Brain & Nervous System Health Center

Baby Noor's Surgery Went 'Very Well'

Iraqi Baby With Spina Bifida May Still Need More Surgery

From the WebMD Archives

Jan. 9, 2006 -- An operation for Baby Noor, a 3-month-old Iraqi baby with a rare and severe form of the birth defect spina bifida, went "very well," says the doctor who led the operation.

Roger Hudgins, MD, spoke about the operation at news conference. He's the chief of neurosurgery at Children's Healthcare of Atlanta, where the surgery was done.

Noor is "smiling and cooing," Hudgins said.

The operation was "difficult," as expected, according to Hudgins. He says Noor may need more surgery, will be paralyzed from the waist down, and will have problems with bladder and bowel control.

Complications of spina bifida can range from minor physical problems to severe physical and mental disabilities, according to the National Institute of Neurological Disorders and Stroke (NINDS). The severity of the complications depends on the location and the size of the birth defect as well as other factors. The higher the defect is located on the spine, the more nerves are involved and damaged.

Hopes for Mental Development

He voiced hope that Noor's mental development will be normal. "This is a special baby," Hudgins said, praising Noor's family, his colleagues who worked with him in Noor's care, and the U.S. soldiers who brought Noor to the U.S. for the lifesaving procedure.

The operation took about three hours, says Patty Turlington, a Children's Healthcare of Atlanta spokeswoman. Baby Noor was "resting comfortably with her family" after the surgery, Turlington says.

Noor was spotted by soldiers of the Georgia Army National Guard's 48th Brigade during a raid on a Baghdad home in early December. She was airlifted to Atlanta for lifesaving surgery, accompanied by family members.

How Spina Bifida Develops

During embryo development, special cells form a tube-like structure along what will be the back of embryo. This structure soon (in early pregnancy) develops into the brain and spinal cord of the embryo.

Spina bifida is a birth defect in which the spine or brain and their protective coverings develop incompletely. The nerves involved are often damaged and cannot be repaired; the function of the nerves at and below the defect cannot be restored.

Continued

Spina bifida is the most common type of neural tube birth defect. Noor has spina bifida aperta (myelomeningocele). That type of spina bifida generally involves a fluid-filled sac visible on the back. In most cases of myelomeningocele there is no layer of skin covering the sac and a section of spinal cord is exposed. Baby Noor survived for three months because she developed a leak-proof covering over the open area.

During Noor's operation, the skin was rolled up so that her spinal cord could be put back in place and closed up, which helps prevent infection and helps protect the exposed nerves and tissue from further damage. Then muscles and skin were sewn over the spinal cord.

According to the NINDS, many individuals with spina bifida will need assistive devices such as braces, crutches, or wheelchairs.

U.S. babies with the condition normally get such surgery within a few days of birth.

Hudgins says he and his colleagues will be watching to see if fluid starts to build up in Noor's brain. Noor has another complication called Chiari malformation, in which the rear portion of the brain places downward pressure on the spinal canal and blocks fluid flow around the brain and spinal cord. This condition can lead to problems breathing, feeding, and swallowing. If so, Noor will likely undergo another operation to put a shunt in place to relieve that fluid buildup.

Preventing Spina Bifida

About one in 2,000 U.S. babies are born with spina bifida. Getting enough folic acid before and during pregnancy helps reduce the risk of neural tube defects.

For that reason, health experts advise all women of childbearing age to get 400 micrograms per day of folic acid, which is also called folate.

The recommendation isn't just for women who are trying to become pregnant, since many pregnancies are unplanned.

Folic acid is found in supplements, leafy green vegetables (such as spinach), and fortified foods, such as breakfast cereals. Since 1996, the U.S. has required folic acid to be added to enriched grain products including breads and flours.

Researchers recommend that any woman who could become pregnant get a daily intake of 400 micrograms of synthetic folic acid per day from fortified foods and/or dietary supplements. That advice comes from the web site of the NIH's Office of Dietary Supplements.

WebMD Health News

Sources

SOURCES: Roger Hudgins, MD, chief of neurosurgery, Children's Healthcare of Atlanta. Patty Turlington, spokeswoman, Children's Healthcare of Atlanta. News release, Children's Healthcare of Atlanta. Office of Dietary Supplements, "Dietary Supplement Fact Sheet: Folate."
© 2006 WebMD, Inc. All rights reserved.

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