What is meningomyelocele in children?

Meningomyelocele, also commonly known as myelomeningocele, is a type of spina bifida. Spina bifida is a birth defect in which the spinal canal and the backbone don’t close before the baby is born. This type of birth defect is also called a neural tube defect.

The spinal cord and the meninges (the tissue that covers the spinal cord) may protrude through the child’s back. In some cases, the skin on the child’s back covers the spinal cord and meninges. In other cases, the spinal cord and meninges may stick through the skin.

Spina bifida most commonly occurs in three forms:

Of these three, meningomyelocele is the most severe. Spina bifida occulta is the mildest and most common.

What are the symptoms of meningomyelocele?

A baby with meningomyelocele is born with the spinal cord exposed. A sac on the baby’s mid to lower back may cover the exposed spinal cord.

The exact symptoms and their severity depend on your child’s particular case. Meningomyelocele is often very severe, because the spinal cord has usually not developed properly and the brain is usually affected.

Abnormalities in the spinal cord often cause problems in leg, bladder, and bowel function. Some children might lose complete control of their bladder or bowel. Their legs may be partially or completely paralyzed or lack sensation. In other children, these body parts and their functions are only mildly affected.

Other possible symptoms include:

  • orthopedic deformities
  • hydrocephalus (buildup of fluid in the skull that leads to swelling of the brain)
  • Chiari malformation (structural defects in the part of the brain that controls balance)

Because the spinal cord is exposed, a child with meningomyelocele is at risk of developing bacterial meningitis.

What causes meningomyelocele?

Doctors don’t know exactly why this condition occurs. It’s possible that a lack of folic acid before and during early pregnancy impairs the development of the spinal cord. The condition may also be partly genetic. In many cases, however, there is no family connection.

How is meningomyelocele diagnosed?

This condition is usually diagnosed during the second trimester of pregnancy, when women can have a blood test called the quadruple screen. The test can screen for several conditions including meningomyelocele, Down syndrome, and other congenital diseases of the baby. Most women who carry a baby with neural tube defects have elevated levels of maternal alpha fetoprotein (AFP).

If the screen test is positive, further tests such a pregnancy ultrasound or amniocentesis can confirm the diagnosis.

How is meningomyelocele treated?

This condition is typically diagnosed during early pregnancy. Some women opt to terminate the pregnancy.

If you choose not to do so, your baby will most likely need surgery after birth. Prompt surgery can help protect your child from infections such as meningitis. Your doctor may prescribe antibiotics as an additional measure in preventing these infections.

If your child has hydrocephalus, sometimes called water on the brain, they may need to have a shunt inserted. The shunt drains extra liquid from around the brain and reduces pressure.

Your child may not develop bladder control. If this is the case, they may need a catheter to help drain the bladder.

Because of the effect this condition can have on your child’s lower limbs, they may need to wear braces. Braces are orthopedic devices that support the legs or main part of the body.

In most cases, your child’s treatment will be lifelong. They’ll need to see a doctor regularly to assess any developing problems. They may also need to use a wheelchair for life.

What is the long-term outlook?

Modern treatments have lengthened the life span for people with spina bifida. The University of Northern Carolina estimates 90 percent of people with this condition live to adulthood. Treatments for spina bifida are continuing to improve.

Babies with spina bifida often require many surgeries to treat the physical abnormalities they’re born with. Babies are most likely to die as a result of a birth defect, or because of a complication from a surgery to fix a birth defect, in the first few years after diagnosis.

How can I prevent meningomyelocele?

Spina bifida and other neural tube defects are believed to be related to low levels of folic acid. It’s important to take folic acid supplements during pregnancy. Folic acid is a B vitamin that is important in the development of red blood cells and is important for good health in general, especially during pregnancy. You should take a folic acid supplement before you become pregnant.