <a href="/Article?contentid=978&language=French">garçons</a> et les <a href="/Article?contentid=979&language=French">filles</a> sont légèrement différentes. Un membre de l’équipe d’urologie vous en parlera.</p><h3>Problèmes intestinaux</h3><p>Parfois, les nerfs qui permettent d’aller à la selle sont faibles ou ne fonctionnent pas. L’infirmière évaluera si les intestins de votre bébé fonctionnent correctement. L’infirmière peut vous donnera des conseils pour aider au fonctionnement des intestins de votre bébé et protéger la peau de votre bébé autour de l’anus.</p><h3>Allergies et sensibilité au latex </h3><p>Les bébés atteints de spina-bifida ont un risque élevé de développer une sensibilité au latex ou une allergie. Il est important de s’assurer que les produits tels que les gants, les cathéters et les tétines ne contiennent pas de latex.</p><h3>Insertion basse de la moelle</h3><p>Chez les enfants atteints de spina-bifida, la moelle épinière reste parfois coincée à l’endroit où les vertèbres ne sont pas complètement refermées. C’est ce qu’on appelle une <a href="/Article?contentid=861&language=French">insertion basse de la moelle épinière</a>.</p><h2>Ressources</h2><p>Il existe de nombreuses ressources disponibles pour vous aider à en apprendre davantage sur le spina bifida.</p><p>Spina Bifida and Hydrocepahlus Association of Ontario</p> <a href="http://www.sbhao.on.ca/">http://www.sbhao.on.ca/</a> (en anglais seulement)<p></p><p>Holland Bloorview Kids Rehabilitation Hospital</p> <a href="http://www.hollandbloorview.ca/">http://www.hollandbloorview.ca/</a> (en anglais seulement)<p></p><p>Public Health Agency of Canada. (2013). <em>Congenital Anomalies in Canada 2013: A Perinatal Health Surveillance Report</em>. Retrieved from http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf.</p>

 

 

Spina bifida848.000000000000Spina bifidaSpina bifidaSEnglishNeurologyNewborn (0-28 days)SpineSpinal CordConditions and diseasesCaregivers 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, FRCSC9.4000000000000056.70000000000002007.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Spina bifida occurs when a baby’s spine and spinal cord do not develop properly in the womb, leaving an opening in the spine. Learn about the four different types of spina bifida, their causes and how it is diagnosed.</p><h2>What is spina bifida?</h2><p>The spinal cord is a thick bundle of nerves that carries messages between the brain and the rest of the body. It floats in a liquid called cerebrospinal fluid (CSF). This liquid nourishes and protects the brain and spinal cord. The CSF is covered by a lining made of three thin layers called the meninges. This lining is normally protected by the bones of the back (the vertebrae).</p><p>In people with spina bifida, the bones that protect the spinal cord have not formed completely while the baby is developing in the mother’s womb. This leaves the lining, the CSF, and the spinal cord unprotected. 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><h2>The four main types of spina bifida</h2><p>There are four main types of spina bifida:</p><ul><li>spina bifida occulta</li><li>lipomyelomeningocele</li><li>meningocele</li><li>myelomeningocele</li></ul><p>“Meningo” refers to the lining of the vertebral canal. “Myelo” refers to the spinal cord itself. “Cele” means something bulging out.</p> <figure class="asset-c-80"> <span class="asset-image-title">Types of spina bifida</span> <img src="https://assets.aboutkidshealth.ca/akhassets/spina_bifida_V2_EN.jpg" alt="" /> <figcaption class="asset-image-caption">There are four common types of spina bifida: spina bifida occulta, lipomyelomeningocele, meningocele and myelomeningocele. Spina bifida occurs when a baby’s spine and spinal cord do not develop properly in the womb, leaving an opening in the spine. When this happens the spinal fluid, the nerves and the lining of the spinal cord (meninges) can bulge out through this defect in the baby’s back.</figcaption> </figure> <h3>Spina bifida occulta</h3><p>Spina bifida occulta is the mildest form of spina bifida. It occurs when a small section of the outer part of the vertebrae (the bones of the spine) have not completely closed, leaving an opening. In this type of spina bifida, the spinal cord and its coverings (the meninges) are usually not damaged and they do not protrude or bulge through the opening. There may be a dimple, tuft of hair, birthmark or fatty bulge at the site of the defect. This type of spina bifida may not be detected before birth. Many people may have this type of spina bifida and not be aware of it.</p><h3>Lipomyelomeningocele</h3><p>A lipomyelomeningocele (ly-po-my-low-meh-nin-go-seal) is a form of spina bifida where the outer part of the vertebrae have not completely closed, leaving an opening. Some abnormal fatty tissue pushes through the opening and may cause compression of the nerves.</p><h3>Meningocele</h3><p>A meningocele (meh-nin-go-seal) is a more severe form of spina bifida. It occurs when the outer part of the vertebrae have not completely closed, leaving an opening. The spinal cord itself may not be affected, but its protective coverings (the meninges) may be damaged and pushed through the opening to form a sac containing CSF. This sac is often covered with skin.</p><p>With a meningocele, the spinal cord stays inside the back where it belongs. This means that children with a meningocele may have normal movement and normal feeling in their legs and feet.</p><h3>Myelomeningocele</h3><p>A myelomeningocele (my-low-meh-nin-go-cele) is the most severe form of spina bifida. It occurs when the outer part of the vertebrae have not completely closed, leaving an opening. With a myelomeningocele, both the covering of the spinal cord (the meninges) and the spinal cord itself are pushed out through the opening. Usually they protrude into a covered, fluid-filled sac that has a very thin membrane and can easily split, exposing its delicate contents.</p><p>Because part of the spinal cord bulges into the sac, the spinal cord fails to develop properly and nerves are damaged. Most children with a myelomeningocele will have some difficulty with movement and feeling in their legs and feet, and may be paralyzed.</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 cerebrospinal fluid (CSF), the nerves and the lining of the spinal cord can bulge out through a defect in the baby’s back.</li><li>There are four common types of spina bifida: Myelomeningocele, meningocele, lipomyelomeningocele and spina bifida occulta.</li><li>What causes spina bifida is unknown but spina bifida and other neural tube defects are less likely to occur when women get enough folic acid.</li></ul><h2>Causes of spina bifida</h2><p>All of the causes of spina bifida are not known but there are genetic, environmental and nutritional risks linked to spina bifida.</p><ul><li>Some spina bifida is found in families, meaning there may be a genetic link.</li><li>What you eat during pregnancy may have an impact on healthy growth of the spinal cord.</li><li>Some medications that interfere with the body’s ability to use folate and folic acid could increase risk.</li><li>Women with diabetes whose blood sugars are not well controlled have a higher risk.</li><li>Increased body temperature (for example from using a sauna or hot tub) in early weeks of pregnancy may increase risk.</li></ul><p>Spina bifida and other neural tube defects are less likely to occur when women get enough folic acid. These defects occur in early pregnancy, often before many women even know they are pregnant. If there is any possibility of becoming pregnant, it is important to have a well-balanced diet rich in folic acid. If you are planning to become pregnant, it is essential that you begin taking folic acid daily, at least three or four months before you start trying to conceive. Talk with your doctor about the right dosage for you. The usual recommended dose is 400 micrograms (mcg) of folic acid a day. Often this can be found in a prenatal vitamin. If you have had a pregnancy affected by spina bifida, or a family history of spina bifida or are taking certain medications, you may require a higher dose of folic acid.</p><h2>Diagnosis of spina bifida</h2><p>Spina bifida can be diagnosed during pregnancy or after the baby is born.</p><h3>During pregnancy</h3><p>There are tests that can be done during pregnancy that can indicate if the baby has a high chance of having spina bifida.</p><ul><li>Alpha-fetoprotein (AFP) blood test – AFP is a protein made by unborn babies. AFP crosses from the baby through the placenta to the mother. A test is done that measures AFP levels in the mother's blood. If there are high levels of AFP in the mother's blood this might mean that the baby has spina bifida.</li><li>Ultrasound – this is a common test during pregnancy that allows health-care providers to see images of the unborn baby. In some cases an ultrasound can show if the baby has spina bifida.</li><li>Amniocentesis – this is a test that takes a small sample of amniotic fluid from the mother’s womb. If this fluid has a higher than average level of AFP then the baby might have spina bifida.</li><li>Fetal MRI – if initial tests suggest there is a high chance of spina bifida then a fetal MRI can be done. This is an MRI that is done on the pregnant mother to assess the unborn baby.</li></ul><p>Spina bifida occulta may not be diagnosed until late childhood, adulthood or may not be diagnosed at all.</p><h2>Treatment of spina bifida</h2><p>Meningocele where only the meninges are pushed through the opening and myelomeningocele where the meninges and spinal cord are pushed out through the opening 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 treatment of spina bifida please read <a href="/Article?contentid=2532&language=English">Spina bifida: Treatment and caring for your child after surgical repair</a>.</p><h2>Health problems linked to or caused by spina bifida</h2><p>Every child with spina bifida is different with their own medical, mobility and learning challenges. Some children may only be mildly affected while others may have more severe disabilities. Being born with spina bifida brings life-long challenges. Your child’s health-care team will work together with you to help your child achieve their greatest potential.</p><p>The following health issues are common for children with spina bifida.</p><h3>Hydrocephalus</h3><p>About 80 percent of babies born with spina bifida, primarily those with myelomeningocele, will also have <a href="/Article?contentid=858&language=English">hydrocephalus</a>. Hydrocephalus is an abnormal build-up of CSF in the ventricles inside the brain.</p><h3>Chiari malformation</h3><p>Nearly all babies born with myelomeningocele have a <a href="/Article?contentid=853&language=English">Chiari malformation</a> type 2. This is when the lower part of the brain (the brainstem) sits too low in your child’s upper spine area. Some children with Chiari malformation type 2 may have feeding problems (for example, weak suck when feeding, gagging, choking, trouble swallowing), breathing trouble and some may have weakness of the arms. Surgery may be required to decrease the pressure on the lower part of the brain.</p><h3>Leg function (movement) and sensation (feeling)</h3><p>In children with spina bifida, the nerves in the spinal canal are often damaged or improperly formed, and therefore they may not able to control the muscles properly or sometimes feel properly. Some children may be paralyzed, not able to move their legs at all, while others can stand and walk to some extent.</p><h3>Muscles and bones</h3><p>Muscles and bones may also be affected by spina bifida. A baby with spina bifida may be born with <a href="/Article?contentid=1192&language=English">clubfoot</a>, this is when the baby's feet are turned in at the ankle.</p><p>The baby's hips may also be affected as different muscles may be stronger than others interfering with how the hips move and function. This can cause dislocation of the hip.</p><p>Muscles around the spine may also be affected. Any difference in muscle strength can affect the position of the spine and cause an abnormal curve.</p><p>If your child has clubfoot or any leg bone issues an orthopaedic surgeon will speak to you about options for correcting this in the future.</p><h3>Bladder problems</h3><p>With spina bifida, the nerves that tell the bladder to empty and release urine (pee) are often weak or not working. This means you may have to help your baby to pee and empty their bladder. When your baby is born, a tube or catheter will be put inside their bladder through the urethra every few hours to see if they can pee on their own and empty their bladder. The urethra is the tube inside the body that carries urine from the bladder to the outside of the body. If your baby is unable to fully empty their bladder, they are at risk for an infection and possibly damage to their kidneys. You may need to learn how to empty your baby’s bladder using a catheter before you can take them home. Instructions for <a href="/Article?contentid=978&language=English">boys</a> and <a href="/Article?contentid=979&language=English">girls</a> are slightly different. A member of the urology team will talk to you about this.</p><h3>Bowel problems</h3><p>Sometimes the nerves that make the bowels move are weak or not working. The nurse will be assessing how well your baby’s bowels move. The nurse can teach you how to help your baby’s bowels move better and how to protect your baby’s skin around their anus.</p><h3>Latex allergies/sensitivity</h3><p>Babies with spina bifida have a high risk of developing a latex sensitivity or allergy. It is important to make sure that products such as gloves, catheters and soothers do not contain latex.</p><h3>Tethered cord</h3><p>In children with spina bifida, sometimes the spinal cord gets stuck at the site where the vertebrae have not closed completely. This is called a <a href="/Article?contentid=861&language=English">tethered cord</a>.</p><h2>Looking ahead</h2><p>Babies born with spina bifida require ongoing assessment as they grow and develop. They will be followed by a number of different medical teams. Some children may be in special spina bifida clinics.</p><h2>Resources</h2><p>There are many resources available to help you learn more about spina bifida.</p><p>Spina Bifida and Hydrocepahlus 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 http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf.</p>https://assets.aboutkidshealth.ca/akhassets/spina_bifida_V2_EN.jpgSpina bifidaFalse

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