SPINA BIFIDA AND

NEWBORN RESPIRATORY
DISTRESS SYNDROME
Prepared by: Leonida R. Carolino
Spina Bifida (Newborn)
What is Spina Bifida?
- When a baby's spine and
spinal cord don't develop
properly in the womb, causing a
gap in the spine.
Spina Bifida (Newborn)
It is a type of neural tube
defect.
Neural Tube is a structure that
eventually develops into the
baby's brain and spinal cord. It
is form in early pregnancy and
closes about 4 weeks after
conception.
Spina Bifida (Newborn)
When the neural tube doesn’t
close all the way, the backbone
that protects the spinal cord
doesn’t form and close as it
should that often results in
damage to the spinal cord and
nerves.
Spina Bifida (Newborn)
Risk Factor!
LACK OF FOLIC ACID before and in early
stage of pregnancy.
TYPES OF SPINA BIFIDA
 Myelomeningocele
The most severe type of spina
bifida; the baby's spinal canal
remains open along several vertebrae
in the back, allowing the spinal cord
and protective membranes around it to
push out and form a sac in the baby.
It causes moderate to severe
disabilities such as problems
affecting how the person goes to the
bathroom, loss of feeling in the
person’s legs or feet, and not being
able to move the legs.
 Meningocele
Another serious type
of spina bifida where the
protective membranes around the
spinal cord (meninges) push out
through the spine; the spinal
cord usually develops normally
so surgery can often be used to
remove the membranes without
damaging the nerves . It can
cause minor disabilities.
 Spina Bifida Occulta
The most common and mildest
type of spina bifida; or more
vertebrae don't form properly,
but the gap in the spine is
very small; spina bifida
occulta doesn't usually cause
any problems and most people
are unaware that they have it.
It is sometimes called
“hidden” spina bifida.
 Symptoms
 Spina Bifida Occulta the most
obvious sign might be a tuft
of hair or a birthmark at the
site of the defect.
 Meningocele and
Myelomeningocele, you can see the
sac poking through the infant’s
back. In the case of Meningocele,
there may be a thin layer of skin
over the sac.
 In most cases of
SPINA BIFIDA, surgery
can be used to close
the opening in the
spine.
The nervous system will usually
have been damaged, which can
lead to problems such as:
weakness or total paralysis of the
legs
bowel incontinence and urinary
incontinence
loss of skin sensation in the legs
and around the bottom – the child is
unable to feel hot or cold, which can
lead to accidental injury
Many babies will have or
develop hydrocephalus (a
build-up of fluid on the
brain), which can
further damage the
brain.
Causes Spina Bifida
(Newborn) :
low folic acid intake during
pregnancy
having a family history of
spina bifida
medication – taking certain
medications during pregnancy
has been linked to an increased
risk of having a baby with
spina bifida.
 Blood test
A sample of the
mother’s blood is tested to
see if it has a certain
protein the baby makes called
AFP.
If the level of AFP is very
high, it could mean the baby
has spina bifida or another
neural tube defect.
 Ultrasound
High-frequency sound
waves bounce off tissues in
your body to make black-
and-white pictures of the
baby on a computer monitor.
If your baby has spina
bifida, you may see an open
spine or a sac poking out
of the spine.
 Amniocentesis
If the blood test shows a high
level of AFP but the ultrasound
looks normal, your doctor may
recommend amniocentesis. This is
when your doctor uses a needle to
take a small amount of fluid from
the amniotic sac around the baby.
If there’s a high level of AFP in
that fluid, that means the skin
around the baby's sac is missing
and AFP has leaked into the
amniotic sac.
 Tests After Birth
Once the baby is born, a
number of tests may be
carried out to assess the
severity of the condition
and help decide which
treatments are appropriate.
Tests may include
monitoring your child's head growth and
carrying out a brain scan, using
an ultrasound scan, CT scan or MRI scan,
to check for hydrocephalus (excess fluid
on the brain)
ultrasound scans of the bladder and
kidneys to check whether your baby stores
urine normally
an assessment of your baby's movements to
check for paralysis
In most cases, surgery to repair the
spine will be recommended soon after your
baby is born.
 Treatment
Treatments for the symptoms or
conditions associated with spina bifida
include:
surgery soon after birth to close the
opening in the spine and treat
hydrocephalus
therapies to help make day-to-day life
easier and improve independence, such
as physiotherapy and occupational therapy
assistive devices and mobility
equipment, such as a wheelchair,
or walking aids
treatments for bowel and urinary
problems
Preventions!
Take folic acid supplements
before and during pregnancy.
Preventions!
Eat foods that contain folate
(the natural form of folic
acid), such as broccoli, spinach
and chickpeas. Folic acid is
also in dark green vegetables,
egg yolks, and some fortified
breads, pastas, rice,
and breakfast cereals.
Avoid overheating your body, as
might happen if you use a hot
tub or sauna.
Preventions!
Talk to your doctor about any
prescription and over-the-counter
drugs, vitamins, and dietary or
herbal supplements you are
taking.
 If you have a medical
condition―such
as diabetes or obesity―be sure it
is under control before you
become pregnant.
Newborn Respiratory
Distress Syndrome
Newborn Respiratory Distress
Syndrome
• Newborn respiratory
distress syndrome (NRDS)
happens when a baby's
lungs are not fully
developed and cannot
provide enough oxygen,
causing breathing
difficulties.
Newborn Respiratory Distress
Syndrome
• A breathing disorder of premature newborns in
which the air sacs (alveoli) in a newborn’s
lungs do not remain open because the production
of a substance that coats the alveoli
(surfactant) is absent or insufficient.
• This disease is mainly confined to premature
babies. Insufficient surfactant leads to
alveolar collapse; re-inflation with each breath
exhausts the baby, and respiratory failure
follows.
• Hypoxia leads to decreased cardiac output,
hypotension, acidosis and renal failure. It is
the
major cause of death from prematurity.
Newborn Respiratory Distress
Syndrome
It's also known as infant
respiratory distress syndrome,
hyaline membrane disease or
surfactant deficiency lung
disease. It usually occurs when
the baby's lungs have not produced
enough surfactant.
Newborn Respiratory Distress
Syndrome
Surfactant is made up of
proteins and fats, helps
keep the lungs inflated and
prevents them collapsing.
Newborn Respiratory Distress
Syndrome
A baby normally begins
producing surfactant sometime
between weeks 24 and 28 of
pregnancy. Most babies produce
enough to breathe normally by
week 34.
Newborn Respiratory Distress
Syndrome
Risk factors:
 Preterm babies ( 91%risk if born at
23–25 weeks; 52% risk if 30–31
weeks.)
 Maternal diabetes,
 Male babies,
 2nd twin,
 Caesarean deliveries.
Newborn Respiratory Distress
Syndrome
Symptoms of NRDS
 Respiratory distress shortly after birth
(within first 4 hours)
 tachypnea ( respiratory rate >60/min)
 grunting
 nasal flaring
 cyanosis
 Chest retractions (pulling in at the ribs and
sternum during breathing)
• *Chest X ray shows diffuse granular patterns
(ground glass appearance) ± air bronchograms.
Newborn Respiratory Distress
Syndrome
Differential Diagnosis
 Transient tachypnea of the newborn (TTN) is
due to excess lung fluid. It usually
resolves after 24 hours.
 Meconium aspiration ;
 Congenital pneumonia (group B strep);
 Tracheo-oesophageal fistula (suspect if
respiratory problems after feeds);
 Congenital lung abnormality;
 Sepsis.
Newborn Respiratory Distress
Syndrome
Treating NRDS
The main aim of treatment for NRDS
is to help the baby breathe.
Newborn Respiratory Distress
Syndrome
Treatment before birth
 If you're thought to be at risk of giving
birth before week 34 of pregnancy,
treatment for NRDS can begin before birth.
 You may have a steroid injection before
your baby is delivered. A second dose is
usually given 24 hours after the first.
 The steroids stimulate the development of
the baby's lungs.
 You may also be offered magnesium sulphate
to reduce the risk of developmental
problems linked to being born early.
Newborn Respiratory Distress
Syndrome
If you take magnesium sulphate for
more than 5 to 7 days or several
times during your pregnancy, your
newborn baby may be offered extra
check because prolonged use of
magnesium sulphate in pregnancy
has in rare cases been linked to
bone problems in newborn babies.
Newborn Respiratory Distress
Syndrome
Treatment after the birth
 If the symptoms are mild, they may
only need extra oxygen. It's usually
given through an incubator or tubes
into their nose.
 If symptoms are more severe, your
baby will be attached to a breathing
machine (ventilator) to either
support or take over their breathing.
Newborn Respiratory Distress
Syndrome
Treatment:
 Delay clamping of cord by 3 min to
promote placento–fetal transfusion.
 Wrap up to keep warm and take to NICU
incubator.
 If gestation is less than or equal to
26 weeks, intubate and give
prophylactic surfactant via ET tube ±
2 further doses if ongoing O2 demand
or ventilation requirement.
Newborn Respiratory Distress
Syndrome
 Give oxygen via an oxygen–air
blender, using lowest concentration
of O2 possible provided there is an
adequate heart rate response.
 If spontaneously breathing stabilize
with CPAP (5–6cm H2O).
 Babies at high risk of RDS should get
natural surfactant (reduces mortality
and air leaks).
Newborn Respiratory Distress
Syndrome
 Rock gently to aid spread in the
bronchial tree.
 Monitor O2, as needs may suddenly
decrease.
 Aim for saturations between 85–93% to
reduce risk of retinopathy of
prematurity and broncho-pulmonary
dysplasia.
Newborn Respiratory Distress
Syndrome
Some centers give a dose of
surfactant then extubate pending
developments; others keep the
baby intubated and extubate as
tolerated.
If blood gases worsen, intubate
and support ventilation before
fatigue sets in.
Newborn Respiratory Distress
Syndrome
Fluids: Give 10% glucose
intravenously.
Nutrition: Get help. Inositol is
an essential nutrient promoting
surfactant maturation and plays
a vital role in neonatal life.
Supplementing nutrition of
premature babies with inositol
reduces complications.
Newborn Respiratory Distress
Syndrome
Full parenteral nutrition can
be started on day 1.
Minimal enteral feeding can
also be started on day 1.
Newborn Respiratory Distress
Syndrome
Prevention
Betamethasone or dexamethasone should
be offered to all women at risk of
preterm delivery from 23–35 weeks.
Mothers at high risk should be
transferred to perinatal centers with
experience in managing RDS.
• Additional Resources

https://drive.google.com/open?id=1k555Y-
CKIYHidsRQNTvz3eqEGxx6sOsR

https://drive.google.com/open?id=1f_PSudt5yykFwti2gOFEFA
sFDfJAZgiZ

https://drive.google.com/open?id=1VhNx0wLcF2-
7xWC6p3m8UgeQdD5K6crF