81 A three-layer fetoscopic spina bifida closure has fewer neonatal complications than open in-utero closure

Abstract

Spina bifida is one of the most common congenital anomalies of the central nervous system. This study compares neonatal outcomes between in-utero closure of spina bifida using a three-layer fetoscopic approach and the conventional open hysterotomy approach. This retrospective cohort study included all consecutive patients who underwent in-utero spina bifida closure using either open hysterotomy (n=43) or a three-layer fetoscopic approach (n=41) at a single institution, between 2012 and 2020. The three-layer fetoscopic closure comprised a bovine collagen patch, a myofascial layer and a skin layer. The frequency of a composite of adverse neonatal outcomes including low 5-minute Apgar scores (≤3), respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis and neonatal death were compared between the study groups. Regression analyses were performed to determine the association of a three-layer fetoscopic spina bifida closure and the composite of adverse neonatal outcomes adjusted for maternal BMI, gestational age (GA) at surgery, chorioamniotic membrane separation, delivery mode, preterm prelabor rupture of membranes and GA at delivery at <37 weeks. The three-layer fetoscopic spina bifida closure was associated with a lower rate of the composite of adverse neonatal outcomes than the open hysterotomy spina bifida closure (14.6% vs. 37.2%; p=0.025). The median gestational age at delivery and birthweight in the three-layer fetoscopic approach group were significantly higher than in the open hysterotomy approach group; whereas maternal BMI was significantly higher in the latter group (see Table 1). Regression analysis demonstrated that the three-layer fetoscopic spina bifida closure is associated with a lower risk for the composite of adverse neonatal outcomes adjusted for confounding variables (adjusted odds ratio: 0.15; 95% CI: 0.04-0.57; p=0.006). In-utero spina bifida closure using a three-layer fetoscopic approach is associated with fewer adverse neonatal outcomes than the conventional open hysterotomy spina bifida closure.