In utero Hepatitis B Immunization during Fetal Surgery for Spina Bifida.

Authors :: Moehrlen U
Elrod J
Ochsenbein-Kölble N
Berger C
Speck RF
Mazzone L
Krähenmann F
Zimmermann R
Meuli M
Source :: Fetal diagnosis and therapy [Fetal Diagn Ther] 2020; Vol. 47 (4), pp. 328-332. Date of Electronic Publication: 2019 Nov 13.
Publication Year :: 2020
Abstract: Background: Fetal surgery for spina bifida aperta may lead to significantly better outcomes than postnatal repair, particularly regarding shunt-dependent hydrocephalus, independent ambulation, and voiding functions. The "Management of Myelomeningocele Study" (MOMS) represents the current benchmark, also in terms of eligibility criteria.<br />Case Report: A positive maternal hepatitis B virus (HBV) status is a MOMS exclusion criterion. Here, we report on the first successful active and passive in utero HBV vaccination of a spina bifida fetus carried by a HBV-positive mother undergoing maternal-fetal surgery. The now 2-year-old infant is healthy, HBV negative, and drew maximal benefit from prenatal surgery.<br />Discussion and Conclusion: Taken together, this patient benefitted maximally from fetal surgery for spina bifida, despite meeting an exclusion criterion. Thus, generally speaking, eligibility criteria for fetal surgery can be challenged under certain circumstances for the benefit of the patient.<br /> (© 2019 S. Karger AG, Basel.)