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Short-term prognostic factors in myelomeningocele patients

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Abstract

Purpose

Patients with myelomeningocele have a high mortality and neurological disabilities that are correlated with the anatomical characteristics of the defect and with the development of acquired complications. The challenge in the postnatal management of myelomeningocele (MMC) is the early recognition of cases at risk for complications in order to establish individualized treatment strategies. This study aims to identify short-term prognostic markers for newborns with MMC. Anatomical characteristics of the spinal defect and technical aspects of the neurosurgical correction were analyzed for this purpose.

Methods

A retrospective cohort study was conducted in 70 patients with MMC born between January 2007 and December 2013. Features of MMC anatomy and neurosurgical treatment were analyzed for the following outcomes: neonatal resuscitation, length of hospital stay, need for ventricular shunt, wound dehiscence, wound infection, central nervous system infection, and sepsis.

Results

Large MMC was associated with central nervous system (CNS) infection, wound complications, and longer hospital stay. Patients with thoracic MMC required longer hospital stay. Surgical repair performed after 48 h of life increased in 5.72 times the risk of CNS infection. Absence of antenatal hydrocephalus was a favorable prognostic marker.

Conclusion

Extent of the spinal cord defect and the time of surgical correction influenced the short-term outcomes of patients with myelomeningocele. Extensive lesions were associated with higher rates of CNS infections, surgical wound complications, and prolonged hospital stay. Interventions performed within 48 h after birth significantly reduced occurrence of CNS infections. Absence of antenatal hydrocephalus was associated with fewer complications in the first days of life.

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Abbreviations

(MMC):

Myelomeningocele

(CSF):

Cerebrospinal fluid

(CNS):

Central nervous system

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Authors and Affiliations

  1. Discipline of Pediatrics, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil

    Andre Broggin Dutra Rodrigues, Vera Lucia Jornada Krebs & Werther Brunow de Carvalho

  2. Division of Neurosurgery, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil

    Hamilton Matushita

  3. Alameda Joaquim Eugênio de Lima, 881—Jardim Paulista, São Paulo, SP, Conjunto 101, 01403-001, Brazil

    Andre Broggin Dutra Rodrigues

Authors
  1. Andre Broggin Dutra Rodrigues
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  2. Vera Lucia Jornada Krebs
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  3. Hamilton Matushita
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  4. Werther Brunow de Carvalho
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Corresponding author

Correspondence to Andre Broggin Dutra Rodrigues.

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The research ethics committee of our institution approved this study.

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The authors have no financial relationships relevant to this article to disclose.

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This research had no financial support.

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The authors declare that they have no competing interests.

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Rodrigues, A.B.D., Krebs, V.L.J., Matushita, H. et al. Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst 32, 675–680 (2016). https://doi.org/10.1007/s00381-016-3012-7

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  • DOI: https://doi.org/10.1007/s00381-016-3012-7

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