Myelomeningocele (children)
Alternative names:
spina bifida
Treatment:
The goals of initial treatment are to reduce the amount of neurologic damage caused by the defect, to minimize complications such as infection, and to aid the family in coping with the disorder. Follow-up neurologic testing as the child gets older helps to guide rehabilitation.
Early surgical repair of the defect is usually recommended, although surgical repair may be performed later to allow the infant to tolerate the procedure better.
Before surgery, the infant must be handled carefully to reduce damage to the exposed spinal cord. This may include positioning, protective devices, and modifications in the methods of handling, feeding, bathing, and caring for the infant.
Antibiotics may be used aggressively to treat or prevent meningitis, urinary tract infections, or other infections.
Gentle downward pressure over the bladder may aid in drainage of the bladder. In severe cases, indwelling or intermittent bladder drainage catheters may be needed. A diet high in fiber, and bowel training programs, may improve bowel function. Orthopedic intervention or physical therapy may be needed to treat musculoskeletal symptoms. Other neurologic losses are treated according to the type and extent of the loss of function. The goal of these interventions is to minimize future disability and maximize functioning.
Occasionally, surgical shunting to correct hydrocephalus causes the myelomeningocele to spontaneously reduce, and normal growth of the child may cover the defect.
Counseling and support groups (such as the spina bifida - support group) may help families to cope with the disorder.
Genetic counseling may be recommended. In some cases where severe defect is detected early in the pregnancy, therapeutic abortion may be considered.
Expectations (prognosis):
The defect of myelomeningocele can usually be surgically corrected. With treatment, length of life is not severely affected. Neurologic damage is often irreversible.
Complications:
Calling your health care provider:
Call your health care provider if a protrusion is present on the spine of a newborn infant.
Call for an appointment with your health care provider if the child is late in walking or crawling.
Follow-up monitoring should be ongoing as the child ages to assess extent of neurologic damage, symptoms of complications occur. Symptoms of hydrocephalus include bulging soft spots (fontanelles), irritability, lethargy, and difficulty feeding. Symptoms of meningitis include fever, stiff neck (unwillingness to bend or move neck/head), irritability, and a high-pitched cry.
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