1. MYELOMENINGIOCELE PRESENTED BY: REMYA P (NICU)

2. DEMOGRAPHIC DATA MRN-192979 DATE OF BIRTH:24-12-2012 AGE:NEW BORN GESTATIONAL AGE:38 WEEKS WEIGHT:3.8 KG SEX:FEMALE DIAGNOSIS: OPENED MENINGIOCELE

3. PHYSICAL ASSESSMENT GENERAL APPEARANCE Freely moving upper limbs No movement in lower limbs Opened Myelomeningocele in the back

4. VITAL SIGNS Temperature:36.8 c Heart rate:138/mt Respiration:52/mt(symmetrical chest movement) Blood pressure:99/34(62)

5. ANTHROPROMETRIC MEASUREMENT Head circumference:34 cm Chest circumference:32 cm Weight:3.8 kg Length:48 cm

6. SKIN Pinkish in colour Cord clamp tight& cord drying Hair silky &soft with individual strands Lanugo present only in sacral area Opened Myelomeningocele present in back &strands of hair present at the back

7. NOSE Nostrils patent bilaterally No nasal discharges MOUTH &THROAT Uvula midline Minimal salivation Tongue moves freely &doesn’t protrude Sucking Rooting Gagging Reflex present

8. NECK Short &thick Turns easily side to side Equal anterio posterior lateral diameter Evident Xyphoid Process ABDOMEN Dome shaped abdomen Soft palpation Well formed umbilical cord Cord dry at back Bilateral equal femoral pulses Bowel sounds present on auscultation

9. GENETALIA Mucosal tag is attached to the wall of vagina Labia majora at term and enlarged EXTREMITIES Equal and bilateral movement &tone in upper limbs only Fingers ten&ten toes Negative heel Grasp eflex present only in upper limbs Leg appear bowed Palmar creases present Sole creses absent

10. PATIENT HISTORY Mother presented with 38 weeks of gestational age No medical history for mother PRESENT MEDICAL HISTORY Baby delivered via LSCS.Baby cried immediately after birth APGAR 6/9 at 1-5 months Baby is having opened Myelomeningocele on the back

11. DISEASE CONDITION Myelomeningocele is a birth defect in which the backbone &spinal cord do not close before birth.This causes the spinal cord &meanings to stick out the child s back

13. ETIOLOGY Unknown Low levels of folic acid in woman s body before &during early pregnancy is thought to be an important one

14. SIGNS &SYMPTOMS A new born may have a sac sticking out of the mild to lower back Loss of bladder or bowel control Partial or complete lack of sensation Partial or complete paralysis of the legs Weakness of the hips legs or feet of newborn

15. OTHER SYMPTOMS Abnormal feet or legs such club foot Build up of fluid inside the skull Hair at the back part of pelvis Dimpling of the sacral area

16. SIGNS AND TESTS Prenatal screening can help diagnose this condition.During the second trimester pregnant women can have a blood test called the quadruple screen.This test screens for Myelomeningocele.Down syndrome &other congenital diseases in the baby.Most women carrying a baby with spin bifida will have a higher than normal levels of a protein called maternal alpha feto protein If the quadruple screen test is positive further testing is needed to confirm the diagnosis.Such tests may include Pregnancy ultrasound Amniocentesis

17. TREATMENT(MEDICAL) Genetic counseling may be recommended In some cases severe effect is detected a therapeutic abortion may be considered After birth surgery to repair the defect Before surgery the infant must be handled carefully to reduce damage to the exposed spinal cord The children who was hydrocephalus may need a ventricular peritoneal shunt. This will help to drain the extra fluid

18. COMPLICATIONS Difficult delivery with problems resulting from a traumatic birth including cerebral palsy &decreased oxygen to the brain Frequent urinary tract infections Hydrocephalus Loss of bowel or bladder control Meningitis

19. NURSING PROBLEMS Impaired physical mobility Impaired bowel &bladder control Risk for infection related to rupture or bilateral invasion Risk for infection Risk for complication

20. HEALTH TEACHING Teach parents about checking head circumference once a week in any hospital Instruct parents about the importance of regular health care periodic eye examinations &developmental follow up Before discharge parents should feel comfortable in their abilities to care the infant Ensure that the family receive information on routine well baby care Instruct parents about kangaroo care &breast feeding Proper covering of baby Health teaching regarding the prevention of hyperthermia hypothermia and infection

21. CONCLUSION Presented a case of full term newborn baby with opened Myelomeningocele Surgical repair of meningiomyelocele done on the 4 th day of life After 1 month neurosurgeon consultation done. advise for observe head circumference at present no need for V-P shunt Vaccinated with BCG &HEP B Vitamin A&D once daily for month Follow up to any MOH hospital after 1 week

22. BIBLIOGRAPHY 1.Lippincot manual of nursing practice 9 th edition 2.Medline pius medical encyclopedia 3.Nelson text book of pediatrics 18 th edition