Congenital Neuro Conditions Reference

A neural tube defect where the spinal cord and meninges protrude in a sac on the back. The pre-op priority is protecting the sac from rupture and infection:

• Position prone or side-lying — never on the back, which presses on the sac.
• Cover the sac with a sterile, moist (saline) nonadherent dressing; keep it from drying.
• Latex-free environment from birth — these children have a very high rate of latex allergy from repeated exposures.
• Meticulous perineal care to keep stool and urine away from the sac; assess for leaking CSF.
• Monitor for associated hydrocephalus (measure head circumference) and assess lower-extremity movement and bladder/bowel function.

Prevention: maternal folic acid before and during early pregnancy markedly reduces neural tube defects — the single biggest teaching point.

Excess CSF raises intracranial pressure. The signs differ by whether the sutures have fused:

• Infant (open sutures): bulging/tense fontanelle, rapidly increasing head circumference, separated sutures, “setting-sun” eyes, high-pitched cry, irritability, poor feeding, vomiting.
• Older child (fused sutures): headache (often worse in the morning), vomiting, altered consciousness, papilledema — classic increased ICP.

A ventriculoperitoneal (VP) shunt drains CSF to the abdomen. Post-op care: position flat or per neurosurgery to avoid rapid decompression, measure head circumference, and watch for two problems — shunt malfunction (returning ICP signs) and infection (fever, redness along the tract, irritability). As the child grows, the shunt needs revision.

A non-progressive motor disorder from injury to the developing brain; spastic CP is the most common type. Early clues: persistent primitive reflexes, abnormal muscle tone (stiff or floppy), failure to meet motor milestones, scissoring of the legs, feeding difficulty, and early hand preference.

The brain lesion doesn’t worsen, but nursing care is lifelong and functional: safe feeding and aspiration precautions, nutrition, mobility and positioning, contracture prevention, communication support, and seizure management when present. Many children have normal intelligence — never assume cognition from motor impairment. Care is interdisciplinary (PT, OT, speech, orthopedics) and the goal is maximizing independence.