Spinal Where Skin Does Not Have Cover in Babies

What is a myelomeningocele?

A myelomeningocele (pronounced my-elo-men-IN-go-seal) is a defect of the courage (spine) and spinal cord. Before birth, the baby'southward spine, the spinal string and the spinal culvert practise not form or shut unremarkably.

A myelomeningocele is the most serious form ofspina bifida.

In babies with myelomeningocele:

• The bones of the spine (vertebrae) do not form the normal style.
• A pocket-size sac extends through an opening in the spine. A membrane covers the sac.
• The sac holdscerebrospinal fluid (CSF) and tissues that protect the spinal cord (meninges).
• The sac may too contain parts of the spinal cord and nerves.

Sometimes the sac opens up. It can open up because of normal movements of your infant, either earlier or during birth.

A myelomeningocele can happen anywhere along the spinal string. It is most common in the lower back (lumbar and sacral areas). There is nerve harm below the level of the myelomeningocele. Equally a result of the nerve damage, babies may accept symptoms.

Babies with myelomeningoceles lower in the spine have less severe symptoms. Babies with higher myelomeningoceles have more severe symptoms.

Myelomeningocele in Children

Myelomeningoceles are present when a child is born (congenital). Nearly 1 to 5 children in every 1,000 born in the United States take a myelomeningocele. The condition develops during the third week of a woman'due south pregnancy.

Doctors practice not know exactly what causes myelomeningoceles. Evidence suggests genes may play a role, but the office is non potent. If a woman has one kid with a myelomeningocele, there is a less than half-dozen% run a risk that she will accept other children with the condition.

We practise know what can help prevent myelomeningoceles. Early in pregnancy, it is very important for women to get enoughfolic acrid in their diets. This vitamin helps the babe's neural tube develop properly. The neural tube develops into the infant's encephalon and spinal cord. Neural tube defects like myelomeningocele accept become less common as doctors have learned nigh the link with folic acid and as more than women have taken folic acid supplements during pregnancy.

Myelomeningocele at Seattle Children'due south

Seattle Children'southward has been a leader for 50 years in providing consummate, coordinated care for children with myelomeningoceles. These children often have other complex problems along with their spinal defect and need many types of care as they abound up. Our neurosurgeons shut the hole in your baby's back and piece of work closely with experts from other medical fields – similar Urology, Neurodevelopmental and Orthopedics – to make sure your kid gets all the care they need.

Doctors in our community usually observe myelomeningoceles during exams before the baby is built-in. They refer most 20 babies with a myelomeningocele to Seattle Children's each year. Usually, the babies are transferred from the infirmary where they are born to Seattle Children's shortly after their birth. Our neurosurgeons close the defect, usually within 24 to 48 hours of nascency. If your newborn is critically ill due to myelomeningocele, we provide specialized care in our Neuro NICU – the only neonatal neurocritical care program in Washington, Wyoming, Alaska, Montana and Idaho.

If you are meaning and your physician detects that your baby has a myelomeningocele, yous tin come to Seattle Children's Prenatal Diagnosis and Treatment Program for an evaluation. Our doctors will consult on what handling your baby might need and what to expect.

In some cases, the defect can exist closed before your baby is born. Families in our region who are interested in learning more than near surgery during pregnancy are encouraged to contact centers of their pick in other states. Seattle Children'due south Prenatal Diagnosis and Treatment Programme will then work with the heart of your choice to facilitate care collaboration. In some cases, it is possible to return to Seattle for delivery. Seattle Children's would remain the center for the infant'southward long-term health care related to spina bifida regardless of delivery location.

Most children with a myelomeningocele develop hydrocephalus. Neurosurgeons at Seattle Children'due south have a great bargain of feel putting in shunts, a mutual treatment for hydrocephalus. Nosotros too have a lot of experience treating children with the related problems of tethered spinal cord, Chiari malformation and syringomyelia.

"Out of all the priceless gifts our care teams have given usa, at that place's 1 that sustains u.s.a.: the simple belief that our son has boundless potential." Malachi was diagnosed with myelomeningocele when his mom, Whitney, was 19 weeks pregnant. In the starting time days of his life, Malachi fought through disquisitional brain, spinal and centre surgeries. He got the expert care he needed when specialists came together at Seattle Children's – the but nationally ranked, standalone children'southward hospital in the region. Today, he's thriving. Read Malachi's story.

Symptoms of Myelomeningocele

A infant with a myelomeningocele has a sac belongings parts of the spinal string sticking though their dorsum. The baby is missing function, like movement or awareness, beneath the level of the problem. The higher the myelomeningocele is on the baby's spinal string, the more than function is missing.

Myelomeningocele tin cause symptoms that include:

• Issues moving parts of the body below the opening in the back
• Lack of awareness in their legs and feet
• Poor or no bowel and float control
• Twisted or abnormal legs and feet; for instance, clubfoot
• Also much cerebrospinal fluid in the head (hydrocephalus)
• Bug with how the dorsum of the encephalon formed (Chiari ii malformation)
• Learning differences or delayed milestones (impaired cognitive development)

Diagnosing Myelomeningocele

Your doctor may find the status before your babe is born. Significant women may have a blood test called the quadruple screen to check for signs of certain weather. If the test shows yous accept high levels of a protein (maternal blastoff fetoprotein, AFP) in your blood, your developing baby might takespina bifida. You may have other tests to brand sure of the diagnosis. These include:

• Ultrasound
• Amniocentesis

Seattle Children's Prenatal Clinic sees pregnant women whose doctors accept constitute a myelomeningocele. Our doctors can consult with yous nigh what to wait and what treatment your baby might need.

Doctors too notice myelomeningoceles later a baby is born. The infant may have imaging tests that let doctors see the spine. They include:

• X-ray
• Ultrasound
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)

Treating Myelomeningocele

As children born with a myelomeningocele grow, they virtually likely volition need treatment such as medicines and physical therapy. Some may need aids like braces, crutches or wheelchairs. Soon afterward nascency, even so, handling for your infant is surgery.

Surgery for Myelomeningocele

The child is in position for repair of his spina bifida.

At Seattle Children'southward, our expert neurosurgeons and plastic surgeons work together to practise surgery to embrace your babe's spinal string inside your babe'southward first 48 hours of life to:

• Limit the chance of infection
• Foreclose more harm to the spinal cord

The surgery does not help your baby develop office that they were not born with.

First, the neurosurgeon closes the covering around the spinal cord (dura mater). Then the neurosurgeon and plastic surgeon close the muscles effectually the spinal cord. Finally, they close the peel over the open area. The plastic surgeon may demand to have a piece of peel from your baby's back or bottom to brand a flap (peel graft) to close the open surface area.

Closing the spinal cord defect in spina bifida.

Many babies with a myelomeningocele also take too much cerebrospinal fluid in their heads (hydrocephalus). If your baby has severe hydrocephalus at birth, they may need surgery for a temporary bleed in the first few days later nativity. If a temporary drain is used, a neurosurgeon will place a long-term shunt when your infant is stable.

If your baby does not have hydrocephalus at nascence, doctors wait to see if information technology develops subsequently. If so, neurosurgeons put in a shunt at that time.

Not all babies with a myelomeningocele demand a shunt. Near babies who need a shunt get information technology 4 to 8 weeks after nascence.

Fetal surgery

In some cases, neurosurgeons can shut the defect earlier the baby is born (in utero closure or fetal closure). The surgery is done around the 24th week of pregnancy. Families in our region who are interested in learning more well-nigh surgery during pregnancy are encouraged to contact centers of their pick in other states. Families tin review specifics of the process and acquire more well-nigh whether they would authorize. Seattle Children's Prenatal Diagnosis and Treatment Program will then work with the center of your choice to facilitate records sharing and care collaboration. In some cases it is possible to render to Seattle for delivery. Regardless of commitment location, Seattle Children'southward would remain the center for the baby's long-term wellness care related to spina bifida.

If your doctor detects that your baby has a myelomeningocele before nascence, you can come to Seattle Children's Prenatal Diagnosis and Treatment Program for an evaluation. Our doctors can consult with you almost what to expect and what treatment your baby might demand.

Ongoing Care

Some children with myelomeningoceles accept other conditions, like hydrocephalus, tethered spinal string, Chiari malformationand syringomyelia, that need handling.

Often, children with myelomeningoceles have other circuitous problems related to their nervous systems, such every bit bug with movement, lack of awareness, and lack of bowel and bladder control. These problems may crave long-term care.

Each kid is different, and we will tailor your child's treatment to their needs. Your child'southward neurosurgeon will work closely with other experts at Seattle Children'due south to appraise all your child's needs and provide long-term coordinated intendance.

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Source: https://www.seattlechildrens.org/conditions/myelomeningocele/

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