Prognostic Factors And Accompanying Anomalies In Neonates With Meningomyelocele: Experience Of 40 Patients

Abstract

Aim: The aim of this study was to determine clinical features and short-term prognosis of hospitalized neonates with meningomyelocele, and to asses the association between the serum levels of vitamin D and meningomyelocele.Material and Methods: In this single center retrospective study, all infants with meningomyelocele were considered eligible. This study was conducted in Tepecik Training and Research Hospital between January 2014 and December 2015. Data of the patients were noted from the medical records.Results: A total of 40 infants with meningomyelocele were eligible for the study. The mean gestational age of infants was 38.6 ± 2.2 weeks and mean birth weight was 3099 ± 553 g. None of the mothers had taken folic acid support preconceptionally. The meningomyelocele was localized in lumbar 80% , thoracolumbar 12.5% and cervical 7.5% areas. The average time of surgical operation for meningomyelocele was 5.1 ± 4.65 days and the rate of operation in the first 72 hours of life for meningomyelocele was 50%. The mean length of stay in hospital was 27.3 ± 13.8 days, although the length of stay is shorter in the early surgery group first 72 hours than late surgery group after 72 hours there were no statistically significant difference between the groups p=0.25 . The incidence of sepsis in the study group was 45% and length of stay was statistically longer in the infants with sepsis p=0.006 . Additional accompanying anomalies were hydrocephaly 77.5% , hydronephrosis 10% , congenital heart disease 7.5% and congenital hypothyroidism 7.5% . The mortality rate of babies during the hospitalization was 0%. Of all patients, 70% of the infants had vitamin D deficiency, 20% of the infants had vitamin D insufficiency and only 10% of the infants had normal serum vitamin D levels, but vitamin D levels were statistically similar between sepsis and non-sepsis group.Conclusion: Surgical operation of meningomyelocele within 72 hours of life and to prevent sepsis development after operation reduces duration of hospitalizaton. This study also shows an association between a decreased vitamin D level and meningomyelocele.

Keywords

• Newborn,meningomyelocele,operation time,sepsis,vitamin D

Meningomyelosel Olgularında Prognozu Etkileyen Faktörler ve Eşlik Eden Anomaliler: 40 Olguluk Deneyim

Abstract

Amaç: Bu çalışmada kliniğimizde yenidoğan döneminde izlenen ve opere edilen meningomyelosel tanılı olguların klinik özellikleri, kısa dönem prognozları ve D vitamin ile meningomyelosel arasındaki ilişkinin değerlendirilmesi amaçlandı.Gereç ve Yöntemler: İzmir Tepecik Eğitim ve Araştırma Hastanesi’ne Ocak 2014 ile Aralık 2015 tarihleri arasında meningomyelosel tanısıyla yenidoğan kliniğine yatırılan tüm bebekler bu tek merkezli retrospektif çalışmaya alındı. Hastalara ait verilere tıbbi kayıtlardan ulaşıldı.Bulgular: Çalışmaya toplam 40 bebek dahil edildi. Hastaların ortalama doğum ağırlığı 3099 ± 553 g ve ortalama gebelik yaşı 38.6 ± 2.2 haftaydı. Antenatal dönemde folik asit kullanan anne yoktu. Meningomiyelosel %80 lomber, %12.5 torakolomber ve %7.5 servikal bölgedeydi. Ortalama operasyon zamanı 5.1 ± 4.65 gündü ve hastaların %50’si ilk 72 saatte operasyon geçirmişti. Ortalama yatış süresi 27.3 ± 13.8 gündü, ilk 72 saatte opere edilen grupta yaşamın 72. saatinden sonra opere edilen gruba göre hastanede yatış süresi daha kısa olsa da gruplar arasında istatistiksel açıdan anlamlı bir fark yoktu. Çalışmada operasyon sonrası sepsis oranı %45 olarak saptandı ve yatış süresi sepsis grubunda istatiksel olarak daha uzun bulundu p=0.006 . Hidrosefali %77.5 , hidronefroz %10 , konjenital kalp hastalığı %7.5 ve konjenital hipotiroidizm %7.5 eşlik eden ek anomalilerdi. Serum D vitamini düzeyi tüm hastaların %70’inde eksik, %20’sinde yetersiz ve %10’unda normal olarak saptandı, ancak serum D vitamini düzeylerinde sepsis saptanan grupla saptanmayan grup arasında istatiksel olarak fark yoktu.Sonuç: Yenidoğan döneminde meningomyelosel tanısı alan bebeklerin yaşamın ilk 3 günü içerisinde opere edilmesi ve operasyon sonrası sepsis gelişiminin önlenmesi hastanede yatış süresini kısaltır. Bu çalışmada aynı zamanda azalmış serum D vitamini düzeyleri ile meningomyelosel arasında bir ilişki olduğu gösterildi.

Keywords

• Yenidoğan,meningomyelosel,operasyon zamanı,sepsis,D vitamini

References

1. KIinsman SL, Johnston MV. Congenital anomalies of the central nervous system. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, (eds). Nel- son Textbook of Pediatrics, 20th ed. Philadelphia: Saunders 2016;2802- 2819.
2. Zaganjor I, Sekkarie A, Tsang BL, Williams J, Razzaghi H, Mulinare J, et al. Describing the prevalence of neural tube defects worldwide: a syste- matic literature review. Plos One 2016;11(4):1-31.
3. Back SA, Plawner LL. Congenital malformations of the central nervous system. In: Gleason CA, Devaskar SU. (eds). Avery’s Diseases of the Newborn. 9th ed. Philadelphia: Elsevier 2012;844-868.
4. Tuncbilek E, Boduroglu K, Alikasifoglu M. Neural tube defects in Turkey: prevalence, distrubition and risk factors. Turk J Pediatr 1999;41:299- 305.
5. Berry RJ, Li Z, Erickson JD, Li S, Moore CA, Wang H, et al. Prevention of neural-tube defects with folic acid in China. China-u.S. Collaborative Project for Neural Tube Defect Prevention. N Engl J Med 1999;341:1485– 1490.
6. Food and Drug Administration. Food standards of identity for enriched grain products to require addition of folic acid. Final Rule 21 CFR 1996; 131: 3702-3737.
7. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398-417.
8. Leger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G , et al; ESPE-PES-SLEP-JSPE-APEG-APPES-ISPAE; Congenital Hypothyroidism Consensus Conference Group. European Society for Paediatric Endocri- nology consensus guidelines on screening, diagnosis and management of congenital hypothyroidism. J Clin Endocrinol Metab 2014;99:363- 384.

9. Gitto E, Karbownik M, Reiter RJ, Tan DX, Cuzzocrea S, Chiurazzi P, et al. Effects of melatonin treatment in septic newborns. Pediatr Res 2001;50:756–760.
10. Greene S, Lee PS, Deibert CP, Tempel ZJ, Zwagerman NT, Florio K, et al. The impact of mode of delivery on infant neurologic outcomes in myelo- meningocele. Am J Obstet Gynecol 2016;215(4):495.e1-495.
11. Cuppen I, Eggink AJ, Lotgering FK, Rotteveel JJ, Mullaart RA, Roeleveld N, et al. Influence of birth mode on early neurological outcome in infants with myelomeningocele. Eur J Obstet Gynecol Reprod Biol 2011;156:18- 22.
12. Bulbul A, Can E, Uslu S, Bas EK, Sahin Y, Yilmaz A, et al. Effect of opera- tion time on prognosis and defined additional anomalies among neonatal meningomyelocele cases. The Medical Bulletin of Sisli Etfal Hospital, 2010;44(2):61-65.
13. Altas M, Aras M, Altas ZG, Aras Z, Serarslan Y, Yılmaz N. Retrospective analysis of neural tube defect patients. MKU Med J 2012;3(9):22-28.
14. Greene WB, Terry RC, DeMasi RA, Herrington RT. Effect of race and gen- der on neurological level in myelomeningocele. Dev Med Child Neurol 1991;33:110-117.
15. De Wals P, Tairou F, Van Allen MI, Uh SH, Lowry RB, Sibbald B, et al. Reduction in neural-tube defects after folic acid fortiŞcation in Canada. N Engl J Med 2007;357:135–142.
16. LaFranchi SH, Huang SA. Hypothyroidism. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, (eds). Nelson Textbook of Pediatrics, 20th ed. Phi- ladelphia: Saunders 2016; 2665-2675.
17. Reddy PA, Rajagopal G, Harinarayan CV, Vanaja V, Rajasekhar D, Suresh V, et al. High Prevalence of Associated Birth Defects in Congenital Hypo- thyroidism. Int J Pediatr Endocrinol 2010;2010:940-980.
18. Ritter S, Tani LY, Shaddy RE, Minich LL. Are screening echocardiograms warranted for neonates with meningomyelocele? Arch Pediatr Adolesc Med 1999;153:1264–1266.
19. Baradaran N, Ahmadi H, Nejat F, El Khashab M , Mahdavi A. Nonneu- ral congenital abnormalities concurring with myelomeningocele: re- port of 17 cases and review of current theories. Pediatr Neurosurg. 2008;44:353-359.
20. Flood HD, Ritchey ML, Bloom DA, Huang C, McGuire EJ. Outcome of reflux in children with myelodysplasia managed by bladder pressure mo- nitoring. J Urol 1994;152(5 Pt 1):1574-1577.
21. Bauer SB, Hallett M, Khoshbin S, Lebowitz RL, Winston KR, Gibson S, et al. Predictive value of urodynamic evaluation in newborns with mye- lodysplasia. JAMA 1984;252(5):650-652.
22. Aygun C, Vurucu S, Celik FC, Dagnar A, Tanyeri B, Kucukoduk S. Expe- rience of a tertiary care center on 100 newborns with neural tube defe- cts. Turk J Pediatr 2013;55:359-364.
23. Rodrigues AB, Krebs VL, Matushita H, de Carvalho WB. Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst 2016;32:675–680.
24. Cizmeci MN, Kanburoglu MK, Akelma AZ, Ayyildiz A, Kutukoglu I, Malli DD, et al. Cord-blood 25-hydroxyvitamin D levels and risk of early-onset neonatal sepsis: a case-control study from a tertiary care center in Tur- key. Eur J Pediatr 2015;174:809–815.
25. Cetinkaya M, Cekmez F, Buyukkale G, Erener-Ercan T, Demir F, Tunc T, et al. Lower vitamin D levels are associated with increased risk of early-on- set neonatal sepsis in term infants. J Perinatol 2015;35:39–45.
26. Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol 2010;202:429e1–429ee.
27. Nasri K, Ben Fradj MK, Feki M, Kaabechi N, Sahraoui M, Masmoudi A, et al. Maternal 25-hydroxyvitamin D level and the occurrence of neural tube defects in Tunisia. Int J Gynaecol Obstet 2016;134(2):131-134.
28. Okurowska-Zawada B, Kozerska A, Żelazowska B, Kułak W, Wasilews- ka A, Wysocka J. Serum 25-hydroxyvitamin D, osteocalcin, and parat- hormone status in children with meningomyelocele. Neuropediatrics 2012;43(6):314-319.