Spina bifida is a neural birth defect, which means it mainly affects the spinal cord. When the spinal cord forms during the first month of pregnancy, the spinal canal doesn’t close completely. According to the Centers of Disease Control and Prevention (CDC), every year about one out of every 2,758 babies born in the United States has spina bifida. People with spina bifida may have an increased risk of contracting infections, which in turn, increases their risk of developing sepsis.
Sometimes incorrectly called blood poisoning, sepsis is the body’s potentially deadly response to infection. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival. Sepsis and septic shock can result from an infection anywhere in the body. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain, fatigue, organ dysfunction, and/or amputations.
Three main types of spina bifida
There are three main types of spina bifida:
Spina bifida occulta, the mildest form of the condition, is also the most common. The Spina Bifida Association (SBA) says that up to 15% of healthy people have spina bifida occulta, but they don’t know it. There is a defect in the spinal canal, but outside, the skin is fully formed. A child with spina bifida occulta may have a small different-looking patch on the skin right over where the defect is. Sometimes the spina bifida is only detected when someone has x-rays for another reason, and the radiologist sees the lesion.
Meningocele is the least common form of spina bifida. When a baby with a meningocele is born, there is an opening in the back. A small part of the meninges, the membranes that surround the spinal cord, come through the opening. In most cases, a surgeon can reinsert the membranes and close up the hole, leaving few neurological (nerve) problems.
Myelomeningocele is the most severe form of spina bifida. A baby with myelomeningocele has a hole in the back. Part of the undeveloped spinal cord comes through that hole. Most children with myelomeningocele also have a condition called Chiari malformation. This causes hydrocephalus, fluid on the brain. People with this form of spina bifida usually do not have control of their lower body, including their bowel and bladder.
Why are people with spina bifida at higher risk of infection?
People with myelomeningocele are at higher risk of developing infection. Since there is often no or limited feeling in the lower part of the body, pressure injuries are a constant concern. These injuries could result from sitting in one position in a wheelchair for too long, a brace rubbing against the skin, or injuries that aren’t felt and noticed until they are infected.
People with this form also might also empty their bladder through self-catheterization. This means the person inserts a catheter into their urethra several times a day, instead of urinating in a toilet. The catheter procedure is usually a clean procedure, but not sterile, as it is when done in a hospital. Repeat catheterizations can cause urinary tract infections (UTI). Because there may be no feeling in the lower abdomen, a UTI may be present for a while before someone notices it. If they are incontinent, meaning they pass urine or stool involuntarily, there is always the risk that the urine or stool will cause the skin to develop sores.
Those in this group also may need multiple surgeries. For example, if they have hydrocephalus, they might have a shunt, a tube, inserted to drain fluid from the brain to the abdomen or heart. Shunts can break or become dislodged, requiring surgery.
People with the milder forms – spina bifida occulta or meningocele – are not usually at higher risk of infections, unless they need surgery for a meningocele repair.
If you or someone you know has spina bifida and you suspect an infection, seek help as soon as possible to reduce the risk of sepsis. Learn more about the signs and symptoms of sepsis below.
Posted October 13, 2021.