Figure 1: SPINA BIFIDA CARE PATHWAY
| Day | -1 | 0 | 1 | 2 | 3 | 4 | 7 |
| Hx | Gestational age, parity, family history of NTD, vaccinations, any antibiotics or folk remedies; feeding; voiding; stooling; vomiting; fevers; seizures | Feeding; vomiting; seizures; voiding; alertness | |||||
| Exam | Vitals: T/P/RR/Wt; toxic/non-toxic, irratable; HC; weight; mucous membranes; sunset eyes, vision; fontanelle; LE: motor level R & L, contractures, deformities; patulous anus?; SB lesion - site, open / covered / infected; other systems PRN | Vitals q4h | Temp; pulse; resp. rate each shift; HC daily | ||||
| dressing appearance | wound appearance | ||||||
| Tests | CBC; serum creatinine | Renal & head US | |||||
| Procedures | Antiseptic soap body wash tid; saline-soaked gauze to wound tid | Surgery | Remove dressing | Bladder evaluation | |||
| Medications | Start IV gentamycin 5 mg/kg/d & ceftriaxone 100 mg/kg/d (unless SB completely skin covered) | Preop ceftriaxone 100 mg/kg if skin covered | IV gentamycin 5 mg/kg/d & ceftriaxone 100 mg/kg/d (unless SB completely skin-covered | ||||
| Counseling / Social / Spritual |
Discuss disease & implications; assess family & social situation & discuss payment options; spiritual assessment | Prayer with parent & child pre-op | CIC teaching if indicated | Discharge planning; payment discussion | Follow-up planning; folic acid teaching; folic acid, catheters & KY supplies | ||
| Pastoral care | |||||||
| Diet | Nutritional assessment | NPO past 4 AM | Regular diet; supplement if necessary | ||||
| Physiotherapy | Assessment | Casting & teaching as needed | |||||
| Events | Admission | Discharge if well & no hydrocephalus | |||||