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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

  • Rebecca Y. DuEmail author
  • Melissa A. LoPresti
  • Caroline C. Hadley
  • Sandi Lam
Original Paper

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.

Keywords

Neural tube defect Spina bifida Mycotoxin Fumonisin Folate Public health Global neurosurgery Public policy 

Abbreviations and acronyms

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

Notes

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.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Supplementary material

381_2018_4023_MOESM1_ESM.docx (35 kb)
ESM 1 (DOCX 35 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Rebecca Y. Du
    • 1
    Email author
  • Melissa A. LoPresti
    • 1
  • Caroline C. Hadley
    • 1
  • Sandi Lam
    • 1
  1. 1.Department of Neurosurgery, Baylor College of Medicine; Division of Pediatric NeurosurgeryTexas Children’s HospitalHoustonUSA

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