"Neural tube defect is one of the most common birth defect in the babies that is affecting the brain, the spinal tissue as well as the spinal column. That happens very early in the pregnancy, and most of the time if the pregnancy is unplanned, the woman doesn’t know that she is pregnant, we can classify the neural tube defects in two ways. The open neural tube defect or the closed neural tube defect depending on whether this neural tissue is exposed from outside or not. In open neural tube defect the most common is spina bifida. Here there is a protrusion from the lower part of the vertebral column from the lower part of the vertebral column from the defect and through that either the meninges or part of the spinal tissue can be protruded. The second most common thing is anencephaly, but this is the most severe form of neural tube defect. Here a part of the skull and the brain tissue is absent, and most of the times the babies who have anencepahy are not compatible with life. So the babies either die in utero or immediately post delivery. Third common is the encephalocele. Here a part of the brain tissue is protruded just blew the vertebra in the back of the neck. The closed neural tube defect as the name suggests is covered with a membrane or skin tissue or epithelium. Here from outside we can see a tuft of hairs, or there may be swelling over that area or sometimes there can be hemangioma or dilated blood vessels that you can see. These are the neurocutaneous markers or signatures that the baby can have. Sometimes even the gluteal fold can be abnormally placed"

"Neural tube defect are quite common. Previously it was almost 5 to 6 % per thousand live births. The overall prevalence of neural tube defect is around 1 to 2 per thousand live births but in India it is 4 to 5 per thousand live births. For prevention of neural tube defect, the magic drug is folic acid. Before folic acid was there, the incidence of neural tube defects was very high, it started in the 1990’s and after that the incidence of neural tube defect has drastically came down. So for folci acid it is ideal that any lady who is in the reproductive age group, they should take folic acid enriched diet. In the diet she can either take the folic acid enriched breakfast cereals, or if available in the bread, pasta, regular food items, or she can take folic acid rich foods like orange juice and green leafy vegetables. If you are not comfortable to take that, then you have to take some tablets, if your gynecologist will prescribe you the folic acid capsules. If it is a planned pregnancy, you should start taking folic acid tablets when you are planning. Ideally it should be 1 month before your conception and you should continue folic acid till the first trimester. So the research has shown that if you have taken folic acid one month prior to conception, and it continues to first trimester then the chances of neural tube defect can reduce upto 50 to 70%"

"Neural tube defect is a multifactorial disease. So any lady who is getting pregnant or who is capable of getting pregnant, can have neural tube defect, but there are certainly some risk factors. The most important if you have a previous pregnancy which is affected with neural tube defect, then subsequent chance of neural tube defect increases. If I have one baby who is having neural tube defect then my chance will be around 5% . If I have 2 babies who is having neural tube defect, then my subsequent risk increase upto almost 10 to 20%. Right now we are having lot of lifestyle diseases like diabetes, obesity. Both of them are associated with neural tube defect. Sometimes if the mother is having some fits or seizure disorders, and if she is taking some medications, like valproic acid or carbamazepine, in the first trimester, that can also lead to neural tube defect in the baby and sometimes a simple thing like high grade fever, that can also lead to neural tube defect and the last is the ladies who are from lower socioeconomic status, mainly due to the poor nutrition, poor folic acid, they can also lead to neural tube defect in the babies"

"The symptoms of the neural tube defect depends on the severity of the disease. If my baby is having anencephaly, most of the times the baby is not born alive. So those are the very severe form of neural tube defect. But luckily most of the time what we seek is a spina bifida. In spina bifida there is a defect in the vertebral column and depending on the level of the defect, the baby will present with multiple symptoms. It can be paralysis of the whole upper limb and lower limb. Because it is affecting the nerve tissue, the baby can have some urinary complaint or stool retention or incontinence of stool. If the lesion is higher up, it can lead to deafness, blindness, as well as it can lead to some developmental delay. Sometimes spina bifida patient can have urinary tract infection because of the urinary incontinence they can have multiple urinary tract infections and that can lead to damage of the kidneys"

"We can diagnose neural tube defect really fast. Early in the second trimester, we do the maternal serum alfafetoprotein level in the routine triple test . If the maternal alfafetoprotein levels are much higher say 2 to 2.5 times higher then the baby affected with neural tube defect are very high. That we can diagnose and subsequently confirm with amniotic fluid test also. In amniotic fluid, we can test by the acetylcoline esterase. That also gives us an idea about whether the baby has neural tube defects or no. The second diagnosis from the further ultrasonography. If we do a detailed ultrasonography, in the second trimester, almost 90 to 95% of the open neural tube defects can be diagnosed on the sonography. The treatment of the neural tube defect starts from the prevention of neural tube defects. As we know that folic acid is the magic bullet, if we start the folic acid in the mothers, we can prevent the mothers from having a neural tube defect affected pregnancy and once the neural tube defect happens, there is no cure for that baby. That we can do is we can treat the baby and we can prevent the complications of neural tube defect. Suppose if the baby is born with a spina bifida defect, then we have to take the baby immediately for the surgery to close the defect. Otherwise it can get infected and that can lead to their morbidity. If the baby is having some tethered cord. There the cord is attached to the lower part of the spinal cord and as the babies grow, the nerve fibers get stretched and the baby can get more and more symptoms with that. Here we have to surgically release the cord so that the baby can get rid of the symptoms. Other common complications of neural tube defect is a hydrocephalus. Here there is a collection of the CSF or the brain fluid surrounding the parenchyma and to treat hydrocephalus, most of the times you have to put a shunt in the babies head and, it is just nothing but a small tubes in the babies head that we have to put a shunt in the babies head and that drains the surrounding fluid. Another most common thing that we see in these type of babies is a there is a lot of difficulty in the ambulation and the mobility. So they need lots of support in the form of braces, crutches, wheelchairs, lot of physiotherapy , family support for these babies for the actual morbidity. Last but not the least, we now that these babies have some urinary retention and urinary tract infection. So there are bladder surgeries that we can do in these babies to help the bay to make them continent as well as they need multiple catheterization to present them socially acceptable and many of the times we have to give them antibiotics so that urinary tract infection can be prevented and kidney damage can be prevented in an earlier stage"