Spinal dysraphism Archives - Revista Brasileira de Ginecologia e Obstetrícia
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Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(3):238-244
, , , , , , , To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair.
Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic’s medical records. Children were included if they had ≥1 year of postoperative follow-up andmet the criteria for fetal surgery. The children’s data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure.
Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations.
Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(3):238-244
, , , , , , , To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair.
Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic’s medical records. Children were included if they had ≥1 year of postoperative follow-up andmet the criteria for fetal surgery. The children’s data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure.
Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations.
Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(5):268-274
DOI 10.1590/S0100-72032005000500007
PURPOSES: to analyze the frequency, associated risk factors for the occurrence of spina bifida and differences between the newborns carrying this malformation and the newborns' morbidities. METHODS: data were obtained through interview of 47 cases and 47 controls, born in the five maternities of the city of Pelotas, during the period from January 1, 1990 to December 31, 2003. This is a population-based case-control study, comprising all births occurred in hospitals. The control was the normal newborn that was born after each case with spina bifida. All data were obtained by using the model ECLAMC questionnaire. The planning of analysis of data included the use of the Student's t test, chi² and odds ratio. RESULTS: in this period there were approximately 77,000 births. Of these, 1,043 (1.35%) presented some type of congenital malformation. Among these, 47 of 162 anomalies of the neural tube (29%) were spina bifida cases. Significant differences have been found in the number of previous stillborn babies, as well as a higher rate of spina bifida cases in females. In this study, many factors such as the use of medical drugs; acute and chronic illnesses; number of gestations; age, education and occupation of the parents, among others, did not influence the occurrence of spina bifida. CONCLUSIONS: spina bifida must be considered as an important factor of risk for perinatal morbidity, and its occurrence is associated with a history of previous stillborn babies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(5):268-274
DOI 10.1590/S0100-72032005000500007
PURPOSES: to analyze the frequency, associated risk factors for the occurrence of spina bifida and differences between the newborns carrying this malformation and the newborns' morbidities. METHODS: data were obtained through interview of 47 cases and 47 controls, born in the five maternities of the city of Pelotas, during the period from January 1, 1990 to December 31, 2003. This is a population-based case-control study, comprising all births occurred in hospitals. The control was the normal newborn that was born after each case with spina bifida. All data were obtained by using the model ECLAMC questionnaire. The planning of analysis of data included the use of the Student's t test, chi² and odds ratio. RESULTS: in this period there were approximately 77,000 births. Of these, 1,043 (1.35%) presented some type of congenital malformation. Among these, 47 of 162 anomalies of the neural tube (29%) were spina bifida cases. Significant differences have been found in the number of previous stillborn babies, as well as a higher rate of spina bifida cases in females. In this study, many factors such as the use of medical drugs; acute and chronic illnesses; number of gestations; age, education and occupation of the parents, among others, did not influence the occurrence of spina bifida. CONCLUSIONS: spina bifida must be considered as an important factor of risk for perinatal morbidity, and its occurrence is associated with a history of previous stillborn babies.