eMedicine Specialties > Neurology > Pediatric Neurology

Neural Tube Defects: Follow-up

Author: George I Jallo, MD, Associate Professor of Neurosurgery, Pediatrics and Oncology, Director, Clinical Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine
Coauthor(s): Tibor Becske, MD, Assistant Professor, Department of Neurology, New York University Medical Center
Contributor Information and Disclosures

Updated: Dec 15, 2008

Follow-up

Further Inpatient Care

  • Neonatology
  • Pediatric neurology
  • Pediatric orthopedics
  • Urology
  • Physical medicine
  • Orthopedic surgery

Further Outpatient Care

Children with open NTDs need comprehensive follow-up in a multimodality setting involving numerous specialties and subspecialties.

Complications

  • Infections
  • Bladder dysfunction

Prognosis

Prognosis depends upon the defect and ranges from excellent to poor.

Patient Education

  • Many groups exist with interests concerning the particular child.
  • For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education article Spina Bifida.

Miscellaneous

Special Concerns

  • Prevention: Two major interventional strategies have been accepted for prevention of NTDs: antenatal screening with subsequent termination of affected pregnancies and vitamin supplementation.
    • Antenatal screening begins with measurement of serum alpha-fetoprotein (AFP) at 16-18 weeks of gestation.
      • Normally, AFP is not present in the amniotic fluid, but in open NTDs it appears in the amniotic fluid through a direct communication between the CSF and the amniotic fluid.
      • It becomes detectable between the fifth and ninth weeks of gestation.
      • It also crosses the placenta and reaches maximal maternal blood levels around the 14th week.
      • Values 2.5 times above the normal are considered indicative of NTD.
      • About 75% of open spina bifida cases produce a positive maternal AFP test.
    • Ultrasonography also is performed in high-risk pregnancies (mothers who had a prior pregnancy with an NTD, or those taking valproate during early pregnancy). If the ultrasound does not clearly show an NTD, amniocentesis with measurement of AFP is indicated.
    • Measurement of amniotic fluid acetylcholinesterase provides a confirmation of the diagnosis. Termination of pregnancy is advised if this test is also positive.
    • The sensitivity of the entire screening process is estimated to be 86% for anencephaly and 78% for open spina bifida. The specificity is 99.99%.
    • Several clinical studies have shown that pregnant women who received folate during pregnancy had a significantly lower incidence of NTDs in their newborns.
  • In-utero closure: A current open trial is investigating the benefits of in-utero closure of these open defects and the long-term benefits of this trial. It is currently open and enrolling patients.
 


More on Neural Tube Defects

Overview: Neural Tube Defects
Differential Diagnoses & Workup: Neural Tube Defects
Treatment & Medication: Neural Tube Defects
Follow-up: Neural Tube Defects
Multimedia: Neural Tube Defects
References
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References

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  2. Copp AJ. Prevention of neural tube defects: vitamins, enzymes and genes. Curr Opin Neurol. Apr 1998;11(2):97-102. [Medline].

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  10. MMWR. Use of dietary supplements containing folic acid among women of childbearing age--United States, 2005. MMWR Morb Mortal Wkly Rep. Sep 30 2005;54(38):955-8. [Medline].

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Further Reading

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Keywords

neural tube defect, NTD, anencephaly, encephalocele, meningocele, meningomyelocele, craniorachischisis totalis, congenital dermal sinus, spina bifida aperta, cystica, myelomeningocele, meningocele, myeloschisis, congenital dermal sinus, lipomatous malformations, lipomyelomeningoceles, split-cord malformations, diastematomyelia, diplomyelia, caudal agenesis, associated hydrocephalus, Chiari II malformation, neurulation

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Contributor Information and Disclosures

Author

George I Jallo, MD, Associate Professor of Neurosurgery, Pediatrics and Oncology, Director, Clinical Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine
George I Jallo, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, and American Society of Pediatric Neurosurgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Tibor Becske, MD, Assistant Professor, Department of Neurology, New York University Medical Center
Tibor Becske, MD is a member of the following medical societies: American Association of Neurological Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Robert Stanley Rust Jr, MD, MA, Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia; Chair-Elect, Child Neurology Section, American Academy of Neurology
Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Kenneth J Mack, MD, PhD, Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic
Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Neurology, Division of Pediatrics, Department of Pediatrics, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
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