NORCET 9 Mains - 2025: In a newborn with spina bifida myelomeningocele, which clinical sign most strongly suggests an associated com…

NORCET 9 Mains - 2025

Child Health Nursing (Pediatrics)

Medium

Appeared in: NORCET 9 Mains - 2025

Explanation

Spina bifida myelomeningocele is frequently associated with a Chiari II malformation, which obstructs the flow of cerebrospinal fluid (CSF).
This obstruction leads to hydrocephalus, an accumulation of CSF in the brain's ventricles, causing increased intracranial pressure (ICP).
In a newborn, whose skull bones are not yet fused, this increased pressure manifests as a bulging of the fontanelles (soft spots).
Therefore, a bulging fontanelle is a primary and urgent sign of hydrocephalus, a major complication of myelomeningocele.

Option B: A tuft of hair in the lumbosacral area is a cutaneous marker for spina bifida occulta, a closed and milder form of neural tube defect where the spinal cord does not protrude.
Option C: A sunken fontanelle is a classic sign of dehydration due to fluid loss.
Option D: Myelomeningocele involves damage to the lower motor neurons of the spinal cord. This results in flaccid paralysis and absent or diminished deep tendon reflexes below the level of the lesion.

Clinical Relevance

Nursing practice connection: Knowing Assessment of Complications in Spina Bifida Myelomeningocele helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A core nursing responsibility for infants with myelomeningocele is vigilant monitoring for signs of increased ICP. This includes daily head circumference measurements and regular fontanelle assessment.
Protecting the exposed sac is paramount to prevent infection (meningitis) and injury. The infant must be positioned prone and the sac covered with a sterile, moist dressing.
What if? If the infant had a sunken fontanelle instead, the priority would shift from assessing for hydrocephalus to managing dehydration. This would involve notifying the physician and preparing for fluid resuscitation, a completely different intervention.

How to Approach the Question

First, identify the core condition in the question: a newborn with spina bifida myelomeningocele.
Next, recall the most common and serious complications associated with this condition. For myelomeningocele, hydrocephalus is the primary concern.
Think about the pathophysiology of the complication. Hydrocephalus leads to increased intracranial pressure (ICP).
Consider the patient's age (newborn) and how the complication would manifest. In an infant with open fontanelles, increased ICP causes them to bulge.
Evaluate each option. A bulging fontanelle directly matches the expected sign of hydrocephalus. The other options relate to a different condition (tuft of hair), an opposite condition (sunken fontanelle), or an incorrect neurological response (hyperactive reflexes).

Concept Tested & Keywords

Concept Tested: Assessment of Complications in Spina Bifida Myelomeningocele
Stem keywords: newborn, spina bifida myelomeningocele, clinical sign, complication
Lead-in keywords: most strongly suggests
Clinical cues: The patient is a newborn, which is significant because their cranial sutures are not fused, making fontanelle changes a key indicator of intracranial pressure.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1368-1370, 2212-2214