4Case Presentation PMHx Social Hx Medications : Denies prenatal US ‘Normal’ Prenatal CourseGood ApgarsGood amniotic fluid from birth –per reportSocial HxSmall Town21 yo Non smokerDenied alcohol and illicit drug usageSingle, no childrenMedications :ES Tylenol PRN
5Case PresentationFamily HxNo malignancyROSAs in HPI
6Physical Examination Vitals signs : AFVSS General : NAD GU: uncirc, bilateral testes descendedAbd : ND, no masses, no hepatosplenomegaly. No inguinal hernia, umbilical stump is clearExt : No edema or cyanosis. MAE x 4Back: large patch of irregular tissue at midline
16Incidence and Prevalence 1/1000PrevalenceIncreased incidence in families of Celtic and Irish heritage (genetic or environmental?)Increased incidence in minorities (genetic or environmental?)Increased incidence in families
18Neural Tube Development Normal embryological developmentNeural plate development -18th dayCranial closure 24th day (upper spine)Caudal closure 26th day (lower spine)
19Preventive CareThe United States Public Health Service recommends that: "All women of childbearing age in the United States who are capable of becoming pregnant should consume 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other neural tube defects." Folic acid is a "B" vitamin that can be found in such foods as: cereals, broccoli, spinach, corn and others, and also as a vitamin supplement.
20Clinical Considerations What factors contribute to neural tube defects?
21High Risk for Renal Injury Increasing age, evidence of hydroureteronephrosis and vesicoureteric reflux, high leak pressures, and low bladder volume define a high risk bladder in our population and predispose to renal injury in patients of myelodysplasia.Early referral for bladder risk assessment and management of all myelodysplasia patients is recommended.Indian Pediatr Jun;44(6):Risk factors for renal injury in patients with meningomyelocele.Arora G, Narasimhan KL, Saxena AK, Kaur B, Mittal BR.