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Factors associated with the timeliness of postnatal surgical repair of spina bifida

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Abstract

Purpose

Clinical guidelines recommend repair of open spina bifida (SB) prenatally or within the first days of an infant’s life. We examined maternal, infant, and health care system factors associated with time-to-repair among infants with postnatal repair.

Methods

This retrospective, statewide, population-based study examined infants with SB born in Florida 1998–2007, ascertained by the Florida Birth Defects Registry. We used procedure codes from hospital discharge records to identify the first recorded myelomeningocele repair (ICD-9 CM procedure code 03.52) among infants with birth hospitalizations. Using Poisson multivariable regression, we examined time-to-repair by hydrocephalus, SB type (isolated [no other coded major birth defect] versus non-isolated), and other selected factors.

Results

Of 199 infants with a recorded birth hospitalization and coded myelomeningocele repair, 87.9 % had hydrocephalus and 19.6 % had non-isolated SB. About 76.4 % of infants had repair by day 2 of life. In adjusted analyses, infants with hydrocephalus were more likely to have timely repair (adjusted prevalence ratio (aPR) = 1.48, 95 % confidence interval (CI) 1.02–2.14) than infants without hydrocephalus. SB type was not associated with repair timing. Infants born in lower level nursery care hospitals with were less likely to have timely repairs (aPR = 0.71, 95 % CI 0.52–0.98) than those born in higher level nursery care hospitals.

Conclusions

Most infants with SB had surgical repair in the first 2 days of life. Lower level birth hospital nursery care was associated with later repairs. Prenatal diagnosis can facilitate planning for a birth hospital with higher level of nursery care, thus improving opportunities for timely repair.

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Acknowledgments

The authors thank the FBDR within the FDOH, the FDOH Children’s Medical Services Program, and the Florida AHCA for data accessibility and acquisition. We also thank Jean Paul Tanner, MPH with the University of South Florida, Jason Salemi, PhD, MPH with Baylor College of Medicine, and Marie Bailey, MA, MSW with the FDOH for consultations on data linkages and variables. In addition, we thank Adrienne Henderson, MPH with AHCA, Florida Center for Health Information and Policy Analysis, Gloria Barker, BS also with AHCA, Florida Center for Health Information and Policy Analysis, and Karen Freeman, MPH, MS with the FDOH for consultations on hospital discharge data and hospitals. Finally, we thank Phoebe Thorpe, MD, MPH from CDC’s NCBDDD for her clinical recommendations on diagnostic and procedural coding, and April Dawson, MPH, also with the NCBDDD, for her SAS expertise and assistance in variable construction.

Author information

Authors and Affiliations

  1. South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC, 29210, USA

    Elizabeth Radcliff

  2. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Cynthia H. Cassell, Judy K. Thibadeau & Scott D. Grosse

  3. Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, USA

    Sarah B. Laditka

  4. Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Florida Birth Defects Registry, Tallahassee, Florida, USA

    Jane Correia

  5. Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA

    Russell S. Kirby

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  1. Elizabeth Radcliff
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  2. Cynthia H. Cassell
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  3. Sarah B. Laditka
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  4. Judy K. Thibadeau
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  6. Scott D. Grosse
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Corresponding author

Correspondence to Elizabeth Radcliff.

Ethics declarations

The Institutional Review Boards at the University of North Carolina at Charlotte, the FDOH, and CDC approved this study.

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no financial relationships relevant to this article to disclose.

Grant information

This project was supported in part by Research Grant #5-FY09–533 from the March of Dimes Foundation.

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Radcliff, E., Cassell, C.H., Laditka, S.B. et al. Factors associated with the timeliness of postnatal surgical repair of spina bifida. Childs Nerv Syst 32, 1479–1487 (2016). https://doi.org/10.1007/s00381-016-3105-3

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  • DOI: https://doi.org/10.1007/s00381-016-3105-3

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