Neural Tube Defect (Myelomeningocele) Postnatal Management

Pathway Background and Objectives

Open neural tube defects result from a failure of primary neurulation, leading to abnormal development of the spinal cord at and below the level of the defect. 
Secondary injury can occur from mechanical and chemical trauma, as well as infection. Defects that are open at birth should be covered with sterile, moist dressings and the defect should be closed within 48 hours to prevent desiccation, heat loss, and infection. At Connecticut Children’s, we have been experiencing an increase in volume of patients with open neural tube defects.

Objectives:

  • Standardize delivery room and NICU-based management of neonates with open neural tube defects
  • Reduce infection rate through the appropriate use of antibiotics, as well as standardized wound care / dressing changes
  • Standardize monitoring for hydrocephalus and criteria for CSF diversion
  • Clarify the necessary team members / consults who must help direct the patient’s care until discharge and outpatient
     

Algorithm  Educational Module

  • # of patients entering pathway
  • % utilization of order set
  • NICU length of stay
  • % patients (of those not repaired prenatally) undergoing myelomeningocele repair within 48 hours of delivery
  • % patients requiring VP shunt prior to discharge
  • % patients with wound issues / wound infections
  • % patients with ventriculitis and/or shunt infection
  • % patients requiring intermittent catheterization upon discharge
  1. Cohen AR, Robinson S. Early management of myelomeningocele. In: Pediatric neurosurgery, McLone DG (Ed), WB Saunders, Philadelphia 2001. p.241.
  2. McLone DG. Care of the neonate with a myelomeningocele. Neurosurg Clin N Am 1998; 9:111.
  3. Charney EB, Melchionni JB, Antonucci DL. Ventriculitis in newborns with myelomeningocele. Am J Dis Child 1991; 145:287.
  4. Adzick NS, Thom EA, Spong CY, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011; 364:993-1004.
  5. Joseph DB, Baum MA, Tanaka ST, et al. Urologic guidelines for the care and management of people with spina bifida. J Pediatr Rehabil Med 2020; 13(4):479-489.
     

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