Neural tube defects

Neural tube defects (NTDs) is a group of devastating congenital anomalies, which usually lead to severe lifelong disabilities. In addition, they contribute to a significant amount of spontaneous abortions and perinatal deaths. Myelomeningocele is the most common form of NTD, and is usually associated with severe lifelong disability. The other forms are Meningocele, Encephalocele, Anencephaly and Spina bifida occulta. The NTDs results from failure of spontaneous closure of the neural tube between 3rd and 4th week of embryonic development. Because they occur so early in pregnancy, before most women are aware that they are pregnant, it is usually difficult to prevent these severe anomalies secondarily. In developing countries like Ethiopia, the problem is larger than in Western countries because the antenatal coverage is low. If pregnant mothers come for follow up, they usually come after the second trimester of their pregnancy. Therefore, at diagnosis it is often too late for terminating pregnancy.
Birth defects are the leading causes of perinatal and childhood mortality and morbidity in the first 5 years of life. The World Health Organization estimates 1 in 33 newborns will have birth defects, which come to 3.2million newborns per annum, 95% of these being born in LICs. (6) Every year, more than 300 000 children are born with NTDs (NTD), the second most common group of serious birth defects .(2) NTDs are a group of congenital abnormalities that still cause hundreds of thousands of deaths in 0–4 year’s age group, while a similar number of surviving children remains disabled for life. One of the sustainable Development Goals initiated by the United Nations was dedicated to reducing global mortality rates of children in this age group. (7)

NTDs commonly affect families with low socio-economic status, as they relate significantly to maternal malnutrition and micronutrient deficiency during pregnancy. The surviving children need lifelong multi-disciplinary rehabilitation care, which creates a double burden on the families. (2) It is currently rarely seen in developed countries due to public awareness, prenatal screening programs and national folic acid fortification.
There are various classification systems for NTDs; the Lemire classification system is the most commonly used. It classifies NTDs as Neurulation defects, which is due to non-closure of the neural tube resulting in open lesions; and Post-neurulation defects, which is a migration abnormality producing skin-covered lesions.(1 )
NTDs can alternatively be categorized into simple and complex forms. Simple form involves only one type of malformation, without any associated malformation (split cord, syringomyelia, Chiari-malformations and hydrocephalus). How to define the complex form is controversial; it comprises a wide variety of lesions not falling into the domain of the simple forms. Complex dysraphisms usually arises when the malformations arise during more than one developmental stage

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