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Jessica Kinsey
Prevention: 70%
Maternal folic acid
supplementation
Image from: http://wiki.cns.org/wiki/index.php/Spina_bifida
Myelomeningocele
Neural Tube Defects1
Anecephaly, encephalocele, spina bifida
Complications
Anecephaly: Failure of fusion in cranial region of
neural tube4
Termination, stillbirths, survive hours-days
Etiology
Occurs at birth, more common in
girls than boys2,3
NTD2,3
High Risk: Hispanic, Caucasian
Low Risk: African American, Asian
Family History1
Siblings of affected individuals 3-8%
Drugs1
Valproic acid and Carbamazepine
Image from:
http://blog.amsvans.com/
adorable-spina-bifidacover-girl-lights-upparents-magazine/
Etiology
Inadequate folic acid1
Increases risk by 2-8x
MTHFR Deficiency2
10% of whites
Image from:
http://www.mountainside
-medical.com/naturesbounty-folic-acid400mcg-tablets.html
Genetics2
Risk Factors1
Labs/Parameters 1,7
Blood tests
Alpha-fetoprotein
Two-dimensional ultrasound
Ability to detect in 79% of cases
Amniocentesis
Remove sample of amniotic fluid
to assess AFP
Diagnostic Tests3
Blood pressure for hypertension for adults if
blood pressure is higher than 120/80
Bone mineral density for osteoporosis
Pressure sore evaluation if necessary
Hematocrit or hemoglobin levels, if anemia is
potential problem
Blood urea nitrogen and other renal issues
evaluated
Glucose tolerance and lipid disorder tests if
overweight
Treatment 1
No treatment until after birth
Caesarean birth may be safer
Surgical Treatment
https://www.youtube.com/watch?v=YG4nrRnAlcc
Common Associations3
Epilepsy occurs in approximately 20%
Urinary tract infections and bowel dysfunction
Due to paralysis and renal problems
Referral to Dietitians3
All children should be seen before age 5
Weekly in infancy
Monthly after age 1 month
Every 3 months after age 1 year
Referral to Dietitians3
Mechanical feeding problems, allergies, diarrhea,
constipation, diabetes, obesity, hypertension, lipid
disorders, food or vitamin/mineral faddism, use of
alternative therapy
Obesity
Major concern after age 4 if the lesion from
myelomeningocele is high and child can no longer
walk
Eating disorders
Food Recall
Indicates individuals ability to make independent
food choices, skill level for tasks like food preparation,
ability to shop, willingness to follow direction
Swallowing difficulty
Condition associated with malformation of brain
Nutrition Treatment3,5
General, healthful diet of nutrient-dense foods
Low calorie
7 kcal/cm of height for minimally active
9-11 kcal/cm of height for highly active
Obesity
Increased fluids
Increased fiber
Bowel issues
Nutrition Treatment3,5
Folic Acid
400 mcg/day depending on lesion and ambulation
Increased protein
Skin impairments and healing
Nutrition Treatment3
Bladder/Renal Issues
Acid ash diet
Latex Allergy
Avoid avocado, kiwi, bananas, water chestnuts,
chickpeas
Recommended Foods3
Lunch:
2 slices whole-wheat
bread, 3 ounces turkey
breast, 1 slice low-fat
cheese
1 cup broccoli
1 cup low-fat vanilla
yogurt
1 apple
3 cups water
Dinner:
Snacks:
Celery and peanut
butter
Apple and carrot sticks
Granola bar
cup almonds
3 cups water
Medications9
Mother: Folate supplementation
Multivitamins
Antibiotics for UTI
Amoxicillin, Trimethoprim
Anticholinergic Drugs 10
Continence, prevention of infection, and preservation
of urinary tract
Independence
Confidence, Self-esteem
Motility/Physical Activity
Urination/Bowel Movements: Incontinence, UTI
Skin complications: Blisters, sores, burns, calluses
Latex allergy
Special Olympics3
Careers3
Encourage careers that do not require
extensive standing/walking
Image from:
http://www.cdc.gov/ncb
ddd/spinabifida/schoolage.html
References
1. Mitchell L, Adzick N, Melchionne J, Pasquariello P, Sutton L, Whitehead A. Spina
bifida. Lancet [serial online]. November 20, 2004;364(9448):1885-1895. Available
from: MEDLINE with Full Text, Ipswich, MA. Accessed October 13, 2014.
2. Frey L, Hauser W. Epidemiology of neural tube defects. Epilepsia [serial online].
2003;44 Suppl 3:4-13. Available from: MEDLINE with Full Text, Ipswich, MA.
Accessed October 15, 2014.
3. Academy of Nutrition and Dietetics. Nutrition Care Manual. Spina Bifida. 2014.
Available at:
http://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&ncm_toc_id=2
55331&ncm_heading=Nutrition%20Care&ncm_content_id=110090#Overview.
Accessed November 11, 2014.
4. Mastroiacovo P, Leoncini E. More folic acid, the five questions: why, who, when, how
much, and how. Biofactors (Oxford, England) [serial online]. July 2011;37(4):272279. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 15,
2014.
5. National Center on Birth Defects and Developmental Disabilities, Center for Disease
Control and Prevention. Living with Spina Bifida: Toddlers and Preschoolers,
Infants, Adolescents and Teens, Young Adults. September 18, 2014. Available at:
http://www.cdc.gov/ncbddd/spinabifida/toddler.html. Accessed October 15, 2014.
References
6. Bower C, Miller M, Payne J, Serna P. Promotion of folate for the prevention of neural tube
defects: who benefits?. Paediatric And Perinatal Epidemiology [serial online]. November
2005;19(6):435-444. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed
October 15, 2014.
7. Araujo Jnior E, Nakano M, Moron A, et al. Comparison between 2D ultrasonography and
magnetic resonance imaging for assessing brain and spine parameters in fetuses with spina
bifida. Archives Of Gynecology And Obstetrics [serial online]. May 2013;287(5):845-849.
Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 15, 2014.
8. American Dietetic Association. Journal of the American Dietetic Association. Position of the
American Dietetic Association: Providing Nutrition Services for People with
Developmental Disabilities and Special Health Care Needs. February 2010. Available at:
http://www.eatright.org/search.aspx?search=spina%20bifida. Accessed November 11,
2014.
9. Zegers B, Winkler-Seinstra P, Uiterwaal C, de Jong T, Kimpen J, de Jong-de Vos van
Steenwijk C. Urinary tract infections in children with spina bifida: an inventory of 41
European centers. Pediatric Nephrology (Berlin, Germany) [serial online]. April
2009;24(4):783-788. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed
October 15, 2014.
10. Ferrara P, D'Aleo C, Salvaggio E, et al. Plasma antidiuretic hormone levels in children with
spina bifida. Urologia Internationalis [serial online]. 2002;68(3):144-147. Available from:
MEDLINE with Full Text, Ipswich, MA. Accessed October 15, 2014.