Abstract
To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair. Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic's medical records. Children were included if they had ≥ 1 year of postoperative follow-up and met the criteria for fetal surgery. The children's data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure. Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations. Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting.
Highlights
The worldwide incidence of neural tube defects (NTDs) ranges from 1 to 2 in every 1,000 live births.[1]
Children with Myelomeningocele Meeting the Criteria for Fetal Surgery Peixoto-Filho et al Conclusion Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent urinary tract infection. Note (UTI), develop renal failure, and be hospitalized
Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting
Summary
The worldwide incidence of neural tube defects (NTDs) ranges from 1 to 2 in every 1,000 live births.[1] In Brazil, the prevalence of NTD is estimated between 1.4 and 1.5 in 10,000 births.[2] Myelomeningocele (MMC) is the most common NTD, and is characterized by a dorsal midline lesion composed of a neural plaque (placode) adherent to the adjacent dysplastic epithelial tissue.[2] In the early 1950s, the survival rate of individuals with MMC was below 10%.3. Before 2011, surgical repair of the spinal defect after birth was the only alternative for MMC treatment, with unfavorable results. Clinical evidence in animal models suggests that antenatal MMC repair may favor neurological development. Fetal surgery increases the risks to maternal health, which do not exist in neonatal surgery.[3] After the Management of Myelomeningocele Study (MOMS trial), a prospective randomized clinical trial comparing antenatal and postnatal repair, antenatal surgery became universally accepted.[4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
