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Açık Spinal Disrafizm Nedeniyle Opere Olan Yenidoğanlarda Komorbid Durumlar ve Bunların Gebelikte Folik Asit Kullanımıyla İlişkisinin Retrospektif İncelenmesi

Year 2018, Volume: 8 Issue: 3, 194 - 202, 01.12.2018

Abstract

Amaç: Biz bu çalışmada, opere edilen meningosel ve miyelomeningosel olgularına eşlik eden komorbid durumları ve bunların gebelikte kullanılan folik asitle ilişkisini incelemeyi amaçladık.
Materyal ve Metot: Meningosel ve myelomeningosel tanısıyla opere edilen 81 yenidoğan bu çalışmaya dahil edildi. Hasta dosyaları
retrospektif olarak taranarak olguların veriler kaydedildi. Olgular, gebelik döneminde folik asit kullanan ve kullanmayan grup olarak ikiye
ayrıldı. İki grup arasında yenidoğanların ağırlık, boy, hemogram, biyokimya, tanı zamanı, doğum şekli, maturite, lokalizasyon, tip, nörolojik
defisit, skolyoz, hidrosefali, cerrahi zamanı, ventrikülomegali, tedavi
şekli, ek patoloji, tetheredcord sendromu, dermal sinüs traktı, maternal hastalık birlikteliği ve BOS fistülü gibi malformasyonların sayısı,
karşılaştırıldı.
Bulgular: Antenatal dönemde folik asit kullanımı %44,4 olarak
saptandı. Meningomiyelosel %40,7 lomber, ve %46,9 sakral bölgedeydi. Erken tanılı yenidoğanlarda ( <1 hafta) operasyon oranı
daha (%60,5) yüksekti. Cerrahi zamanlama ile komplikasyonlar arasında anlamlı bir ilişki yoktu. Hidrosefali (%55,0), ventrikülomegali
(%61,7), skolyoz (%34,6), BOS fistülü (%4,9) ve dermal sinüs traktı
(%46,9) eşlik eden ek anomalilerdi. Folik asit kullanılan ve kullanılmayan gruplar karşılaştırıldığında, folik asit kullanılmayan grupta
sezaryenle doğum oranı (%75) (p=0,017), myelomeningosel oranı (%80) (p<0,01), paraparezi %39,5 ve parapleji %16 (p=0,006)
anlamlı derecede yüksek, dermal sinüs traktı (%35,6) (p=0,022)
ve ortalama doğum ağırlığı ise anlamlı derecede düşük (p=0,04)
saptandı.
Sonuç: Bizim yaptığımız bu retrospektif çalışmada, meningosel
ve miyelomeningosel tanısıyla opere olan yenidoğanlarda gebelik
döneminde folik asit kullanımı daha yüksek doğum ağırlığı ve daha
yüksek oranda normal doğumla birliktelik göstermekte, daha az
oranda miyelomeningosel, parapleji ve parapareziye neden olmakta ancak folik asit kullanımı daha yüksek oranda dermal sinüs traktına neden olmaktadır, bu bilgiler doğrultusunda gebelik döneminde
folik asit kullanımını önermekteyiz.

References

  • 1. KIinsman SL, Johnston MV. Congenital anomalies of the central nervous system. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, (eds). Nelson 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 systematic 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 theNewborn. 9th ed. Philadelphia: Elsevier 2012;844-868.
  • 4. 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.
  • 5-Donnelly JG1. Folic acid. Crit Rev Clin Lab Sci. 2001 Jun;38(3):183-223.
  • 6-Refsum H1. Folate, vitamin B12 and homocysteine in relation to birth defects and pregnancy outcome. Br J Nutr. 2001 May;85 Suppl 2:S109-13.
  • 7-Rosenquist TH1, Finnell RH. Genes, folate and homocysteine in embryonic development. Proc Nutr Soc. 2001 Feb;60(1):53-61.
  • 8-Födinger M, Hörl WH, Sunder-Plassmann G. Molecular biology of 5,10-methylenetetrahydrofolate reductase. J Nephrol. 2000 Jan-Feb;13(1):20-33. Review.
  • 9-Molloy AM, Daly S, Mills JL, Kirke PN, Whitehead AS, Ramsbottom D, Conley MR, Weir DG, Scott JM. Thermolabile variant of 5,10-methylenetetrahydrofolate reductase associated with low red-cell folates: implications for folate intake recommendations. Lancet. 1997 May 31;349(9065):1591-3.
  • 10-Li W1, Li Z1, Zhou D1, Zhang X1, Yan J2, Huang G3. Maternal folic acid deficiency stimulates neural cell apoptosis via miR-34aassociated with Bcl-2 in the rat foetal brain. Int J Dev Neurosci. 2018 Nov 14;72:6-12.
  • 11-Viswanathan M1, Treiman KA2, Kish-Doto J3, Middleton JC4, Coker-Schwimmer EJ4, Nicholson WK5. Folic Acid Supplementation for the Prevention of Neural Tube Defects: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017 Jan 10;317(2):190-203.
  • 12-Dessie MA, Zeleke EG, Workie SB, Berihun AW. Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: cross-sectional study. BMC Pregnancy Childbirth. 2017 Sep 21;17(1):313.
  • 13-Liu J, Xie J, Li Z, Greene NDE, Ren A. Sex differences in the prevalence of neural tube defects and preventive effects of folic acid (FA) supplementation among five counties in northern China: results from a population-based birth defect surveillance programme. BMJ Open. 2018 Nov 8;8(11):e022565.
  • 14- Ito K, Hanaoka T, Tamura N, Sasaki S, Miyashita C, Araki A et al. Association Between Maternal Serum Folate Concentrations in the First Trimester and the Risk of Birth Defects: The Hokkaido Study of Environment and Children's Health. J Epidemiol. 2018 Oct 13.
  • 15-Ishikawa T, Obara T, Nishigori H, Nishigori T, Metoki H, Ishikuro M et al. Update on the prevalence and determinants of folic acid use in Japan evaluated with 91,538 pregnant women: the Japan Environment and Children's Study. J Matern Fetal Neonatal Med. 2018 Aug 19:1-10.
  • 16-Mutlu M, Aslan Y, Kader Ş, Aktürk FC, Yazar U. Evaluation of newborns open neural tube defect retrospectively. Turkiye Klinikleri J Pediatr 2018;27(1):20-7.
  • 17-Frelut ML, de Courcy GP, Christidès JP, Blot P, Navarro J. Relationship between maternal folate status and foetal hypotrophy in a population with a good socio-economical level. Int J Vitam Nutr Res. 1995;65(4):267-71.
  • 18-Wani MA. Neural tube defect and folic acid. JK Pract. 2000 Jan-Mar;7(1):1-3.
  • 19- Mazumdar M, Ibne Hasan MO, Hamid R, Valeri L, Paul L, Selhub J, et al. Arsenic is associated with reduced effect of folic acid in myelomeningoceleprevention: a case control study in Bangladesh. Environ Health. 2015 Apr 10;14:34.
  • 20-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 myelomeningocele.Am J Obstet Gynecol 2016;215(4):495.e1-495.
  • 21-Bulbul A, Can E, Uslu S, Bas EK, Sahin Y, Yilmaz A, et al. Effect of operation time on prognosis and defined additional anomalies among neonatal meningomyelocele cases. The Medical Bulletin of Sisli Etfal Hospital, 2010;44(2):61-65.
  • 22-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.
  • 23-Greene WB, Terry RC, DeMasi RA, Herrington RT. Effect of race and gender on neurological level in myelomeningocele. Dev Med Child Neural 1991;33:110-117.
  • 24-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.
  • 25-MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet 338: 131-137, 1991
  • 26-Sandford MK, Kissling GE, Joubert PE: Neural tube defect etiology: New evidence concerning maternal hyperthermia,health and diet. Dev Med Child Neurol 34:661-675, 1992
  • 27-Czeizel AE, Dudas I: Prevention of the first occurence of neuraltube defects by periconceptional vitamin supplementation.N Engl J Med 327: 1832-1835, 1992
  • 28-Flood HD, Ritchey ML, Bloom DA, Huang C, McGuire EJ. Outcome of reflux in children with myelodysplasia managed by bladder pressure monitoring. J Urol 1994;152(5 Pt 1):1574-1577.
  • 29-Bauer SB, Hallett M, Khoshbin S, Lebowitz RL, Winston KR, Gibson S,et al. Predictive value of urodynamic evaluation in newborns with myelodysplasia.JAMA 1984;252(5):650-652.
  • 30-Flood HD, Ritchey ML, Bloom DA, Huang C, McGuire EJ. Outcome of reflux in children with myelodysplasia managed by bladder pressure monitoring. J Urol 1994;152(5 Pt 1):1574-1577.
  • 31-Aygun C, Vurucu S, Celik FC, Dagnar A, Tanyeri B, Kucukoduk S. Experience of a tertiary care center on 100 newborns with neural tube defects. Turk J Pediatr 2013;55:359-364.
  • 32-Rodrigues AB, Krebs VL, Matushita H, de Carvalho WB. Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst 2016;32:675–680.

Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations with Folic Acid Usage During the Pregnancy

Year 2018, Volume: 8 Issue: 3, 194 - 202, 01.12.2018

Abstract

Aim: In the present study, we aimed to analyze comorbid
conditions associated with operated myelomeningocele and their relationship
with folic acid usage during pregnancy.

Material
and Method:
Eighty-one
newborns who were operated on due to myelomeningocele were included in this
study. The patient’s files were retrospectively reviewed, and the data of the
patients were recorded. The patients were divided into two groups: folic acid
users and non-folic acid users during pregnancy. The two groups were compared
in terms of weight, height, hemogram, biochemistry, time of diagnosis, delivery
method, maturity, localization, type (meningocel or myelomeningocel), neurological
deficit, scoliosis, hydrocephalus, timing of surgery, ventriculomegaly, treatment
method, additional pathology, tethered cord syndrome, dermal sinus, maternal
disease, and number of malformations such as cerebrospinal fluid fistula.

Results: The rate of folic acid usage during the antenatal
period was 44.4%. Myelomeningocele was located in lumbar (40.7%) and sacral
(46.9%) regions. The rate of operation with early diagnosis newborn (1<week)
was high (60.5%). There was no significant relationship between the timing of
surgery and complications. Hydrocephalus (55.0%), ventriculomegaly (61.7%),
scoliosis (34.6%), cerebrospinal fluid fistula (4.9%), and dermal sinus (46.9%)
accompanied anomalies. Comparing the folic acid group with the non-folic acid
group, it was revealed that the rates of cesarean delivery (75%; p = 0.017),
meningomyelocele (80%; p < 0.01), paraparesis (39.5%;p=0.006), paraplegia
(16%; p = 0.006), and dermal sinus (53.1%; p = 0.022) were significantly higher
in the non-folic acid group, whereas the mean birth weight was significantly
lower (p = 0.04) in the non-folic acid group.







Conclusion: In our study, folic acid usage during pregnancy
results in higher birth weight, higher number of normal births, and lower rates
of myelomeningocele, paraplegia, and paraparesis but a higher rate of dermal
sinus in newborn who have been operated for meningocele or myelomeningocele.
Therefore,
we recommend folic acid usage during pregnancy. 

References

  • 1. KIinsman SL, Johnston MV. Congenital anomalies of the central nervous system. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, (eds). Nelson 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 systematic 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 theNewborn. 9th ed. Philadelphia: Elsevier 2012;844-868.
  • 4. 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.
  • 5-Donnelly JG1. Folic acid. Crit Rev Clin Lab Sci. 2001 Jun;38(3):183-223.
  • 6-Refsum H1. Folate, vitamin B12 and homocysteine in relation to birth defects and pregnancy outcome. Br J Nutr. 2001 May;85 Suppl 2:S109-13.
  • 7-Rosenquist TH1, Finnell RH. Genes, folate and homocysteine in embryonic development. Proc Nutr Soc. 2001 Feb;60(1):53-61.
  • 8-Födinger M, Hörl WH, Sunder-Plassmann G. Molecular biology of 5,10-methylenetetrahydrofolate reductase. J Nephrol. 2000 Jan-Feb;13(1):20-33. Review.
  • 9-Molloy AM, Daly S, Mills JL, Kirke PN, Whitehead AS, Ramsbottom D, Conley MR, Weir DG, Scott JM. Thermolabile variant of 5,10-methylenetetrahydrofolate reductase associated with low red-cell folates: implications for folate intake recommendations. Lancet. 1997 May 31;349(9065):1591-3.
  • 10-Li W1, Li Z1, Zhou D1, Zhang X1, Yan J2, Huang G3. Maternal folic acid deficiency stimulates neural cell apoptosis via miR-34aassociated with Bcl-2 in the rat foetal brain. Int J Dev Neurosci. 2018 Nov 14;72:6-12.
  • 11-Viswanathan M1, Treiman KA2, Kish-Doto J3, Middleton JC4, Coker-Schwimmer EJ4, Nicholson WK5. Folic Acid Supplementation for the Prevention of Neural Tube Defects: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017 Jan 10;317(2):190-203.
  • 12-Dessie MA, Zeleke EG, Workie SB, Berihun AW. Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: cross-sectional study. BMC Pregnancy Childbirth. 2017 Sep 21;17(1):313.
  • 13-Liu J, Xie J, Li Z, Greene NDE, Ren A. Sex differences in the prevalence of neural tube defects and preventive effects of folic acid (FA) supplementation among five counties in northern China: results from a population-based birth defect surveillance programme. BMJ Open. 2018 Nov 8;8(11):e022565.
  • 14- Ito K, Hanaoka T, Tamura N, Sasaki S, Miyashita C, Araki A et al. Association Between Maternal Serum Folate Concentrations in the First Trimester and the Risk of Birth Defects: The Hokkaido Study of Environment and Children's Health. J Epidemiol. 2018 Oct 13.
  • 15-Ishikawa T, Obara T, Nishigori H, Nishigori T, Metoki H, Ishikuro M et al. Update on the prevalence and determinants of folic acid use in Japan evaluated with 91,538 pregnant women: the Japan Environment and Children's Study. J Matern Fetal Neonatal Med. 2018 Aug 19:1-10.
  • 16-Mutlu M, Aslan Y, Kader Ş, Aktürk FC, Yazar U. Evaluation of newborns open neural tube defect retrospectively. Turkiye Klinikleri J Pediatr 2018;27(1):20-7.
  • 17-Frelut ML, de Courcy GP, Christidès JP, Blot P, Navarro J. Relationship between maternal folate status and foetal hypotrophy in a population with a good socio-economical level. Int J Vitam Nutr Res. 1995;65(4):267-71.
  • 18-Wani MA. Neural tube defect and folic acid. JK Pract. 2000 Jan-Mar;7(1):1-3.
  • 19- Mazumdar M, Ibne Hasan MO, Hamid R, Valeri L, Paul L, Selhub J, et al. Arsenic is associated with reduced effect of folic acid in myelomeningoceleprevention: a case control study in Bangladesh. Environ Health. 2015 Apr 10;14:34.
  • 20-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 myelomeningocele.Am J Obstet Gynecol 2016;215(4):495.e1-495.
  • 21-Bulbul A, Can E, Uslu S, Bas EK, Sahin Y, Yilmaz A, et al. Effect of operation time on prognosis and defined additional anomalies among neonatal meningomyelocele cases. The Medical Bulletin of Sisli Etfal Hospital, 2010;44(2):61-65.
  • 22-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.
  • 23-Greene WB, Terry RC, DeMasi RA, Herrington RT. Effect of race and gender on neurological level in myelomeningocele. Dev Med Child Neural 1991;33:110-117.
  • 24-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.
  • 25-MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet 338: 131-137, 1991
  • 26-Sandford MK, Kissling GE, Joubert PE: Neural tube defect etiology: New evidence concerning maternal hyperthermia,health and diet. Dev Med Child Neurol 34:661-675, 1992
  • 27-Czeizel AE, Dudas I: Prevention of the first occurence of neuraltube defects by periconceptional vitamin supplementation.N Engl J Med 327: 1832-1835, 1992
  • 28-Flood HD, Ritchey ML, Bloom DA, Huang C, McGuire EJ. Outcome of reflux in children with myelodysplasia managed by bladder pressure monitoring. J Urol 1994;152(5 Pt 1):1574-1577.
  • 29-Bauer SB, Hallett M, Khoshbin S, Lebowitz RL, Winston KR, Gibson S,et al. Predictive value of urodynamic evaluation in newborns with myelodysplasia.JAMA 1984;252(5):650-652.
  • 30-Flood HD, Ritchey ML, Bloom DA, Huang C, McGuire EJ. Outcome of reflux in children with myelodysplasia managed by bladder pressure monitoring. J Urol 1994;152(5 Pt 1):1574-1577.
  • 31-Aygun C, Vurucu S, Celik FC, Dagnar A, Tanyeri B, Kucukoduk S. Experience of a tertiary care center on 100 newborns with neural tube defects. Turk J Pediatr 2013;55:359-364.
  • 32-Rodrigues AB, Krebs VL, Matushita H, de Carvalho WB. Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst 2016;32:675–680.
There are 32 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Abdurrahman Çetin This is me

Abdulkadir Yektaş This is me

Publication Date December 1, 2018
Published in Issue Year 2018 Volume: 8 Issue: 3

Cite

APA Çetin, A., & Yektaş, A. (2018). Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations with Folic Acid Usage During the Pregnancy. Kafkas Journal of Medical Sciences, 8(3), 194-202.
AMA Çetin A, Yektaş A. Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations with Folic Acid Usage During the Pregnancy. KAFKAS TIP BİL DERG. December 2018;8(3):194-202.
Chicago Çetin, Abdurrahman, and Abdulkadir Yektaş. “Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations With Folic Acid Usage During the Pregnancy”. Kafkas Journal of Medical Sciences 8, no. 3 (December 2018): 194-202.
EndNote Çetin A, Yektaş A (December 1, 2018) Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations with Folic Acid Usage During the Pregnancy. Kafkas Journal of Medical Sciences 8 3 194–202.
IEEE A. Çetin and A. Yektaş, “Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations with Folic Acid Usage During the Pregnancy”, KAFKAS TIP BİL DERG, vol. 8, no. 3, pp. 194–202, 2018.
ISNAD Çetin, Abdurrahman - Yektaş, Abdulkadir. “Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations With Folic Acid Usage During the Pregnancy”. Kafkas Journal of Medical Sciences 8/3 (December 2018), 194-202.
JAMA Çetin A, Yektaş A. Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations with Folic Acid Usage During the Pregnancy. KAFKAS TIP BİL DERG. 2018;8:194–202.
MLA Çetin, Abdurrahman and Abdulkadir Yektaş. “Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations With Folic Acid Usage During the Pregnancy”. Kafkas Journal of Medical Sciences, vol. 8, no. 3, 2018, pp. 194-02.
Vancouver Çetin A, Yektaş A. Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations with Folic Acid Usage During the Pregnancy. KAFKAS TIP BİL DERG. 2018;8(3):194-202.