On Friday, I’ll present about the causes of the spina bifida, the prevalenceofhydrocephalus and prevalence of complications of spina bifida at intermediate and low level of lesion. Syukriah and I will also present about the treatment of the sore footbut we’ll post about this treatment later. Thank you.
Epidemiology of spina bifida
Spina Bifida is a neural tube defect that affects approximately 3,000 pregnancies each year. According to the Spina Bifida Association of America, it is estimated that more than 70,000 people in the United States are living with this birth defect.
Up to 90 % of children with the worst form of spina bifida have hydrocephalus (fluid on the brain) and must have surgery to insert a “shunt” that helps drain the fluid—the shunt stays in place for the lifetime of the person.
In fact, 95 % of neural tube defects (NTDs) occur in women with no personal or family history of NTDs.
A previous NTD-affected pregnancy increases a woman’s chance to have another NTD-affected pregnancy approximately 20 times.
There were 66 children who attended the clinic on a regular basis during that period, with ages ranging from two to 17 years.
None of the children with low level lesions used any appliances; in contrast all children with high level lesions required one, the majority of whom (88.9%) used wheelchairs.
Of the 26 children with intermediate level lesions who required an appliance, 16 (61.5%) used a wheelchair.
Ten (15.2%) children developed skin breakdown at some point during the study period. The incidence of skin breakdown among the children with low level lesions was lower than those with intermediate or high level lesion.
Fifty-three (80%) children had a documented urinary tract infection necessitating treatment at some point during the study period, with similar rates of infection among the three levels of lesions.
Twenty-eight (42.4%) children had hydrocephalus, of whom 25 (89.3%) underwent a shunting procedure in early infancy. Nine (36%) of those shunted had a shunt malfunction (blockage with or without concomitant infection) at some point in life. Children with low-level lesions were less likely to develop hydrocephalus than those with intermediate or high level lesions, but the rates of shunting and shunt complications were similar for children with hydrocephalus in all three groups.
Forty (60.6%) children in the study were of school-going age (Table III). Of these, 25 (62.5%) were attending normal class, 8 (20%) attended either special classes in integrated schools or schools for the handicapped while 7 (17.5%) did not attend school at all.
More children with low-level lesions attended mainstream school (normal or integrated classes) compared to those with intermediate or high- level lesions (93.3% vs 64%), but this did not reach statistical significance (p = 0.059).
The children with high or intermediate-level lesions cited multiple problems (transport problems, inaccessible classrooms and toilets, social stigma of wetting and soiling) as the reasons for not attending school. The sole child with low-level lesion who was not schooling was an adolescent who cited poor academic performance and difficulty with proper toilet access to perform CIC as the reasons for dropping out of school.
Like others(1,4,7), the incidence of hydrocephalus was higher among children with thoracic or lumbar lesions than those with sacral lesions. However, the long-term impact on intellectual ability in these children is determined by the occurrence of shunt dysfunction rather than the presence of hydrocephalus per se.
The cumulative incidence of skin breakdown is known to increase with age
No one knows for sure. Experts think that both genetics (one or more genes) and the person’s environment might interact to cause Spina Bifida.It is possible that a person inherits multiple genes that make them susceptible to having Spina Bifida, but something in the environment triggers the Spina Bifida to develop.
U.S. birth certificate data in this report demonstrate a 24% decline in spina bifida in 2001 births (based on preliminary data) compared with the occurrence of spina bifida in 1996 (before folic acid fortification).
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