Spina Bifida Treatment in Singapore
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What is Spina Bifida?
A condition known as spina bifida is caused by a failure to form the spinal cord and spine correctly. This is a form of neural tube defect. In the embryo, the neural tube is the structure that will eventually develop into the baby's brain, spinal cord, and surrounding tissues.
The neural tube usually closes by the 28th day after conception, having formed early in pregnancy. However, in spina bifida, some of the neural tube fails to close completely, affecting both the spinal cord and the bones of the spine.
What is the Importance of Timely Treatment?
Early treatment of spina bifida can reduce impairment, prevent infection and hydrocephalus, and improve cognitive and emotional development. Early therapies for controlling symptoms and improving quality of life include surgical interventions, physical therapy, and support. Early intervention can significantly improve overall outcomes and enable individuals with spina bifida to lead active, fulfilling lives.
What are the Common Symptoms of Spina Bifida?
The common symptoms of spina bifida depend on the location and severity of the defect. In general, they include:
- Physical Disabilities: Paralysis of the legs, partially or wholly dependent on the severity and location of the defect.
- Hydrocephalus: Fluid accumulation in the brain brings about an elongated head and increased pressure inside the cranium.
- Bowel and Bladder Problems include loss of control of bowel and bladder functions, such as incontinence, constipation, or urinary retention.
- Deformities: Abnormal curvature or deformity in the spine in the back.
- Learning/Cognitive Challenges: Mild to moderate learning disorders, depending on the severity of the malformation.
Causes and Risk Factors of Spina Bifida
Causes
Spina bifida has no established aetiology. It is thought to be caused by a combination of environmental, dietary, and genetic risk factors, including a family history of neural tube abnormalities and inadequate folate (vitamin B9) during pregnancy.
Risk Factors
- Genetic Factors: A family history of spina bifida or other neural tube defects may increase the risk, and some genetic changes may also be implicated.
- Folic Acid Deficiency: The most significant risk factor is having a diet that lacks adequate amounts of folic acid (vitamin B9) both before and during the first trimester of pregnancy. Folic acid can prevent spina bifida and other neural tube defects.
- Health of the Mother:
- Obesity: The risk is higher if the individual is obese or overweight before conception.
- Diabetes: The possibility of spina bifida may be higher if the mother's diabetes is not well-controlled during pregnancy.
- Environmental Factors: Exposure to excessive heat (e.g., hot tubs or saunas) may increase the risk during early pregnancy.
- History of Previous Pregnancy with Spina Bifida: If a mother has had a previous child with spina bifida, the risk is higher for future pregnancies.
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Latest Research and Technologies in the Treatment of Spina Bifida in Singapore
Innovative research and cutting-edge technologies are making a real difference in the treatment of spina bifida in Singapore. One exciting development is the use of human amniotic fluid stem cells (hAFSCs) for in utero therapy, which has shown promise in covering exposed spinal cords and promoting neuronal regeneration in animal studies. Additionally, the Singapore Cord Blood Bank (SCBB) plays a crucial role in stem cell research by collecting and preserving cord blood for future medical uses. These initiatives underscore Singapore's dedication to advancing medical research and enhancing the lives of individuals affected by spina bifida.
Spinal Bifida Prevention Tips
To reduce their risk of spina bifida, women should take folic acid daily during the early period of pregnancy and even before conception. Other helpful measures include avoiding certain medications, managing diabetes and obesity, and eating a healthy diet rich in folate. Preventing alcohol, tobacco, and excessive heat exposure should also help maintain a healthy lifestyle. Routine antenatal visits ensure early diagnosis and thus allow early interventions. If these interventions are taken, the possibility of having a baby with spina bifida significantly decreases.
Treatment options for Spina Bifida
Surgery for Spina Bifida: Surgery for spina bifida is possible before delivery, as prenatal surgery, and after delivery.
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VP Shunt: Hydrocephalus (occurs together with spina bifida) treatment can be an implanted shunt that removes excessive fluid from the brain.
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- Clinical assessment:
- Blood Test: Most cases of spina bifida are diagnosed by ultrasound examination during pregnancy, although blood tests may occasionally be used for screening purposes.
- MSAFP test (Maternal serum alpha-fetoprotein): This measures the level of alpha-fetoprotein (AFP), a protein produced by the baby, obtained from a blood sample. Even though slight amounts of AFP regularly move from the baby into the pregnant parent's bloodstream, high levels may be indicative of a neural tube defect known as spina bifida. Usually, various factors can lead to increased levels of AFP, and it's not necessarily linked to spina bifida.
- AFP levels: Other reasons why the AFP level may not be the same in all cases are that there could be more than one baby, or the AFP level may have been estimated inaccurately. A repeat blood test might be necessary to confirm the result. If your AFP levels are still high, you need further tests, like an ultrasound scan.
- Imaging Tests:
- Ultrasound: Ultrasound is often used to visualise the spinal defect and monitor any fluid accumulation (hydrocephalus) or anomalies in the spinal cord to diagnose fetal spina bifida. It also helps determine the severity of the defect before delivery.
- Other diagnostic:
- Amniocentesis: If the prenatal ultrasound confirms the diagnosis of spina bifida, the doctor might ask for the amniocentesis test. This involves taking a sample of fluid surrounding the baby from the amniotic sac using a needle. This examination may be crucial for a doctor to rule out hereditary illnesses.
Our MediRehab facilities, part of MediGence, offer physical therapy services for international patients. We also have convenient teleconsultation options so that patients all over the globe can receive expert treatment remotely. A few services such as:
- Physical Therapy: The primary goals of physical therapy in spina bifida are to strengthen muscles, increase mobility, and enhance posture, balance, and coordination. Physical therapy helps people achieve excellent function and independence by providing them with specific exercises designed to improve movement and strategies for treating joint abnormalities or contractures.
- Depending on the situation, your healthcare professional may prescribe medicine to help control your symptoms and support the treatment plan.
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Hospitals for Spina Bifida in Singapore
Mount Elizabeth Novena Hospital
Novena, Singapore
Mount Elizabeth Novena Hospital located in Novena, Singapore is accredited by JCI. Also listed below are some of the most prominent infrastructural details:
- Capacity of 333 beds
- Intensive Care Unit beds
- Endoscopy beds
- Day ward with 20 beds
- 13 Operating Theatres, which includes 1 Neurological operating room, 2 Cardiac operating rooms, 4 Orthopaedic operating rooms, etc.
- High Dependency Unit (HDU)
- Neonatal Intensive Care Unit (NICU)
- 24/7 Accident & Emergency Department
- Maternity ward
- 1 major operating unit with 13 operating rooms inclusive of 1 hybrid theatre
- In-house Pharmacy
- Rooms are categorized as Single Signature Rooms, Junior Suite and Regal Suite
- All patient rooms are equipped with electric safe, LCD, sofa cum bed, wardrobe, radio channels, and much more
Parkway East Hospital
Singapore, Singapore
Parkway East Hospital located in Joo Chiat Pl, Singapore is accredited by JCI. Also listed below are some of the most prominent infrastructural details:
- Total capacity for 143 beds
- Hospital rooms are available- Single room, 2-bedded room (8), 4-bedded room (2), Deluxe room, and Orchid/Hibiscus Suite
- All rooms are equipped with all ensuite facilities like Free wifi, mini fridge, sofa couch, telephone, in-room safe, TV, etc.
- Maternity wards- Accredited as a baby-friendly hospital under the World Health Organisations Baby-Friendly Hospital Initiative (BFHI)
- 1 Neonatal Intensive Care Unit (NICU) with 14 cots
- Intensive Care Unit
- 1 Operation Theatre with 5 Operating rooms
- 1 Nursery with 30 cots
- 1 Parentcraft room
- 24-hour walk-in-clinic (for emergency)
- 24-hour Pharmacy
Mount Elizabeth Hospital
Singapore, Singapore
Mount Elizabeth Hospital located in Singapore, Singapore is accredited by JCI. Also listed below are some of the most prominent infrastructural details:
- 345 bedded Hospital
- Maternity wards
- The Mount Elizabeth Patient Assistance Centre (MPAC)
- 1 major operating unit with 12 operating rooms and 1 operating theatre dedicated to in vitro fertilisation (IVF)
- Intensive Care Unit
- High Dependency Unit (HDU)
- Neonatal Intensive Care Unit (NICU)
- Accident & Emergency Department
- Rooms are categorized as Single rooms, 2-bedded rooms, 4-bedded rooms, Executive deluxe suite, Daffodil/Magnolia suite, VIP Room, and Royal Suite
- All patient rooms are equipped with electric safe, LCD, sofa cum bed, wardrobe, radio channels, and much more
- Parking lot
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Why Choose Singapore for Spina Bifida Treatment?
Singapore offers cutting-edge spina bifida treatment with novel techniques such as stem cell therapy, robotic surgeries, and fetal surgery. The country is an excellent choice for effective and compassionate treatment due to its well-trained physicians, advanced medical facilities, and focus on early detection and personalised treatment.
Frequently Asked Questions
Spina bifida can impact a child's development in several ways, including physical impairments, muscle weakness or paralysis, particularly in the legs, and mobility issues. It could also cause neurological disorders, including loss of sensation and cognitive impairment. Bowel and bladder control issues are common, but hydrocephalus can affect brain development.
In Singapore, the quality and seriousness of the medical treatment decide how long one with spina bifida lives. Most individuals live up to adulthood and live a fulfilling life due to early intervention and improvement in treatments.
Yes, with the proper support and care, many people with spina bifida can lead everyday lives. However, due to the severity of their conditions, they may face neurological and physical challenges. As long as they receive proper medical care, rehabilitation, assistive technology, and support, people with spina bifida can be self-sufficient, attend school, and have social lives.
Spina bifida currently has no known treatment. Numerous medical techniques, such as surgery to fix the spinal deformity, physical therapy for improving movement, and other treatments that address connected issues, like hydrocephalus, can be used to manage the disease.
The aims of spina bifida treatment are the management of symptoms, prevention of complications, and improvement in quality of life. These include:
- Surgery: The operation is carried out within days after birth to close the spinal deformity and prevent further damage. Fetal surgery is sometimes carried out to correct the problem before delivery
- Physiotherapy: It prevents contractures and enhances muscle strength and movement
- Assistive Devices: Assistive mobility helps with bracing, splinting, and wheelchairs
- Hydrocephalus Treatment: Hydrocephalus treatment can be an implanted shunt that removes excessive fluid from the brain.
- Bladder and Bowel Management: Catheters, drugs, and surgery are administered to manage incontinence issues.
Yes, diagnostic testing and prenatal screening can identify spina bifida before delivery. The most common tests used are MSAFP testing, ultrasound, and amniocentesis.
Depending on the severity, spina bifida can have various long-term effects, but most commonly includes neurological impairments, such as sensory loss or learning challenges, as well as movement problems, including paralysis or weakness in the legs. Most have joint abnormalities, hydrocephalus requiring a shunt, and bladder and bowel dysfunction.
Yes, spina bifida can lead to learning problems in many affected children, particularly in the more severe types of the condition. Mild to moderate cognitive impairments may affect memory, attention, problem-solving, and processing speed.
Hydrocephalus occurs when the brain's cerebrospinal fluid accumulates to such an extent that it increases the pressure inside the skull. It often occurs together with spina bifida, mainly when myelomeningocele, the most severe type, is present. Anomalies in the brain's fluid drainage system, such as those associated with spina bifida, can cause the accumulation of cerebrospinal fluid (CSF).
Hydrocephalus is a condition in which extra fluid in the brain can cause damage if left untreated. It is usually treated with a shunt, a tube inserted into the brain to drain the excess fluid. It is essential to monitor individuals with spina bifida, as it can lead to physical signs such as head enlargement, learning disabilities, and developmental delays.
Yes, spina bifida is treated by fetal surgery in Singapore. In an attempt to close the spinal deformity and prevent further neurological damage, the procedure is performed before birth.