J Korean Neurosurg Soc.  2012 Jun;51(6):359-362. 10.3340/jkns.2012.51.6.359.

The Effect of Surgery Time on Prognosis in Newborns with Meningomyelocele

• Oncel MY
• Ozdemir R
• Kahilogullari G
• Yurttutan
• Erdeve O
• Dilmen U

• KMID: 2190490
• DOI: http://doi.org/10.3340/jkns.2012.51.6.359

Abstract

OBJECTIVE
To investigate the effect of surgery time on prognosis of newborns with meningomyelocele.
METHODS
The records of neonates with meningomyelocele were retrospectively analyzed. Demographic and clinical characteristics as well as information, timing of surgery, and durations of hospital stay and antibiotic therapy were recorded.
RESULTS
The records of 30 babies were included in the final analysis. Overall, the mean gestational age was 37.7+/-2.7 weeks, with a mean birth weight of 2967+/-755 g and head circumference of 35.8+/-3.8 cm. In terms of localization, 46.6% of the meningomyeloceles were lumbosacral, 40% were lumbar, 10% were thoracolumbar and 3.3% were thoracal. The mean size of the meningomyelocele sacs was 4.33+/-1.2 cm. Newborns underwent surgery on average of 8.2+/-5.9 days after birth, with an overall mean duration of hospital stay of 30+/-25.1 days. Patients were divided into two groups based on timing of surgery (group 1, < or =5 days; group 2, >5 days), and comparisons between groups revealed that earlier surgery was associated with significantly shorter durations of hospital stay (p<0.001) and antibiotic therapy (p<0.05).
CONCLUSION
Early surgical intervention (< or =5 days) was associated with a shorter duration of hospital stay and antibiotic therapy as well as a lower complication rate. We recommend that corrective surgery be undertaken as soon as reasonably possible.

Keyword

Meningomyelocele; Surgery time; Prognosis; Newborn

MeSH Terms

Birth Weight
Gestational Age
Head
Humans
Infant, Newborn
Length of Stay
Meningomyelocele
Parturition
Prognosis
Retrospective Studies

Reference

1. Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011; 364:993–1004. PMID: 21306277.

2. Adzick NS, Walsh DS. Myelomeningocele : prenatal diagnosis, pathophysiology and management. Semin Pediatr Surg. 2003; 12:168–174. PMID: 12961110.

3. Bowman RM, McLone DG. Neurosurgical management of spina bifida: research issues. Dev Disabil Res Rev. 2010; 16:82–87. PMID: 20419775.

4. Bruner JP. Intrauterine surgery in myelomeningocele. Semin Fetal Neonatal Med. 2007; 12:471–476. PMID: 17716961.

5. Elliott SP, Villar R, Duncan B. Bacteriuria management and urological evaluation of patients with spina bifida and neurogenic bladder : a multicenter survey. J Urol. 2005; 173:217–220. PMID: 15592079.

6. Frey L, Hauser WA. Epidemiology of neural tube defects. Epilepsia. 2003; 44(Suppl 3):4–13. PMID: 12790881.

7. Koszutski T, Kawalski H, Kudela G, WrÓblewska J, Byrka-Owczarek K, Bohosiewicz J. Babies with myelomeningocele in Poland : parents' attitudes on fetal surgery versus termination of pregnancy. Childs Nerv Syst. 2009; 25:207–210. PMID: 18560842.

8. Liptak GS, Dosa NP. Myelomeningocele. Pediatr Rev. 2010; 31:443–450. PMID: 21041422.

9. Medical Research Council Vitamin Research Study Group. Prevention of neural tube defects : results of the Medical Research Council Vitamin Study. Lancet. 1991; 338:131–137. PMID: 1677062.

10. Northrup H, Volcik KA. Spina bifida and other neural tube defects. Curr Probl Pediatr. 2000; 30:313–332. PMID: 11147289.

11. Onrat ST, Seyman H, Konuk M. Incidence of neural tube defects in Afyonkarahisar, Western Turkey. Genet Mol Res. 2009; 8:154–161. PMID: 19283682.

12. Padmanabhan R. Etiology, pathogenesis and prevention of neural tube defects. Congenit Anom (Kyoto). 2006; 46:55–67. PMID: 16732763.

13. Pinar H, Tatevosyants N, Singer DB. Central nervous system malformations in a perinatal/neonatal autopsy series. Pediatr Dev Pathol. 1998; 1:42–48. PMID: 10463270.

14. Pinto FC, Matushita H, Furlan AL, Alho EJ, Goldenberg DC, Bunduki V, et al. Surgical treatment of myelomeningocele carried out at 'time zero' immediately after birth. Pediatr Neurosurg. 2009; 45:114–118. PMID: 19307745.

15. Tarcan T, Onol FF, Ilker Y, Alpay H, Simşek F, Ozek M. The timing of primary neurosurgical repair significantly affects neurogenic bladder prognosis in children with myelomeningocele. J Urol. 2006; 176:1161–1165. PMID: 16890717.

16. Tunçbilek E, Boduroğlu K, Alikaşifoğlu M. Neural tube defects in Turkey : prevalence, distribution and risk factors. Turk J Pediatr. 1999; 41:299–305. PMID: 10770089.

17. Wald NJ. Folic acid and the prevention of neural-tube defects. N Engl J Med. 2004; 350:101–103. PMID: 14711907.

18. Werler MM, Mitchell AA. Neural-tube defects. N Engl J Med. 2000; 342:1135–1136. author reply 1136-1137. PMID: 10766583.