Pediatrics Case Study

1. What is the rationale for doing cesarean delivery for the babies with myelomeningocele?

Many babies with myelomeningocele tend to be in a feet-first position (Ntimbani, Kelly & Lekgwara, 2019).  If the baby is in this position or if the doctor has noticed a large cyst or sac, cesarean birth may be a safer way to deliver the baby (Ellenbogen, Jenkinson & Mallucci, 2020).

2. Difference between myelomeningocele and meningocele.

Meningocele is a form of spina bifida in which a meningeal sac of cerebrospinal fluid protrudes through the skull while meningomyelocele is a congenital defect of the central nervous system of infants in which membranes and the spinal cord protrude through an opening or defect in the vertebral column (Ntimbani et al., 2019).

3.”My child will not require surgery until she is a year old.”

Surgical closure of open lesion is usually recommended in the first 24 hours to reduce the incidence of infection and trauma to the exposed tissues (Ntimbani et al., 2019).

4. Pulse rate-173beats/min instead of 120-160 breaths/min

5. When the baby has been delivered, a thorough assessment of the lesion should be carried out while laying the infant in prone position to avoid pressure on the lesion (Ellenbogen et al., 2020). On-latex gloves should be used to avoid latex sensitization, and the lesion should be covered using a moist dressing or plastic cover to prevent heat loss (Ellenbogen et al., 2020). The dressing can only be removed in the presence of the surgeon.

6.140/100*10=14 ml

7. Respiratory rate because it is 25breaths /min because this quite low. Normally it should range between 30-60 breathes/minute.

8. Help parents become comfortable with holding the baby by teaching them how to-

  • How to take care of your baby’s incision
  • what to do with your baby’s stitches
  • how to tell if your baby’s incision becomes infected
  • other things to watch for
  • what activities your baby is able to do
  • who your contact is if you have any questions or concerns

9. According to the chart, the FOC of baby R is 38.5. This is normal growth and doesn’t require close monitoring anymore.

References

Ellenbogen, J. R., Jenkinson, M. D., & Mallucci, C. L. (2020). Spina Bifida and Encephalocele. Pediatric Surgery: General Principles and Newborn Surgery, 1213-1235.

Ntimbani, J., Kelly, A., & Lekgwara, P. (2019). Myelomeningocele-A literature review. Interdisciplinary Neurosurgery, 100502.