Infant with spina bifida the nurse should monitor

Explanation

Core Concept: Because infants with spina bifida (myelomeningocele) are at extremely high risk for developing hydrocephalus (often requiring a VP shunt), the nurse must rigorously monitor the infant's head circumference. A rapidly increasing head circumference is the earliest and most critical sign of increasing intracranial pressure (ICP) and shunt malfunction or need for placement.

Clinical Presentation:

• Symptoms: Rapid head growth, bulging fontanelles, separated sutures, irritability, high-pitched cry, and vomiting.
• Complications: Brain damage, blindness, and death if ICP is not relieved.

Diagnosis:

• First-line: Daily measurement of head circumference using a flexible tape measure.
• Gold Standard: Cranial ultrasound or CT/MRI to assess ventricular dilation.

Management:

• Acute: Measure head circumference daily, plot on a growth chart, and assess for other signs of increased ICP.
• Definitive: Neurosurgical intervention (VP shunt placement or revision) if hydrocephalus progresses.