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Doxinate for Doctors/Neural Tube Defects
 
 
Neural tube defects appear to be associated with maternal lack of Folic Acid & thus supplementing the diets of all women of childbearing age with Folic Acid decreases the rate of this disorder (NTD). They are also probably triggered by a combination of environmental and genetic factors (Sadler 2005).
 
Any woman of child-bearing age can potentially give birth to a child suffering from an NTD.
 
In our country the incidences is much higher as compared to the developed world & 95% of NTD’s affect women who do not have any NTD history in their families.
 
A neural tube defect (NTD) is a congenital malformation which occurs between the 20th and 28th day after conception. The cells of the neural plate make up the fetus’ nervous system. In normal development, they fold back onto themselves in order to create what is called the neural tube which becomes the back bone and the spinal cord.
 
After a number of transformations, the superior pole eventually becomes the brain. In the case of an NTD, the neural tube is unable to close completely. The growing brain and spinal cord are then exposed (depending on the location of the anomaly). The most common forms of NTD are Spina bifida (60%), Anencephaly (30%) & Encephalocele (10%) is also observed.
 
 
Spina Bifida:
 
If the neural tube remains open at the caudal extremity, it is a case of Spina Bifida. The spinal cord and the back bone are not able to develop completely and infants have an opening in their back from which a sac full of liquid containing part of the spinal cord may emerge. The extent of the permanent disability depends of the location of the defect on the back bone.

The higher the lesions, the greater the risk of lower-member paralysis. When
 
the lesions are lower, the risk is smaller and the most frequent consequences are lack of bladder and intestine control, Spina bifida can be compounded by a hydrocephalus. Infants with Spina Bifida are operated on at birth in order to prevent further damage to the nervous system.
 
 
Anencephaly:
 
Anencephaly occurs when the head end of the neural tube fails to close. Infants with this disorder are born without a scalp or cerebellum. Their meninx, both hemispheres of the brain and the vault of the cranium/skull are also missing, though they usually do have part of the brain stem. The remaining brain tissue is protected only by a thin membrane.

The infant can be blind and has no or very few reflexes. 25% of anencephalic children who live to the end of the
 
pregnancy die during delivery; 50% have a life expectancy of between a few minutes and 1 day, 25% live up to 10 days (Jaquier 2006).
 
 
Encephalocele:
 
Encephalocele is a type of Neural Tube Defect (NTD) that occurs very early in fetal life where the embryo’s cells that form the skull do not come together to close over the brain. The result is a defect in the bones of the skull, causing brain tissue to protrude from the skull.
 
The protruding tissue may be located on any part of the head but is usually in the middle at the back of the head (midline occipital area).
 
There may be meninges, brain tissue, parts of the ventricles and bone that protrude from the skull. Alphafetoprotein levels are rarely elevated because almost all encephaloceles are covered by skin and therefore this identifying protein does not leak into the amniotic fluid as it does with most other NTD conditions.
 
Encephalocele is typically diagnosed by prenatal ultrasound. The best finding would be to find only fluid in the protruding sac. Encephaloceles located on the front of the skull are more likely not to contain brain tissue and have better outcomes than those at the back of the head.
 
The cause of Encephalocele is not known but it is probably a combination of factors like genetic predisposition and exposure to toxins or infections very early in Fetal Life.
 
Other problems that may happen due to Folic Acid Deficiency:
 
Cleft lip and Cleft palate are birth defects that occur when a baby’s lip or mouth do not form properly. Together, these birth defects commonly are called “Orofacial Clefts”. These birth defects happen early during pregnancy. A baby can have a cleft lip, a cleft palate, or both.
 
 
Cleft Lip:
 
The lip forms between the fourth and seventh weeks of pregnancy. A cleft lip happens if the tissue that makes up the lip does not join completely before birth. This results in an opening in the upper lip. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. Children with a cleft lip also can have a cleft palate.  
 
Cleft Palate:
 
The roof of the mouth is called the "palate." It is formed between the sixth and ninth weeks of pregnancy. A cleft palate happens if the tissue that makes up the roof of the mouth does not join correctly. Among some babies, both the front and back parts of the palate are open. Among other babies, only part of the palate is open.  
 
 
 
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