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Systematic review of clinician awareness of mycotoxin impact in neural tube defects and best practices for pediatric neurosurgeons: implications for public health and policy

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Abstract

Purpose

In lower-income populations, high rates of neural tube defects (NTDs) are a concern. Nutritional folate deficiencies and mycotoxins in contaminated food supplies increase risk of NTDs. As physicians in public health and involved in the care of children with NTDs, pediatric neurosurgeons have an interest in the treatment and prevention of NTDs. We aimed to evaluate the literature to assess the awareness and the existence of best practices/educational materials on this issue to better guide management.

Methods

A systematic review using the National Library of Medicine PubMed database was conducted to find articles related to mycotoxins in foods causing neural tube defects. Additional citation searches of key publications and personal collections were used. Two reviewers evaluated the resulting studies for subject area analysis. Best practice recommendations were drawn from articles selected for full-text review.

Results

Seventy-three articles were identified. Most articles were found in “nutritional sciences” (18), “teratology” (14), and “toxicology” (13). No articles were found in neurosurgery. Thirty-two additional articles were identified through other sources to screen best practice recommendations. Of the 105 articles, 34 journal articles were included in best practice recommendation guidelines. Key recommendations included education of proper food storage, hygienic agricultural practices, decontamination techniques, diet diversification, folate supplementation, risk assessment, and food safety policy and public health initiatives.

Conclusion

There is an absence of neurosurgical literature–related mycotoxins and NTDs. We suggest a set of best practices/educational materials on this topic and advocate pediatric neurosurgery engagement in public health initiatives targeted towards populations most affected by mycotoxins.

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Abbreviations

CAC:

Codex Alimentarius Commission

EFSA:

European Food Consumption Database

EU:

European Union

FDA:

Food and Drug Administration

FOA:

Food and Agriculture Organization

NLM:

National Library of Medicine

NTD:

Neural tube defects

USA:

United States

WHO:

World Health Organization

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Acknowledgements

We thank Dr. Leland Albright for his insights in the preparation of this manuscript and guidance on his important work done in Kijabe, Kenya.

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Authors and Affiliations

  1. Department of Neurosurgery, Baylor College of Medicine; Division of Pediatric Neurosurgery, Texas Children’s Hospital, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA

    Rebecca Y. Du, Melissa A. LoPresti, Caroline C. Hadley & Sandi Lam

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  1. Rebecca Y. Du
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  2. Melissa A. LoPresti
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Correspondence to Rebecca Y. Du.

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Du, R.Y., LoPresti, M.A., Hadley, C.C. et al. Systematic review of clinician awareness of mycotoxin impact in neural tube defects and best practices for pediatric neurosurgeons: implications for public health and policy. Childs Nerv Syst 35, 637–644 (2019). https://doi.org/10.1007/s00381-018-4023-3

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