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Some babies are born with a neural tube defect called spina bifida. A baby has spina bifida when the bones of the spine – the vertebrae – don't form properly around the spinal cord. The result can be a mild or severe form of the condition.
The mild form is the most common, and usually shows itself only through a dimple, birthmark or hairy patch on a person's back. It seldom causes problems or needs treatment.
In a more severe form – called meningocele – fluid leaks out of the spine and pushes against the skin. While a bulge in the skin may be present, there are no other symptoms in many cases. Babies with this condition can have health problems if the nerves around the spine are damaged. For example, if the nerves that control the release of the bowels or bladder are affected, it may be difficult for a child to control these body functions. They also might have trouble moving certain muscles (paralysis). The degree of paralysis depends on where the meningocele is in the spine. The higher the opening is on the back, the more severe the paralysis can be.
The rarest and most severe form of the condition is myelomeningocele. In these cases, parts of the spinal nerves push out of the spinal canal, and the nerves are often damaged. Sometimes the baby's skin is open, exposing the nerves.
Depending on the severity of the defect and where it is on the spine, symptoms vary. Mild defects may cause few or no problems, while more severe defects can cause serious problems, including weakness, loss of bladder control, or paralysis.
Spina bifida can affect anyone, but it is more common among whites, Hispanics and girls.
Other risk factors for spina bifida include:
- A family history of neural tube defects.
- Couples who've had a child with a neural tube defect have a slightly higher chance of having another baby with the same problem.
- Women who were born with a neural tube defect, or have a close relative with one, have a higher chance of passing this on to their child.
- A folate (the natural form of vitamin B-9) deficiency in the mother.
- To prevent folate deficiencies, doctors recommend that pregnant women take folic acid, the synthetic form of vitamin B-9.
- Folic acid can be taken as a pill but is also added to some foods.
- A mother who is obese.
A mother who has diabetes that is not well controlled.
Experts don't know exactly what causes spina bifida. However, based on risk factors, experts think both heredity and environment play a role.
Most children with the mildest form of spina bifida have no symptoms. Many times, even children with meningocele do not have symptoms. However, children with the most severe form of spina bifida often have serious complications, including:
- Little or no feeling in their legs, feet or arms. They may not be able to move the affected limbs.
- Bladder or bowel problems, such as leaking urine or having a hard time passing stools.
- Fluid buildup in the brain (hydrocephalus). Even when treated, the condition can cause seizures, learning problems or vision problems.
- Orthopedic problems such as deformed feet, uneven hips and a curved spine.
Expectant parents may be able to find out if a baby has spina bifida by taking certain prenatal tests.
The alpha-fetoprotein (AFP) test is a blood test done between the 16th and 18th weeks of pregnancy. This test measures how much AFP, which the fetus produces, has passed in the mother's bloodstream. If the amount is high, a repeat test may be done to make sure that the result is correct. If the second result is high, it could mean that a baby has spina bifida. In this case, other tests will be done to double-check and confirm the diagnosis.
In most cases of spina bifida aperta, doctors can see the defect on a prenatal ultrasound. Amniocentesis also can help determine whether a baby has spina bifida. A needle is inserted through the mother's belly and into the uterus to collect fluid that is tested for AFP.
Usually, spina bifida occulta is not found until after a baby is born. To diagnose the condition in these cases, doctors may do an ultrasound on younger babies (less than 3 months old). For older babies, and to confirm results in younger babies, doctors may rely on a fetal magnetic resonance imaging (MRI) scan or computed tomography (CT) scan.
Treatment for urologic and bowel disorders and complications caused by spina bifida, depends on its severity of your child's diagnosis. Because spina bifida can involve many different body systems, like the nervous and skeletal systems, your child may need support from a team of medical professionals. Our urology team works closely with neurosurgeons, orthopedic surgeons, physical and occupational therapists and social workers.
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If your child has been diagnosed, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices.