BACKGROUND AND PURPOSE:

• Inversetti et al. (Ultrasound in Obstetrics & Gynecology, 2018) compared the impact of prenatal vs postnatal spina bifida repair on childhood neurodevelopment

METHODS:

• Systematic review and meta-analysis
• Included the following studies
  • Those that assessed neurological outcome of infants with spina bifida repaired prenatally vs postnatally
  • RCTs and non-randomized prospective controlled studies
• Primary outcome: Neurodevelopmental impairment at 1-year old or later
• Secondary outcomes
  • Preterm birth
  • Need for ventriculoperitoneal (VP) shunt by 12 months of age
  • Absence of signs of hindbrain herniation at the first postnatal MRI evaluation
  • Independent ambulation evaluated at 30 months

RESULTS:

• 2 studies included in systematic review and meta-analysis
  • 213 total children
  • 14 to 53 months of age
• Neurodevelopment
  • Assessed with Bayley Scales of Infant Development II (BSID-II) mental development index
  • Corrected for age
• Neurodevelopmental impairment was similar between children who went through prenatal (23.8%) and postnatal repair (27.8%)
• Risk of preterm birth was higher in the prenatal cohort (P < 0.0001)
  • Odds ratio (OR) 17.62 (95% CI, 7.60–40.87)
• The need for VP shunt placement by 12 months was lower in the prenatal group (P < 0.0001)
  • 41.3% vs 83.0%
  • OR 0.14 (95% CI, 0.08–0.26)
• Need for a shunt was lower in the prenatal group vs postnatal group (P < 0.0001)
  • 41.3% vs 83.0%
  • OR 0.14 (95% CI, 0.08-0.26)
• Neurodevelopmental impairment was not different between those children that did and did not have a shunt (prenatal RCT study only)
• Hindbrain herniation (MRI) was lower in prenatal vs postnatal group (P < 0.0001)
  • 0% vs 4.5%
  • OR 9.45 (95% CI, 3.12–28.64)
• Independent ambulation at 30 months was higher in the prenatal vs postnatal group (P = 0.003)
  • 37.6% vs 18.9%
  • OR 2.59 (95% CI, 1.39–4.86)

CONCLUSION:

• There was no difference in risk of neurodevelopmental impairment when comparing prenatal to postnatal spina bifida repair
• While preterm birth was higher in prenatal repair group, hindbrain herniation rate was reduced and independent ambulation was increased

Learn more – Primary Sources:

Neurodevelopmental outcome of children with spina bifida aperta repaired prenatally vs postnatally: systematic review and meta-analysis

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