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Grand Rounds

Prenatal vs Postnatal Spina Bifida Repair and the Impact on Neurodevelopmental Impairment

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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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Related ObG Topics:

What are the Common Surgical Procedures and Outcomes in Patients with Spina Bifida?
Presence of NTDs in Early Pregnancy Loss
Neural Tube Defects: Definitions, Key Clinical Findings and Management

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