Perspectives on Surgical Care and Outcomes in Spina Bifida.

Abstract

* Abbreviations: PCP — : primary care pediatrician SB — : spina bifida In this issue of Pediatrics , Alabi et al1 describe surgical procedures and health outcomes by age in persons enrolled in the National Spina Bifida Patient Registry. Results from this descriptive study reveal that the incidence of 6 surgical procedure groups and 4 specific designated health outcomes vary by age and type of spina bifida (SB). This data-rich article contains clinically applicable information for pediatricians within the medical home model. There are 2 general observations to be made before looking at the data in more detail. First, the type of SB matters. Myelomeningocele is the most complex form of SB; nonmyelomeningocele forms (lipomyelomeningocele, meningocele, and fatty filum) are less severe and less common. In lipomyelomeningocele, hydrocephalus and Chiari malformation are rare. Most lipomyelomeningoceles occur in the lumbosacral region, which increases the likelihood of independent community ambulation. Although neurogenic bladder and bowel can occur, more patients with nonmyelomeningocele SB achieve continence. This is an important message that primary care pediatricians (PCPs) can share with families as they work together to establish appropriate expectations and interventions. Second, although >80% of participants reported having undergone no additional surgeries after the first year of life,1 the … Address correspondence to Timothy J. Brei, MD, Developmental Pediatrics, Seattle Children’s Hospital, 4800 Sand Point Way NE, Mailstop OC9.840, Seattle, WA 98105. E-mail: timothy.brei{at}seattlechildrens.org