Spina bifida is a birth defect, which occurs when the spine and spinal marrow are not formed properly. It is a type of neural tube defect. Neural tube defects are some of the most common congenital malformations and involve the non-closure or incomplete closure of the embryonic formation from which the nervous system will be formed (the brain and spinal marrow). Normally, the neural tube is formed at the beginning of pregnancy and closes until the 28th day after conception. In babies with spina bifida, part of the neural tube does not close or develops improperly, causing defects in the spinal marrow and spine.

Spina bifida can vary from mild to severe, depending on the type of defect, size, location and complications.

Signs and symptoms vary depending on type and severity.

In the occult spina bifida (occult means hidden), which is the mildest and most common, there are usually no signs or symptoms because the spinal nerves are not involved. Signs may sometimes appear on the skin of the newborn, above the spinal defect, such as: an abnormal tuft of hair, a small dimple or a birthmark.

In Myelomeningocele, known as the open spina bifida which is the most severe type, the spinal canal remains open along several vertebrae in the lower or middle part of the back. Thus, both the membranes and the spinal marrow or nerves come out at birth, forming a sac. Tissues and nerves are usually exposed, although sometimes the skin covers the sac.

The exact cause is not well known, it’s only assumed that a combination of genetic, nutritional and environmental risk factors would be responsible, such as a family history of neural tube defects and folic acid deficiency.

Risk factors:

1. Folate deficiency
The folate, the natural form of vitamin B-9, is important for the development of a healthy child. The synthetic form, which is found in supplements and fortified foods (foods in which it is found) is called folic acid. A folic acid deficiency increases the risk of spina bifida and other neural tube defects.

2. Some medications
Some medications for epilepsy, such as valproic acid, can cause neural tube defects when taken during pregnancy because it interferes with the body's ability to use folic acid.

3. Diabetes Mellitus
Women with diabetes who do not have well-controlled blood sugar levels, have a higher risk of having a child with spina bifida.

4. Obesity
Obesity before pregnancy is associated with an increased risk of congenital malformations of the neural tube, including spina bifida.

5. Increase in body temperature
Some evidence suggests that, increasing body temperature (hyperthermia) in the first weeks of pregnancy, may increase the risk of spina bifida. Raising the core body temperature, due to fever or using a sauna or hot tub, has been associated with a possible slightly increased risk of spina bifida.

Possible complications do not affect all children and can also be treated. Among the most common, we mention:

1. Walking and mobility problems
The nerves that control the leg muscles do not work properly under the spina bifida defect area. This can cause hypotonia of the muscles of the lower limbs and sometimes even paralysis. The baby's gait depends on where the defect is, its size and the care received before and after birth

2. Orthopedic complications
Children with myelomeningocele may have a variety of problems in the legs and spine due to hypotonic muscles (with low muscle tone) in the lower limbs and back.

3. Intestinal and bladder problems
Nerves that innervate the bladder and intestines usually do not work properly when children have myelomeningocele. This is due to the fact that these nerves, responsible for the innervation of the intestine and bladder, originate in the spinal marrow where the neural tube defect is also located, respectively the spina bifida.

4. Accumulation of fluid in the brain (hydrocephalus)
Babies born with myelomeningocele, frequently suffer from fluid accumulation in the brain, a condition known as hydrocephalus, which, however, can be controlled.

Folic acid, administered as a supplement starting at least one month before conception and continuing in the first trimester of pregnancy, greatly reduces the risk of spina bifida and other neural tube defects.

Since many women do not discover that they are pregnant until after the first weeks of pregnancy, it is recommended that all adult women who want to get pregnant, take a daily supplement of 400 to 1,000 mcg (micrograms) of folic acid.

The consumption of foods that contain folic acid is also recommended, such as: beans, peas, citrus fruits, egg yolks, milk, avocado, broccoli, spinach or foods fortified with folic acid, such as: pasta, rice, some whole grains. The body does not absorb folate (nature form of vitamin B-9 as easily as it absorbs synthetic folic acid and the diet does not usually contain the recommended amount of folate, so vitamin supplements are necessary to prevent spina bifida). If the future mother has spina bifida or if she has previously given birth to a child with spina bifida, additional folic acid is needed before becoming pregnant. Also, if the future mother has diabetes, a higher dose of this vitamin B is needed.

Folic acid also helps reduce the risk of other birth defects.

Talk to a doctor before taking folic acid supplements.

Occult spina bifida often does not need any treatment.

But when necessary, the treatment depends on the severity of the condition. This way you can opt for:

1. Surgery before birth
Nervous function in babies with spina bifida may worsen after birth if spina bifida is not treated intrauterinely, the intervention taking place before the 26th week of pregnancy. Intrauterine surgery can also reduce the risk of hydrocephalus. This specialized surgery should be done only at the medical units that have experience in fetal surgery and a multi-specialized approach of the therapeutic team. Usually, the team includes a fetal surgeon, pediatric neurosurgeon, maternal-fetal medicine specialist, fetal cardiologist and neonatologist.

2. Surgery after childbirth
Myelomeningocele requires surgical intervention, which can help minimize the risk of infection associated with exposed nerves and protect the spinal cord. During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the child's body and covers them with muscles and skin. At the same time, the neurosurgeon can place a … in the child's brain to control hydrocephalus.

Physical therapy is necessary for children with spina bifida to improve motor control.

The objectives of the medical recovery process are established depending on the age of the child and the degree of the affectation, aiming at:

✓ Maintaining a correct posture and balance

✓ Maintaining the joint amplitude through passive and active stretching exercises

✓ Increasing the tone of the abdominal, paravertebral and lower limb muscles, through active exercises and resistive exercises (with light weights, with elastic bands and with medicinal balls)

✓ Improving the function of the upper limb through occupational therapy

The physical therapy program can be complemented by the practice of sports such as swimming.