Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
A 2 month old girl born of non consanguineous marriage presented with hydrocephalus and meningomyelocele diagnosed since birth and excessive crying for 4-5 days. The child had 2 episodes of seizures in last 15 days. On examination, she had wide bulging anterior fontanelle with sun-setting sign and decerebrate posturing with lower lumbosacral meningomyelocele, spastic paraparesis and absent lower limb refluxes.
Expert Opinion :
The parents were counseled about prognosis. They opted for no intervention. The child died in next 48 hours.
Sometimes, it may be necessary not to intervene if it is just going to prolong the suffering of the child.
Answer Discussion :
neelesh kumar
vp shunt, surgical management of meningomyelocele,
folic acid to be started before conception in next pregnancy

3 years ago
the infant should be ,first treated for CNSinfection and then early surgery. periconceptional Folic Acid must be given to mother in next pregnancy
3 years ago
koutha rama
There is no point in doing surgery in this case. This should have been diagnosed antenatally at 16 weeks or even earlier.
If possible.to look into folate pathway genes for the prenatal diagnosis of next pregnancy and also a karyotype on this child
The couple`s homocysteine should be checked and give preconceptional folate, B12 and zinc atleast 3 months prior to pregnancy

3 years ago
Rosa Maria Delgado-Ayala
Check CSF for meningitis {ventricular tap} and treat accordingly if present. Needs VP shunt for hydrocephaly and to correct increased intracranial pressure.

Mother needs preventive therapy with daily folic acid during next pregnancy

3 years ago
Rihi Here Wila
I think this is the severe form of meningomielocele no need any intervention. For next pregnancy, the mother should routinely control and take folic acid everyday.
3 years ago
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