Which position is given to a newborn with meningomyelocele at the lumbo-sacral area?

AIIMS Rishikesh NO - 2019

Child Health Nursing (Pediatrics)

Easy

Appeared in: AIIMS Rishikesh NO - 2019

Explanation

The prone position is the only position that completely removes pressure from the fragile meningomyelocele sac on the newborn's back.
This position is critical to prevent the sac from rupturing, which would cause a cerebrospinal fluid (CSF) leak and expose the infant to a high risk of life-threatening meningitis.
Placing the infant on their abdomen also minimizes the risk of contaminating the lesion with urine or feces.
As seen in the provided image, the infant is correctly placed in the prone position to protect the lumbosacral defect.

Option A: The supine position (lying on the back) is contraindicated as it places the infant's entire weight directly onto the meningomyelocele sac.
Option B: The Sims' position (a semi-prone, side-lying position) is incorrect because it can still put pressure on the sac and does not prevent the infant from rolling onto their back.
Option D: The lateral (side-lying) position is also unsafe. It fails to provide consistent protection, as the infant can easily roll, and it may still allow pressure on the edges of the sac.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pre-operative nursing care and positioning for a newborn with meningomyelocele (spina bifida) as background academic context rather than a clinical decision trigger.
The primary nursing goal before surgery is to protect the sac to prevent infection and further neurological damage. A ruptured sac is a neurosurgical emergency.
Nurses must meticulously cover the sac with a sterile, moist, non-adherent dressing and place the infant under a radiant warmer to maintain body temperature, as they cannot be swaddled.
What if? If the sac appears to be leaking clear fluid, the nurse must immediately notify the surgeon. This indicates a CSF leak, which significantly increases the risk of meningitis. The dressing should be reinforced, but not removed, and the infant's vital signs and neurological status must be monitored closely.

How to Approach the Question

First, identify the core clinical problem in the question: a newborn with a meningomyelocele, which is an exposed sac of neural tissue on the back.
Recall the primary vulnerability of this condition: the sac is extremely fragile and prone to rupture and infection.
Analyze each position option based on the principle of protecting this vulnerable area.
Eliminate any position that would apply pressure to the lumbosacral area (Supine, Sims, Lateral).
Select the only position that removes all pressure from the sac and minimizes contamination risk, which is the prone position.

Concept Tested & Keywords

Concept Tested: Pre-operative nursing care and positioning for a newborn with meningomyelocele (spina bifida).
Stem keywords: newborn, meningomyelocele, lumbo-sacral area, position
Lead-in keywords: Which position
Clinical cues: The diagnosis of meningomyelocele implies an exposed, fragile sac on the back that requires protection.

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