Abstract
Background
The optimal time to closure of a newborn with an open neural tube defect (NTD–myelomeningocele) has been the subject of a number of investigations. One aspect of timing that has received attention is its relationship to repair site and central nervous system (CNS) infection that can lead to irreversible deficits and prolonged hospital stays. No studies have evaluated infection as a function of surgical timing at a national level. We hypothesized an increase in wound infection in those patients with delays in myelomeningocele repair when evaluated in both a single-center and national database.
Methods
Treatment outcomes following documented times to transfer and closure were evaluated at Children’s Hospital of Los Angeles (CHLA) for the years 2004 to 2014. Data of newborns with a myelomeningocele with varying time to repair were also obtained from non-overlapping abstracts of the 2000–2010 Kids’ Inpatient Database (KID) and Nationwide Inpatient Sample (NIS). Poisson multivariable regression analyses were used to assess the effect of time to repair on infection and time to discharge.
Results
At CHLA, 95 neonates who underwent myelomeningocele repair were identified, with a median time from birth to treatment of 1 day. Six (6 %) patients were noted to have postrepair complications. CHLA data was not sufficiently powered to detect a difference in infection following delay in closure. In the NIS, we identified 3775 neonates with repaired myelomeningocele of whom infection was reported in 681 (18 %) patients. There was no significant difference in rates of infection between same-day and 1-day wait times (p = 0.22). Wait times of two (RR = 1.65 [1.23, 2.22], p < 0.01) or more days (RR = 1.88 [1.39, 2.54], p < 0.01), respectively, experienced a 65 % and 88 increase in rates of infection compared to same-day procedures. Prolonged wait time was 32 % less likely at facilities with increased myelomeningocele repair volume (RR = 0.68 [0.56 0.83], p < 0.01). The presence of infection was associated with a 54 % (RR = 1.54 [1.36, 1.74], p < 0.01) increase in the length of stay when compared to neonates without infection.
Conclusion
Myelomeningocele closure, when delayed more than 1 day after birth, is associated with an increased rate of infection and length of stay in the national cohort. High-volume centers are associated with fewer delays to repair. Though constrained by limitations of a national coded database, these results suggest that early myelomeningocele repair decreases the rate of infection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Williams LJ et al. (2002) Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States. Teratology 66(1):33–39
Cragan JD et al. (1995) Surveillance for anencephaly and spina bifida and the impact of prenatal diagnosis—United States, 1985-1994. MMWR CDC Surveill Summ 44(4):1–13
Boulet SL et al. (2008) Trends in the postfortification prevalence of spina bifida and anencephaly in the United States. Birth Defects Res A Clin Mol Teratol 82(7):527–532
Brocklehurst G, Gleave JR, Lewin WS (1967) Early closure of myelomeningocele with especial reference to leg movement. Dev Med Child Neurol (Suppl 13):51–56
Smyth BT et al. (1974) A controlled trial of immediate and delayed closure of myelomeningocele. J Bone Joint Surg (Br) 56(2):297–304
Charney EB et al. (1985) Management of the newborn with myelomeningocele: time for a decision-making process. Pediatrics 75(1):58–64
Boston VE, Wilkinson AJ (1979) A retrospective analysis of conservative versus active management in severe open myelomeningocele. Z Kinderchir Grenzgeb 28(4):340–347
Tarcan T et al. (2006) The timing of primary neurosurgical repair significantly affects neurogenic bladder prognosis in children with myelomeningocele. J Urol 176(3):1161–1165
Pinto FC et al. (2009) Surgical treatment of myelomeningocele carried out at ‘time zero’ immediately after birth. Pediatr Neurosurg 45(2):114–118
Oncel MY et al. (2012) The effect of surgery time on prognosis in newborns with meningomyelocele. J Korean Neurosurg Soc 51(6):359–362
Charney EB, Melchionni JB, Antonucci DL (1991) Ventriculitis in newborns with myelomeningocele. Am J Dis Child 145(3):287–290
Sharrard WJ, Zachary RB, Lorber J (1967) Survival and paralysis in open myelomeningocele with special reference to the time of repair of the spinal lesion. Dev Med Child Neurol (Suppl 13):35–50
John W et al. (1963) A controlled trial of immediate and delayed closure of spina bifida cystica. Arch Dis Child 38(197):18–22
Fernandez-Serrats AA, Guthkelch AN, Parker SA (1967) The prognosis of open myelocele with a note on a trial of Laurence’s operation. Dev Med Child Neurol (Suppl 13):65–74
Tirschwell DL, Longstreth WT Jr (2002) Validating administrative data in stroke research. Stroke 33(10):2465–2470
Schroeder HK et al. (2012) Postsurgical infection after myelomeningocele repair: a multivariate analysis of 60 consecutive cases. Clin Neurol Neurosurg 114(7):981–985
Arslan M et al. (2011) Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate. Turk Neurosurg 21(3):397–402
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Attenello, F.J., Tuchman, A., Christian, E.A. et al. Infection rate correlated with time to repair of open neural tube defects (myelomeningoceles): an institutional and national study. Childs Nerv Syst 32, 1675–1681 (2016). https://doi.org/10.1007/s00381-016-3165-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-016-3165-4