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Cleansweep RN

A. General Information:

  • Failure of posterior vertebral arches to fuse or close during embryologic development.
  • Associated deficits may include sensorimotor disturbance, dislocated hips, talipes equinovarus (club foot) and hydrocephalus.
  • Defect closure is done immediately after birth.
  • Approximately 85% of defects in spine involve the lower thoracic lumbar or sacral area, defects in thoracic and cervical area makes up 15%.

B. Types / Classification:

Spina bifida occulta

  • Posterior vertebral arches fail to close in lumbosacral area.
  • Spinal cord remains intact and usually is not visible, maybe identified by a dimple or tuft of hair on the spine.
  • Child is asymptomatic or may have slight neuromuscular deficit.
  • Meninges are not exposed on the surface.

Spina bifida cystica

  • Protrusion of the spinal cord or its Meninges occurs.
  • Defect results in incomplete closure of the vertebral and neural tubes, resulting in saclike protrusion in the lumbar or sacral area, with varying degrees of nervous tissue involvement.


  • Protrusion involves Meninges and sac-like cysts that contain CSF in the midline of the back usually in the lumbosacral area.
  • Sac is covered with thin skin
  • Spinal cord is not involved and no sensory or motor loss.
  • Neurologic deficit are not present


  • Protrusion of the meninges, CSF and nerve roots, and a portion of spinal cords (herniation of dura and meninges) occurs.
  • Child may have motor and sensory deficit below the site lesion.
    80% of these children have multiple handicaps.
  • The sac is covered by a thin membrane prone to leakage or rupture.

C. Assessment findings:

  • Voluntary movements of lower extremities
  • Withdrawal of lower extremities or crying after pinprick
  • Paralysis of lower extremities (flaccid paralysis)
  • Joint and hip deformities
  • Hydrocephalus
  • Altered bladder and bowel functions
  • Prenatal ultrasound reveals fetal and spinal defects and sac
  • Increased alphafetoprotein (AFP) level prior to 18 weeks of gestation
  • Myelogram shows extent of neural defects
  • Urinalysis, culture and sensitivity (C/S) may identify organism and indicate appropriate antibacterial therapy

D. Nursing Interventions:

  • Evaluate the sac and measure the lesion
  • Monitor neurological status
  • Measure the head circumference and assess anterior fontanel for fullness
  • Protect the sac by covering with a sterile, moist, non-adherent dressing to maintain the moisture of the sac and contents.
  • Change dressing every 2 to 4 hours as prescribed
  • Place the child in prone position to minimize tension on the sac and the risk of trauma
  • Turn the head to sides during feeding
  • Change dressing when it is soiled to prevent infection, use sterile technique
  • Do not use diapers until the defect has been repaired
  • Perform passive ROM exercises to lower extremities
  • Provide adequate nutrition
  • Provide emotional support to the patient and family

E. Medical Management:

  • Surgical intervention by closing the sac within 48 hours of birth to prevent infection and preserve neural tissue
  • Orthopaedic procedures to correct defects of hips, knees and feet
  • Antibiotic therapy to prevent infections
  • Anticholinergic drugs to increase bladder capacity and lower intravesicular pressure
  • Immobilization of cast, braces and tractions for defects of hips, knees and feet

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