Clinical Pathway for the Care of the Neonate with Myelomeningocele/Myeloschisis

Imaging for Infants with Pre- or Post-natal Repair

Symptoms of neurogenic bladder may include:

Study Frequency, Details
Brain Ultrasounds All Infants:
  • On admission
  • Consider prior to discharge
Infants ≤ 32 weeks, consider additional studies if clinically indicated:
  • On admission, consider prior to discharge
  • May consider weekly
Head ultrasound documents ventricle size and serves as a baseline after birth. For infants admitted for an extended period, a repeat US for comparison may be useful to outside providers should the infant develop signs of hydrocephalus.
MRI
Brain and Spine without Contrast
Order prior to discharge
  • The goal is to use no sedation by using an immobilizer
    • Sedation may be associated with prolonged stay, poor feeding, temperature instability, A's & B's
  • Two separate studies scheduled at different times
    • MRI brain1 hour study
    • MRI spine1 hour study
  • Type "myeloseries" in order comments
Immobilizer Use Requires:
  • No sedation
    • Consult Sedation Team to approve immobilizer (pager 11733)
  • Infant on full feeds, free from A's & B's
    • Infants with brief A's & B's requiring no intervention require NICU RN to stay during the study
If unable to use immobilizer:
  • Sedation required - Consult Sedation Team (pager 11733)
  • Combine Brain and Spine studies
RBUS
Renal Bladder US
Pre-natal
  • Perform DOL 2 or 3
  • Additional studies if clinically indicated
Post-natal
  • Perform DOL 2-3 when able to be supine
  • Additional studies if clinically indicated
Goal
Capture infants with spinal shock who have a distended bladder despite a good urine output
Videourodynamic study (VUDS) All Infants
  • Perform at 2 months of age
    • CHOP follow-up:Schedule with Dr. Carr
    • Long distance follow-up:Outside Spina Bifida program
  • A urodynamic study evaluates
    • Bladder capacity
    • Bladder pressure during filling and voiding
    • Sphincter between the bladder and the urethras
    • Infant's voiding pattern

Additional Studies

Hip US Perform at 44 weeks corrected age if clinically indicated (e.g. female, breech, etc.)
Plain Films of Ankle, Foot Discuss with Orthopedics
  • In patients with significant talipes, xrays of the affected foot may be requested to guide treatment