Myelomeningocele Pre-op NSGY Recommendations

(**OPEN DEFECT**)

1.) Admit to NICU

2.) Consult: Peds Neurosurgery, Peds Urology (for recs regarding in/out cath), +/- Peds Orthopedics

3.) Obtain head ultrasound to evaluate ventricles

4.) Labs to be sent (in prep for OR) Type and Screen

5.) Dressing placed to spinal defect - saline soaked non-adherent telfa directly to site, wrap with kerlix gauze roll

6.) Position flat, prone keep off back.  Head of bed should not be elevated.

7.) Antibiotics start Amp/Gent upon admission and will be continued until POD 3 (after repeat head u/s reviewed)

***** NO SCALP IVs *****

8.) Mudflap to prevent stool from getting on spinal defect site

9.) Please obtain daily head circumference measurement (chart to be placed at bedside)

10.) NSGY team will determine timing of OR (within 72 hours) and obtain consent from family

Myelomeningocele Post-op NSGY Recommendations

(**OPEN DEFECT**)

1.) VS per unit protocol

2.) Advance feeds as tolerated

3.) Position flat, prone keep off back, head not elevated above bottom

4.) Ok for parents to hold but must remain flat, off back

5.)  Continue Amp/Gent until POD 3 (after head u/s reviewed by NSGY team)

  ***** NO SCALP IVs *****

6.) Repeat head ultrasound on POD 3 to evaluate ventricles, s/p MMC repair

7.)  Dressing to remain in place until POD 3 NSGY team will remove at appropriate time and make further wound care recommendations

               ** If dressing becomes soiled with stool bedside RN may replace dressing.

8.) Mudflap to prevent stool from getting on incision site

9.) Please obtain daily head circumference measurement (chart to be placed at bedside)

10.) Pain control per NICU

 

Skin-covered Spinal Defect (meningocele, etc) -  NSGY Recommendations

1.) Admit to NICU

2.) Consult : Peds Neurosurgery, Peds Urology (for recs regarding in/out cath), +/- Peds Orthopedics

3.) Obtain head ultrasound to evaluate ventricles

4.) NSGY team will evaluate and determine if MRI needed of total spine (which is likely)

4.) No dressing needed to site

5.) No antibiotics needed

6.) ** NO SCALP IVs **

7.) Activity ad lib

8.) Please obtain daily head circumference measurement (chart to be placed at bedside)

 

S/P In-Utero MMC closure -  NSGY Recommendations

1.) Admit to NICU

2.) Consult : Peds Neurosurgery, Peds Urology (for recs on in/out cath), +/- Peds Orthopedics

3.) Obtain head ultrasound to evaluate ventricles

4.) No dressing needed to site

5.) No antibiotics needed

6.) ** NO SCALP IVs **

7.) Activity ad lib

8.)  If concern regarding incision site NSGY team will evaluate and determine if Plastics consult indicated

9.) Please obtain daily head circumference measurement (chart to be placed at bedside)