A.S.
My sister was born with it 39 years ago.
She had fairly severe physical handicaps growing up. She spent about a year in a body cast at Shriner's Children's Hospital. One of her legs is shorter than the other. She had a rod put in in her back as a 'tween. We calculated she had 10-11 surgeries over the years? She did a stint at Boston Children's Hospital too. She still walks with crutches and needs a special shoe with a lift.
Today she is also a licensed CPA, and a married woman of almost 17 years with two amazing children. She is my best friend, the woman I trust most in the world - and someone without whom I can't imagine living.
There is hope, but it will be scary going for awhile.
With the red hair (and likely European ancestry) I would test for the MTHFR mutation and make sure this child (mom too) is able to adequately absorb folic acid.
Good luck - lots of love and prayers going out to your niece and her family.