{"id":"901ecd7e-b620-479a-9484-286ba30cff19","slug":"como-lo-hago-yo-defectos-del-cierre-del-tubo-neural-en-nicaragua","title":"Como Lo Hago Yo: Defectos Del Cierre Del Tubo Neural En Nicaragua","authors":["Juan Bosco Gonzalez"],"abstract":"En Nicaragua no hay un plan de forltificación de alimentos con ácido fólico. Las madres son muy jóvenes. En La Mascota operamos mas de cuarenta niños por año. Derivación tardía es un problema. La infección preoperatoria tiene que ser descartada. Vancomicina y Ceftriaxone estan indicadas. Estricta regla de asepsia operatoria. Suturamos la plaqueta para asemejar su forma al cilindro normal de la médula. No ceramos la capa de músculo. The Hospital Infantil Manuel de Jesus Rivera, La Mascota is the main pediatric referral hospital in Nicaragua. Since 2010 there is a division of Neurosurgery within the Department of Surgery. Two Neurosurgeons staff the division. We see an average of 44 new cases of neural tube defects (NTD) per year. I have nothing but praise and gratitude for the neonatology department at La Mascota. Every month we perform 3 or 4 four new cases of myelomeningocele (MMCL). The great majority are children of very young women; some are 15 or 16 years old. They come from distant rural areas but many are from the capital as well. Managua is the most densely populated region of the country. In Nicaragua there is no national program for fortifying flour with Folic Acid. What we have in place is a program for providing folic acid to pregnant women when it is known that the malformation has already occurred. I say this acknowledging as well that there may be other factors besides folic acid deficiency responsible for NTD. In any case the importance of folic acid in preventing NTD is such that our government has to implement fortification of flour with folic acid. There are many differences between high-income countries and low and middle -income countries about how to care for children with NTD. Along the years some things have remained the same but some have changed for good. When I trained an attending in Masaya told me that children with NTD had a very short life span, implying that we should not waist resources on them. In our country there are barriers to care. We have only two Neurosurgical centers in the country. Many children and their mothers have to travel for many hours in deficient conditions. When the child arrives, many days after birth, a yellow patina of reactive tissue covers the placode. We need to sample it and wait at least 3 days to determine if it is infected. If it is infected, we request the help of the department of Infectious Diseases and the child is for an added 3 weeks in house. We have spread the word among our colleagues from rural areas that it is imperative that the newborn with NTD be referred to us as soon as possible. Still this is not possible in children coming from the Atlantic coast. In children with infected placode we perform a ventricular tap. Sometimes we obtain dense pus. This year I had three cases of a child with severe ventriculitis but without any signs of infection. The babies were being breast-fed without evidencing any sign of distress. This has leaded me to ponder if the CSF has a role in the immune system or that the ependyma is a strong barrier that prevents the spreading of infection. The patient is usually received with the defect covered by wet gauze directly over the placode and dry gauze on top. The child is then admitted to the neonatal ward.","thumbnailUrl":null,"publishDate":"2014-03-10T00:00:00.000Z","doi":"10.4103/2152-7806.128462","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2015/05/4082/SNI-5-7.pdf"}