83 Ambulatory status after prenatal (fetoscopic/open) and postnatal spina bifida repair. Predictors for independent ambulation

Abstract

Identifying which clinical parameters can predict reliably the chances of a fetus/baby to ambulate independently is of critical relevance. The aims of this study were to compare the ambulatory status of a cohort of children who had prenatal spina bifida repair against those who had postnatal repair and identify predictors for independent ambulation. Retrospective cohort of children who had in utero repair (fetoscopic (N=29), open-hysterotomy (N=27) approaches) or postnatal repair (N=26) in the same institution. Prenatal repair cases followed MOMS trial inclusion criteria for surgery. Postnatal repair cases met MOMS trial criteria based on fetal imaging. Motor function (MF) assessment by ultrasound was recorded at initial evaluation(MF1), 6 weeks post repair(MF2) and prior to birth(MF3). In utero MF was established by the highest myotome used in lower extremities. S1 MF was classified as “intact motor function”. MF was also recorded at birth and 12 months using standard neurological exam. Ambulatory status was recorded longitudinally and classified as independent ambulator (with/without orthosis), walking with assistive devices (ie walker) or as not ambulatory Prenatal and postnatal repair groups showed similar neural tube defects and in utero MF. Gestational age at delivery and birthweights were higher in the postnatal repair group(Table1). No differences in ambulation were observed between groups before 30 months. At that time, a higher proportion of prenatally repaired cases were able to walk. No differences were seen between both methods for prenatal repair(Fig1). Logistic regression analyses showed how “intact MF” at 12 months [OR: 13.6 (95%CI: 2.6-70.9),p<0.01], at MF1 [12.5(1.47-106),0.02], at birth [7.6 (1.89-31.09),p<0.01] and absence of club feet [5.1 (1.25-20.9),0.02] predicted significantly having independent ambulation at 30 months in the prenatal repair group Independent ambulation after prenatal spina bifida repair can be predicted by observing S1 MF pre- and postnatally, this finding can have important clinical implications and on parental counseling.View Large Image Figure ViewerDownload Hi-res image Download (PPT)