MYELOMENINGIOCELE

PRESENTED BY: REMYA P (NICU)

DEMOGRAPHIC DATA MRN-192979 DATE OF BIRTH:24-12-2012 AGE:NEW BORN GESTATIONAL AGE:38 WEEKS WEIGHT:3.8 KG SEX:FEMALE DIAGNOSIS: OPENED MENINGIOCELE

PHYSICAL ASSESSMENT

GENERAL APPEARANCE Freely moving upper limbs No movement in lower limbs Opened Myelomeningocele in the back

VITAL SIGNS

Temperature:36.8 c Heart rate:138/mtRespiration:52/mt(symmetrical chest

movement)Blood pressure:99/34(62)

ANTHROPROMETRIC MEASUREMENT

Head circumference:34 cm Chest circumference:32 cm Weight:3.8 kg Length:48 cm

SKIN

Pinkish in colourCord clamp tight& cord dryingHair silky &soft with individual strandsLanugo present only in sacral areaOpened Myelomeningocele present in back

&strands of hair present at the back

NOSENostrils patent bilaterally No nasal discharges MOUTH &THROATUvula midlineMinimal salivationTongue moves freely &doesn’t protrudeSucking Rooting Gagging Reflex present

NECKShort &thickTurns easily side to sideEqual anterio posterior lateral diameterEvident Xyphoid Process ABDOMENDome shaped abdomen Soft palpation Well formed umbilical cord Cord dry at backBilateral equal femoral pulsesBowel sounds present on auscultation

GENETALIAMucosal tag is attached to the wall of vaginaLabia majora at term and enlarged EXTREMITIESEqual and bilateral movement &tone in upper

limbs onlyFingers ten&ten toesNegative heel Grasp eflex present only in upper limbsLeg appear bowedPalmar creases presentSole creses absent

PATIENT HISTORY

Mother presented with 38 weeks of gestational ageNo medical history for mother PRESENT MEDICAL HISTORYBaby delivered via LSCS.Baby cried immediately after

birthAPGAR 6/9 at 1-5 monthsBaby is having opened Myelomeningocele on the back      

DISEASE CONDITION

Myelomeningocele is a birth defect in which the backbone &spinal cord do not close before birth .This causes the spinal cord &meanings to stick out the child s back

ETIOLOGY

UnknownLow levels of folic acid in woman s body

before &during early pregnancy is thought to be an important one

SIGNS &SYMPTOMS  A new born may have a sac sticking out of the

mild to lower backLoss of bladder or bowel control Partial or complete lack of sensationPartial or complete paralysis of the legs Weakness of the hips legs or feet of newborn

OTHER SYMPTOMS

Abnormal feet or legs such club footBuild up of fluid inside the skull Hair at the back part of pelvis Dimpling of the sacral area

SIGNS AND TESTS Prenatal screening can help diagnose this

condition .During the second trimester pregnant women can have a blood test called the quadruple screen .This test screens for Myelomeningocele .Down syndrome &other congenital diseases in the baby .Most women carrying a baby with spin bifida will have a higher than normal levels of a protein called maternal alpha feto protein

If the quadruple screen test is positive further testing is needed to confirm the diagnosis .Such tests may include

Pregnancy ultrasound Amniocentesis

TREATMENT(MEDICAL) Genetic counseling may be recommendedIn some cases severe effect is detected a

therapeutic abortion may be consideredAfter birth surgery to repair the defect Before

surgery the infant must be handled carefully to reduce damage to the exposed spinal cord

The children who was hydrocephalus may need a ventricular peritoneal shunt. This will help to drain the extra fluid

COMPLICATIONS

Difficult delivery with problems resulting from a traumatic birth including cerebral palsy &decreased oxygen to the brain

Frequent urinary tract infections Hydrocephalus Loss of bowel or bladder controlMeningitis

NURSING PROBLEMS

Impaired physical mobility Impaired bowel &bladder controlRisk for infection related to rupture or bilateral

invasionRisk for infectionRisk for complication

HEALTH TEACHING

Teach parents about checking head circumference once a week in any hospital

Instruct parents about the importance of regular health care periodic eye examinations &developmental follow up

Before discharge parents should feel comfortable in their abilities to care the infant

Ensure that the family receive information on routine well baby care

Instruct parents about kangaroo care &breast feeding Proper covering of babyHealth teaching regarding the prevention of

hyperthermia hypothermia and infection 

CONCLUSIONPresented a case of full term newborn baby

with opened MyelomeningoceleSurgical repair of meningiomyelocele done on

the 4 th day of lifeAfter 1 month neurosurgeon consultation

done . advise for observe head circumference at present no need for V-P shunt

Vaccinated with BCG &HEP BVitamin A&D once daily for monthFollow up to any MOH hospital after 1 week

BIBLIOGRAPHY

1.Lippincot manual of nursing practice 9th edition

2.Medline pius medical encyclopedia 3.Nelson text book of pediatrics 18th edition