Spina Bifida and Osteoporosis - Sep

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Boise State University *

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Medicine

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Apr 3, 2024

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1 Spina Bifida and Osteoporosis Scenario A  Spina Bifida – An ultrasound of a nineteen-week gestation fetus demonstrates spina bifida. Answer the following questions:  What is the etiology for this disorder? Spina bifida is a birth defect of the neural tube (when the spine and spinal cord don't form properly). The neural tube is the structure in a developing embryo that eventually becomes the baby's brain, spinal cord and the tissues that enclose them. Normally, the neural tube forms early in pregnancy, and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube doesn't close or develop properly, causing problems in the spinal cord and in the bones of the spine. The medical community theorizes what causes spina bifida. The cause of spina bifida is thought to result from a combination of genetic, nutritional and environmental risk factors, such as a family history of neural tube defects and folate (vitamin B-9) deficiency ( Spina Bifida , 2022)  What are the steps that can be taken toward potential prevention of this disorder? Doctors recommend taking folic acid (in supplement form) starting at least one month before conception and continuing through the first trimester of pregnancy, greatly reduces the risk of spina bifida and other neural tube defects ( Spina Bifida , 2022). Having enough folic acid in your system by the early weeks of pregnancy is critical to prevent spina bifida. Because many women don't discover that they're pregnant until this time, experts recommend that all women of childbearing age take a daily supplement of 400 micrograms (mcg) of folic acid. Examples of foods containing 400 mcg of folic acid per

2 serving, include: enriched bread, pasta, rice, and some breakfast cereals ( Spina Bifida , 2022).  Why are these effective? The human body doesn't absorb folate as easily as it absorbs synthetic folic acid, and most women don't get the recommended amount of folate through diet alone, so vitamin supplements are necessary to prevent spina bifida. Adult women who are planning pregnancy or who could become pregnant should be advised to get 400 to 800 mcg of folic acid a day ( Spina Bifida , 2022). Also, folic acid will also help reduce the risk of other birth defects, including cleft lip, cleft palate and some congenital heart defects ( Spina Bifida , 2022). It's also a good idea to eat a healthy diet, including foods rich in folate or enriched with folic acid / vitamin B. vitamin B is present naturally in many foods, including: beans and peas, citrus fruits and juices, egg yolks, milk, avocados, and dark green vegetables, such as broccoli and spinach ( Spina Bifida , 2022).  What are long term considerations for this child? In other words, what complications might be associated with this disorder? Children with spina bifida (neural tube defects) have varying degrees of central nervous system problems as well as difficulties with bladder and bowel control and lower limb movement ("Spina Bifida," 2022, p. 1628). A person suffering from spina bifida can move around in different ways. This may include walking without any aids or assistance; walking with braces, crutches or walkers; and using wheelchairs ( Spina Bifida , 2023). People with spina bifida that occurs higher on the spine (near the head) might have paralyzed legs and use wheelchairs. Those with spina bifida lower on the spine (near the hips) might have more use of their legs and use crutches, braces, or walkers, or they might be able to walk without these devices

3 ( Spina Bifida , 2023). People with spina bifida often cannot control when they go to the bathroom. They also can develop urinary tract infections ( Spina Bifida , 2023). It is important to develop a plan for going to the bathroom that works and is as simple as possible. This can lead to increased health, participation, and independence, and avoid embarrassment for people with spina bifida. Healthcare providers can help develop a plan for each person. A tube (catheter) inserted in the bladder can help drain urine. In some cases, extra fiber can be added to the diet to keep bowel movements regular. Surgery also might be recommended ( Spina Bifida , 2023). Throughout this newborn’s whole life (childhood through adulthood) living with spina bifida, this person may have limited feeling in some areas of their body, leaving them unable to feel cuts, bruises, sores, and dry skin. Since a child/adult with spina bifida may not know they have been hurt, they may be unable to tell a parent or caregiver that they need help ( Spina Bifida , 2023). Pressure sores occur when there is prolonged pressure on soft tissue, skin, and muscle. Healthcare professionals report skin wounds as one of the primary diagnoses associated with the hospitalization1 of people with spina bifida. Pressure sores can lead to infection, amputation, or even death ( Spina Bifida , 2023). By checking skin regularly for redness including under braces, people with spina bifida, along with their parents and caregivers, can identify skin problems before they become pressure sores ( Spina Bifida , 2023).  What are the potential treatment options? Why might these be necessary? I work at Yale New Haven Health where, in conjunction with the Yale School of Medicine, have one of the leading Fetal Care Centers and Pediatric Spina Bifida programs in the world. Treatment for spina bifida depends on the type and severity of the condition ( Pediatric Spina Bifida Program , 2023). At Yale, fetal surgery for spina bifida usually occurs in the

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