1. Prenatal Surgery
In recent years, doctors have been experimenting with operating on fetuses with spina bifida between the nineteenth and twenty-fifth week of gestation while still in utero. The benefit of prenatal surgery is that it allows doctors to correct spinal abnormalities before the trauma of the birth process. The goal is to prevent the nerve damage that occurs after birth, before postnatal corrective surgery can be performed and to reduce the risk of infection. These surgeries are rare and only performed in specialized medical centers. To date, long-term benefits of prenatal surgery for spina bifida has not been determined. Additionally, prenatal surgery is very risky for both the mother and the fetus. Extremely premature birth and death are significant risks for the fetus.
2. C-Section Birth
When babies are strongly suspected to have spina birth prenatally, arrangements for a scheduled Caesarean section are usually made. A C-section is the safest way to deliver a baby with severe spina bifida because further nerve damage from passing through the birth canal can be prevented. Additionally, a scheduled C-section allows the hospital to have a team of specialized doctors and nurses on hand to receive the baby and provide appropriate care immediately.
3. Corrective Surgery for Newborns
In cases of myelomeningocele spina bifida in which a sac containing spinal nerves and tissues protrudes from the baby's back, surgery is needed to correct the defect. The timing of the surgery is dependent on the baby's health, but doctors generally strive to get the surgery done as soon as possible to minimize the risk of infection. The surgery can be done as soon as 36 to 48 hours after birth or as late as 6 weeks after birth. Additionally, antibiotics are used preemptively to reduce the risk of infection.
4. Treatment for Complications
Spina bifida carries with it a number of complications that require treatment. For example, a child with spina bifida may also have hydrocephalus (fluid around the brain). Installing a shunt from the brain to the abdomen so that the fluid can drain is the primary treatment for hydrocephalus. The shunt is placed surgically and may be needed indefinitely. Additional complications such as bladder and bowel problems, tethered spinal cord, hip and foot deformities and others may require future surgeries and interventions.
5. Ongoing Treatment
Babies diagnosed with myelomeningocele spina bifida will typically need some form of treatment throughout their lives. No matter how early corrective surgery is performed, there is almost always some irreparable nerve damage that results in some level of disability. Physical therapy to strengthen muscles and to learn to walk with braces or crutches is standard. In some cases, a wheelchair may be needed. Spina bifida can also cause some learning difficulties that may need special attention and cause emotional and social problems. Counseling for both the child with spina bifida and other members of the family can help teach coping skills.
