A 47-day-old baby boy, Eliezer Abraham from Eritrea, East Africa, was brought to Sarvodaya Hospital Sector 8 Faridabad, in a critical condition.
He was born with Lumbosacral Meningomyelocele, the most severe form of Spina Bifida, a birth defect in which the spine does not develop properly. As a result, the spinal cord and nerves were protruding through an opening in his lower back, forming a swelling. The swelling had ruptured and was leaking Cerebrospinal Fluid (CSF)—the fluid that surrounds and protects the brain and spinal cord, putting him at a very high risk of a serious brain infection.
The baby also had Gross Hydrocephalus, a condition in which excess fluid builds up inside the brain. This caused his head to become unusually large and increased pressure on the brain.
When he arrived at the hospital, the baby weighed only 2.7 kg and was in a critical condition, requiring urgent medical and surgical care to save his life.
When the baby was brought to the hospital, he showed several signs of a serious neurological condition, including:
During the baby's brain scans, doctors found signs of ventriculitis, an infection of the fluid-filled spaces inside the brain. The pressure inside the skull had also become dangerously high, causing the brain stem to shift (brain stem herniation). This affected the baby's breathing, leading to rapid and noisy breathing. If left untreated, this could have resulted in aspiration (food or fluid entering the lungs), breathing failure, and could have been life-threatening.
The surgery at this point had become unsafe, and the priority was therefore to first stabilise the baby. He was admitted to the NICU, where he received intensive supportive care, nutritional optimisation, and one week of intravenous antibiotics to control the infection before any surgical intervention could be safely planned.
Once the infection had settled and the baby was stable enough for surgery, Dr Shweta K Sharma, Senior Consultant of Paediatric Surgery, along with her team, proceeded with a carefully planned treatment strategy.
The first procedure involved placement of a Ventriculoperitoneal (VP) Shunt (a surgically implanted medical device used to treat hydrocephalus by draining excess cerebrospinal fluid), which diverted the excess fluid from the brain to the abdomen, relieving the dangerously high pressure caused by gross hydrocephalus.
Following successful fluid diversion, the team performed meticulous repair of the ruptured Lumbosacral Meningomyelocele ( the bulge on the lower back), carefully repositioning and protecting the exposed neural tissues and achieving a watertight closure of the spinal defect.
The surgery had two primary objectives:
It was a complex case as the infection had spread to the brain. Both procedures required exceptional surgical precision and close coordination between the team of multidisciplinary experts.
Following surgery, the baby was closely monitored in the NICU. His recovery has been encouraging.
The infection has resolved successfully, the VP shunt is functioning well, and the spinal wound is healing satisfactorily. The baby's weight has improved from 2.7 kg to 3.5 kg, reflecting good nutritional recovery.
He is currently undergoing nutritional rehabilitation and multidisciplinary follow-up, with regular assessments by paediatric neurosurgery, paediatrics, physiotherapy, and rehabilitation specialists to support his long-term neurological development.
Although surgery cannot reverse nerve damage that occurred before birth, timely intervention has successfully controlled the infection, protected the brain, repaired the spinal defect, and given the child the best possible chance for improved long-term outcomes.
Spina Bifida is a birth defect in which a baby's spine does not develop properly during pregnancy. Normally, the bones of the spine surround and protect the spinal cord. In babies with spina bifida, a part of the spine remains open, allowing the spinal cord or nerves to bulge out through the opening.
This appears as a soft, balloon-like swelling on the baby's back, usually in the lower back. Depending on how severe the condition is, it can affect the baby's ability to move the legs and control bladder and bowel functions.
In many babies, Spina Bifida is also associated with Hydrocephalus. In this condition, excess fluid builds up in the brain, causing the head to become unusually large and increasing pressure inside the skull.
Spina bifida develops very early during pregnancy, usually within the first 3–4 weeks after conception, when the baby's neural tube (the structure that later forms the brain and spinal cord) does not close completely. As a result, part of the spine remains open, allowing the spinal cord and nerves to protrude through the opening.
Several factors increase the risk, including:
Fortunately, many cases can be prevented with adequate folic acid supplementation before conception and during early pregnancy.
Depending on severity, babies may present with:
If you find any unusual signs and symptoms in the baby, immediately consult with a paediatric surgeon
Lumbosacral Meningomyelocele with Gross Hydrocephalus is a severe birth defect that affects both the spine and the brain.
Here's what each term means:
Lumbosacral Meningomyelocele with Gross Hydrocephalus is a medical emergency. Early treatment is essential to:
Although surgery cannot reverse nerve damage that has already occurred before birth, timely intervention can save the baby's life, prevent further deterioration, and significantly improve the quality of life.
Most cases of spina bifida can be detected during pregnancy through routine antenatal ultrasound scans, usually between 18 and 22 weeks of gestation. Early diagnosis gives parents time to understand the condition, receive counselling, and plan delivery at a hospital equipped with neonatal intensive care and paediatric surgical services.
After birth, early intervention by a paediatric surgeon is crucial. Prompt surgical treatment helps close the spinal defect, prevent serious infections such as meningitis, protect the exposed spinal cord from further damage, and manage associated conditions, giving the child the best chance at life.
Although spina bifida is a challenging condition, it is not without hope.
The good news is that many cases of spina bifida can be prevented. Women planning a pregnancy are advised to take 400 micrograms (0.4 mg) of folic acid daily, starting at least one month before conception and continuing through the first trimester.
For women who have previously had a pregnancy affected by a neural tube defect, doctors may recommend a higher dose of folic acid.
Regular antenatal check-ups and routine ultrasound scans also help detect the condition early, allowing timely planning and treatment. If you notice any unusual signs during pregnancy scans, consult with an expert, a paediatric surgeon, immediately, so that the treatment can be planned long before the baby is born.
Though severe, if the condition is managed on time by experienced paediatric surgeons, children with Spina Bifida and Hydrocephalus can live a normal life; their limbs might be affected due to nerve damage, but their speech and cognitive skills can be improved with proper treatment, therapy and rehabilitation.
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