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Clinical outcomes of myelomeningocele infants without antenatal surgery: Mortality and morbidity in a tertiary ICU setting

Year 2024, Volume: 1 Issue: 3, 190 - 194, 11.10.2024
https://doi.org/10.70058/cjm.1517701

Abstract

Clinical Outcomes of Meningomyelocele Infants Without Antenatal Surgery: Mortality and Morbidity in a Tertiary ICU Setting
Objective
To investigate the early clinical outcomes of infants with meningomyelocele
Material and methods
We included infants with meningomyelocele who had undergone treatment in our tertiary neonatal intensive care unit. We included all patients with meningomyelocele between 2016-2023. We retrospectively recorded data and assessed perinatal history, morbidity, and mortality status. A p-value of <0.05 was set for significance.
Results
Our study included 90 patients, with an equal distribution of males and females. The majority (87.4%) were delivered by cesarean section, while 12.6% were delivered vaginally. Chiari malformation was present in 7.8% of patients. The average gestational age was 38 weeks, birth weight was 3070 ± 520 grams, birth length was 48 cm, and head circumference was 35 cm. Clubfoot was observed in 31.5% of patients, and scoliosis/kyphoscoliosis in 13.3%. The average sac width was 7 cm and sac length was 6 cm. Normal foot movements were noted in 11.1% of patients. The average surgery time was 49 hours postnatally. Meningitis/CSF infection developed in 28.9% of patients, and convulsions occurred in 23.3%. Hydrocephalus was detected in 72.2% of patients. During follow-up, 59% required a VP shunt. The mortality rate was 18.9%, with an average hospital stay of 41 days.
Conclusion
The poor prognostic factors were lower gestational age, longer sac length and width for lower extremity tonus, scoliosis for mortality, and head circumference, sac length, and sac width for shunt needs.
Keywords: Meningomyelocele, hydrocephalus, ventriculoperitoneal shunt, neural Tube Defects

References

  • Venkataramana NK. Spinal dysraphism. J Pediatr Neurosci. 2011;6(Suppl 1):S31-S40. doi:10.4103/1817-1745.85707
  • Beaudin AE, Stover PJ. Folate-mediated one-carbon metabolism and neural tube defects: balancing genome synthesis and gene expression. Birth Defects Res C Embryo Today. 2007;81(3):183-203. doi:10.1002/bdrc.20100
  • Iftikhar W, De Jesus O. Spinal Dysraphism and Myelomeningocele. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 23, 2023.
  • Holmes LC, Li V. Occult Spinal Dysraphism. Pediatr Rev. 2019;40(12):650-652. doi:10.1542/pir.2018-0155
  • Farmer DL, Thom EA, Brock JW 3rd, et al. The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes. Am J Obstet Gynecol. 2018;218(2):256.e1-256.e13. doi:10.1016/j.ajog.2017.12.001
  • Fowler JB, De Jesus O, Mesfin FB. Ventriculoperitoneal Shunt. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 23, 2023.
  • Blount JP, Maleknia P, Hopson BD, Rocque BG, Oakes WJ. Hydrocephalus in Spina Bifida. Neurol India. 2021;69(Supplement):367-371. doi:10.4103/0028-3886.332247
  • Cools MJ, Tang AR, Pruthi S, et al. A comparison of MRI appearance and surgical detethering rates between intrauterine and postnatal myelomeningocele closures: a single-center pilot matched cohort study. Childs Nerv Syst. 2023;39(3):647-653. doi:10.1007/ s00381-022-05627-z
  • Vonzun L, Kahr MK, Noll F, et al. Systematic classification of maternal and fetal intervention-related complications following open fetal myelomeningocele repair - results from a large prospective cohort. BJOG. 2021;128(7):1184-1191. doi:10.1111/1471- 0528.16593
  • Al-Kuran O, Jaber DZ, Ahmad A, et al. Understanding perspectives on neural tube defect management: insights from Jordanian parents. J Matern Fetal Neonatal Med. 2024;37(1):2334846. doi:10.1080/147 67058.2024.2334846
  • Bakker MK, Kancherla V, Canfield MA, et al. Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry-Based Study, 2001-2012. Paediatr Perinat Epidemiol. 2019;33(6):436-448. doi:10.1111/ppe.12589
  • Greene S, Lee PS, Deibert CP, et al. The impact of mode of delivery on infant neurologic outcomes in myelomeningocele. Am J Obstet Gynecol. 2016;215(4):495.e1-495.e11. doi:10.1016/j. ajog.2016.05.028
  • Bülbül A, Can E, Uslu S, Baş EK, Şahin Y, Yılmaz A, Nuhoğlu A. Effect of operation time on prognosis and defined additional anomalies among neonatal meningomyelocele cases. Med Bull Sisli Etfal Hosp. 2010;44(2):61-65
  • İlhan Ö, Özdemir SA, Özdemir N, Akbay S, Kanar B, Memur Ş, Bor M, Özer EA. Meningomyelosel Olgularında Prognozu Etkileyen Faktörler ve Eşlik Eden Anomaliler: 40 Olguluk Deneyim. JGON. 2017;14(4):163-7.
  • Akbar M, Bresch B, Seyler TM, et al. Management of orthopaedic sequelae of congenital spinal disorders. J Bone Joint Surg Am. 2009;91 Suppl 6:87-100. doi:10.2106/JBJS.I.00613.
  • Flynn JM, Herrera-Soto JA, Ramirez NF, Fernandez-Feliberti R, Vilella F, Guzman J. Clubfoot release in myelodysplasia. J Pediatr Orthop B. 2004;13(4):259-262. doi:10.1097/01. bpb.0000124491.13918.b7
  • Heyns A, Negrini S, Jansen K, et al. The Prevalence of Scoliosis in Spina Bifida Subpopulations: A Systematic Review. Am J Phys Med Rehabil. 2018;97(11):848-854. doi:10.1097/ PHM.0000000000000966
  • Rodrigues AB, Krebs VL, Matushita H, de Carvalho WB. Shortterm prognostic factors in myelomeningocele patients. Childs Nerv Syst. 2016;32(4):675-680. doi:10.1007/s00381-016-3012-7
  • Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM. Spina bifida. Nat Rev Dis Primers. 2015;1:15007. doi:10.1038/nrdp.2015.7
Year 2024, Volume: 1 Issue: 3, 190 - 194, 11.10.2024
https://doi.org/10.70058/cjm.1517701

Abstract

References

  • Venkataramana NK. Spinal dysraphism. J Pediatr Neurosci. 2011;6(Suppl 1):S31-S40. doi:10.4103/1817-1745.85707
  • Beaudin AE, Stover PJ. Folate-mediated one-carbon metabolism and neural tube defects: balancing genome synthesis and gene expression. Birth Defects Res C Embryo Today. 2007;81(3):183-203. doi:10.1002/bdrc.20100
  • Iftikhar W, De Jesus O. Spinal Dysraphism and Myelomeningocele. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 23, 2023.
  • Holmes LC, Li V. Occult Spinal Dysraphism. Pediatr Rev. 2019;40(12):650-652. doi:10.1542/pir.2018-0155
  • Farmer DL, Thom EA, Brock JW 3rd, et al. The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes. Am J Obstet Gynecol. 2018;218(2):256.e1-256.e13. doi:10.1016/j.ajog.2017.12.001
  • Fowler JB, De Jesus O, Mesfin FB. Ventriculoperitoneal Shunt. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 23, 2023.
  • Blount JP, Maleknia P, Hopson BD, Rocque BG, Oakes WJ. Hydrocephalus in Spina Bifida. Neurol India. 2021;69(Supplement):367-371. doi:10.4103/0028-3886.332247
  • Cools MJ, Tang AR, Pruthi S, et al. A comparison of MRI appearance and surgical detethering rates between intrauterine and postnatal myelomeningocele closures: a single-center pilot matched cohort study. Childs Nerv Syst. 2023;39(3):647-653. doi:10.1007/ s00381-022-05627-z
  • Vonzun L, Kahr MK, Noll F, et al. Systematic classification of maternal and fetal intervention-related complications following open fetal myelomeningocele repair - results from a large prospective cohort. BJOG. 2021;128(7):1184-1191. doi:10.1111/1471- 0528.16593
  • Al-Kuran O, Jaber DZ, Ahmad A, et al. Understanding perspectives on neural tube defect management: insights from Jordanian parents. J Matern Fetal Neonatal Med. 2024;37(1):2334846. doi:10.1080/147 67058.2024.2334846
  • Bakker MK, Kancherla V, Canfield MA, et al. Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry-Based Study, 2001-2012. Paediatr Perinat Epidemiol. 2019;33(6):436-448. doi:10.1111/ppe.12589
  • Greene S, Lee PS, Deibert CP, et al. The impact of mode of delivery on infant neurologic outcomes in myelomeningocele. Am J Obstet Gynecol. 2016;215(4):495.e1-495.e11. doi:10.1016/j. ajog.2016.05.028
  • Bülbül A, Can E, Uslu S, Baş EK, Şahin Y, Yılmaz A, Nuhoğlu A. Effect of operation time on prognosis and defined additional anomalies among neonatal meningomyelocele cases. Med Bull Sisli Etfal Hosp. 2010;44(2):61-65
  • İlhan Ö, Özdemir SA, Özdemir N, Akbay S, Kanar B, Memur Ş, Bor M, Özer EA. Meningomyelosel Olgularında Prognozu Etkileyen Faktörler ve Eşlik Eden Anomaliler: 40 Olguluk Deneyim. JGON. 2017;14(4):163-7.
  • Akbar M, Bresch B, Seyler TM, et al. Management of orthopaedic sequelae of congenital spinal disorders. J Bone Joint Surg Am. 2009;91 Suppl 6:87-100. doi:10.2106/JBJS.I.00613.
  • Flynn JM, Herrera-Soto JA, Ramirez NF, Fernandez-Feliberti R, Vilella F, Guzman J. Clubfoot release in myelodysplasia. J Pediatr Orthop B. 2004;13(4):259-262. doi:10.1097/01. bpb.0000124491.13918.b7
  • Heyns A, Negrini S, Jansen K, et al. The Prevalence of Scoliosis in Spina Bifida Subpopulations: A Systematic Review. Am J Phys Med Rehabil. 2018;97(11):848-854. doi:10.1097/ PHM.0000000000000966
  • Rodrigues AB, Krebs VL, Matushita H, de Carvalho WB. Shortterm prognostic factors in myelomeningocele patients. Childs Nerv Syst. 2016;32(4):675-680. doi:10.1007/s00381-016-3012-7
  • Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM. Spina bifida. Nat Rev Dis Primers. 2015;1:15007. doi:10.1038/nrdp.2015.7
There are 19 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Articles
Authors

Akan Yaman 0000-0002-7550-6765

Baran Cengiz Arcagök 0000-0002-4834-9127

İbrahim Kandemir 0000-0002-1720-9711

Sinem Gülcan Kersin 0000-0003-3634-3243

Alper Birgül 0000-0001-7317-099X

Publication Date October 11, 2024
Submission Date July 17, 2024
Acceptance Date September 5, 2024
Published in Issue Year 2024 Volume: 1 Issue: 3

Cite

Vancouver Yaman A, Arcagök BC, Kandemir İ, Gülcan Kersin S, Birgül A. Clinical outcomes of myelomeningocele infants without antenatal surgery: Mortality and morbidity in a tertiary ICU setting. Cerasus J Med. 2024;1(3):190-4.