Recovery for Myelomeningoceles in Children

Postoperative Orders 

• Observe for signs of hydrocephalus: Initial postnatal and postoperative management is in the neonatal intensive care unit to watch for signs of hydrocephalus or brainstem dysfuntion including central apnea, obstructive apnea, bradycardia, and dysphagia. Head circumference and fontanelle size should be monitored daily.
• Protect surgical site: At the authors’ institution, the infant is nursed and kept prone or in lateral decubitus position as much as possible in the immediate postoperative period, initially lying supine intermittently for care only. After 48–72 hours, activity may be liberalized.
• Bladder care: The baby’s spontaneous voiding should be noted during the immediate postnatal period. Clean, intermittent, straight catheterization is performed on newborns every 4 hours for the first day or two after the catheter is removed. Wet diaper and spontaneous voiding occurrences are recorded as well.
• Urological assessment: Prior to discharge, the urologist should review the results of the ultrasound and voiding cystourethrogram and give recommendations/instructions for clean intermittent catheterization.
• Discharge criteria: Discharge home occurs when the child shows adequate feeding and weight gain, appropriate wound healing, and no need for shunting. Appropriate instructions for home care regarding wound care, straight catheterization technique, etc., are provided to the caretaker.

Postoperative Morbidity

• No unique morbidities