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Prenatal Repair of Myelomeningocele and School-age Functional Outcomes

Authors :
N. Scott Adzick
William O. Walker
Jack M. Fletcher
Amy J. Houtrow
Nalin Gupta
Timothy Cooper
Lori J. Howell
Elizabeth Thom
Cora MacPherson
Orit A. Glenn
Sumit Pruthi
Pamela K. Burrows
John W. Brock
Larissa T. Bilaniuk
Hanmin Lee
Nina H. Thomas
Diana L. Farmer
Mark P. Johnson
Source :
Pediatrics, vol 145, iss 2, Pediatrics
Publication Year :
2020
Publisher :
American Academy of Pediatrics (AAP), 2020.

Abstract

BACKGROUND AND OBJECTIVES: The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. In this study, we compared adaptive behavior and other outcomes at school age (5.9–10.3 years) between prenatal versus postnatal surgery groups. METHODS: Follow-up cohort study of 161 children enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated at a MOMS center or at a home visit by trained blinded examiners. RESULTS: The Vineland composite score was not different between surgery groups (89.0 ± 9.6 in the prenatal group versus 87.5 ± 12.0 in the postnatal group; P = .35). Children in the prenatal group walked without orthotics or assistive devices more often (29% vs 11%; P = .06), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 ± 9 vs 85 ± 18; P < .001), lower rates of hindbrain herniation (60% vs 87%; P < .001), had fewer shunts placed for hydrocephalus (49% vs 85%; P < .001) and, among those with shunts, fewer shunt revisions (47% vs 70%; P = .02) than those in the postnatal group. Parents of children repaired prenatally reported higher mean quality of life z scores (0.15 ± 0.67 vs 0.11 ± 0.73; P = .008) and lower mean family impact scores (32.5 ± 7.8 vs 37.0 ± 8.9; P = .002). CONCLUSIONS: There was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.

Details

ISSN :
10984275 and 00314005
Volume :
145
Database :
OpenAIRE
Journal :
Pediatrics
Accession number :
edsair.doi.dedup.....afcd94be03aebea3973523a221f65eed