Question

Spina Bifida is a neurologic tube defect that occurs between 26 and 30 days of gestation. What are frequent physical consequences of the lesion occurring in the thoracic of the spine?

		Lack of ambulation, loss of sensation, lack of bladder control
		Anemia, obesity
		Hyperactivity, seizures

AAP utilizes specific criteria for diagnosing failure to thrive. Of the following four criterion, SELECT TWO criteria that the AAP would select for this diagnosis: (select 2 answers)

		Breastfed infant lacks appropriate latch and sufficient emptying of the breast. Formula fed infant lacks sufficient emptying of the bottle.
		The weight falls less than two standard deviations below the mean for sex- and age-matched.
		Weight-for-age declined across more than two major percentile lines after having achieved a previously stable pattern.
		Signs and symptoms of neglect are presented.

Poor elderly people have reduced intake of high quality protein that leads to

		poor wound healing
		loss of weight
		thinning of hair
		spoon-shaped nails

Answer 1

Frequent physical consequences of the lesion occurring in the thoracic of the spine are

• Walking and mobility problems. The nerves that control the leg muscles don't work properly below the area of the spina bifida defect. This can cause muscle weakness of the legs and sometimes paralysis. Whether a child can walk typically depends on where the defect is, its size, and the care received before and after birth.
• Orthopedic complications. Children with myelomeningocele can have a variety of problems in the legs and spine because of weak muscles in the legs and back. The types of problems depend on the location of the defect. Possible problems include orthopedic issues such as:
  • Curved spine (scoliosis)
  • Abnormal growth
  • Dislocation of the hip
  • Bone and joint deformities
  • Muscle contractures
• Bowel and bladder problems. Nerves that supply the bladder and bowels usually don't work properly when children have myelomeningocele. This is because the nerves that supply the bowel and bladder come from the lowest level of the spinal cord.
• Accumulation of fluid in the brain (hydrocephalus). Babies born with myelomeningocele commonly experience accumulation of fluid in the brain, a condition known as hydrocephalus.
• Shunt malfunction. Shunts placed in the brain to treat hydrocephalus can stop working or become infected. Warning signs may vary. Some of the warning signs of a shunt that isn't working include:
  • Headaches
  • Vomiting
  • Sleepiness
  • Irritability
  • Swelling or redness along the shunt
  • Confusion
  • Changes in the eyes (fixed downward gaze)
  • Trouble feeding
  • Seizures
• Chiari malformation type II. Chiari malformation (kee-AH-ree mal-for-MAY-shun) type II is a common brain abnormality in children with the myelomeningocele type of spina bifida. The brainstem, or lowest part of the brain above the spinal cord, is elongated and positioned lower than usual. This can cause problems with breathing and swallowing. Rarely, compression on this area of the brain occurs and surgery is needed to relieve the pressure.
• Infection in the tissues surrounding the brain (meningitis). Some babies with myelomeningocele may develop meningitis, an infection in the tissues surrounding the brain. This potentially life-threatening infection may cause brain injury.
• Tethered spinal cord. Tethered spinal cord results when the spinal nerves bind to the scar where the defect was closed surgically. The spinal cord is less able to grow as the child grows. This progressive tethering can cause loss of muscle function to the legs, bowel or bladder. Surgery can limit the degree of disability.
• Sleep-disordered breathing. Both children and adults with spina bifida, particularly myelomeningocele, may have sleep apnea or other sleep disorders. Assessment for a sleep disorder in those with myelomeningocele helps detect sleep-disordered breathing, such as sleep apnea, which warrants treatment to improve health and quality of life.
• Skin problems. Children with spina bifida may get wounds on their feet, legs, buttocks or back. They can't feel when they get a blister or sore. Sores or blisters can turn into deep wounds or foot infections that are hard to treat. Children with myelomeningocele have a higher risk of wound problems in casts.
• Latex allergy. Children with spina bifida have a higher risk of latex allergy, an allergic reaction to natural rubber or latex products. Latex allergy may cause rash, sneezing, itching, watery eyes and a runny nose. It can also cause anaphylaxis, a potentially life-threatening condition in which swelling of the face and airways can make breathing difficult. So it's best to use latex-free gloves and equipment at delivery time and when caring for a child with spina bifida.
• Other complications. More problems may arise as children with spina bifida get older, such as urinary tract infections, gastrointestinal (GI) disorders and depression. Children with myelomeningocele may develop learning disabilities, such as problems paying attention, and difficulty learning reading and math

Breastfed infant lacks appropriate latch and sufficient emptying of the breast. Formula fed infant lacks sufficient emptying of the bottle

The weight falls less than two standard deviations below the mean for sex- and age-matched.