Management of myelomeningocele

William E Kaplan

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

During the past 15 years the care of children with spina bifida has advanced in all areas of medicine and simultaneously catalyzed medical ethics debates throughout the world. The incidence of spina bifida is 1 to 1000 live births. The genetics are multifactorial; however, there is a clear familial tendency toward inheritance. Multiple etiologic factors have been implicated, but currently periconceptional vitamin deficiency is in the forefront. The most accepted pathogenesis for myelomeningocele is an abnormality of embryogenesis, specifically, failure of tube closure at 25 to 28 days. Padget has suggested the appearance of a cleft in the neural tube that permits a 'bleb' of proteinaceous material to protrude into surrounding mesoderm and ectoderm. Although the pathologic abnormalities observed at the site of the neuroplaque are the most obvious, profound changes may be noted throughout the entire central and peripheral nervous system. An awareness of these changes contributes to the comprehensive care of the patient. In the last 4 years, the Myelomeningocele Clinic at Children's Memorial Hospital in Chicago actively served 800 children and continues to grow by 100 new patients per year. Fifty of these children are generally newborns either closed at Children's Memorial Hospital or closed and then immediately transferred. It seems clear from this group of children that aseptic technique prior to closure and accurate reconstruction of the cauda equina has improved overall sensorimotor activity. The muldidisciplinary clinic is the best possible approach to evaluate the multitude of factors that affect the newborn and to enable each clinician to best evaluate the child's status during continued growth. Larger clinics can be aided by using computer systems to evaluate data and improve patient care. For the last 4 years, after all of our patient have been assessed, the information has been transmitted to a central computer terminal. Smaller terminals will be available on all hospital floors to ensure accurate and current information on all admissions. In this way, the staff will be able to determine if treatment protocols have been and will be effective.

Original languageEnglish (US)
Pages (from-to)93-101
Number of pages9
JournalUrologic Clinics of North America
Volume12
Issue number1
StatePublished - Jan 1 1985

ASJC Scopus subject areas

  • Urology

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