Prenatal surgery yields lasting benefits for myelomeningocele

(HealthDay)—For myelomeningocele, prenatal surgery does not improve adaptive behavior but is associated with improved mobility and independent functioning in school-aged children, according to a study published online Jan. 24 in Pediatrics.

Amy J. Houtrow, M.D., Ph.D., M.P.H., from the University of Pittsburgh, and colleagues compared adaptive behavior and other outcomes at school age (6 to 10 years) among 161 children who underwent prenatal versus postnatal surgery in the Management of Myelomeningocele Study.

The researchers observed no difference in the Vineland composite score between the prenatal and postnatal surgery groups (89.0 versus 87.5). Compared with those in the postnatal group, children in the prenatal repair group more often walked independently (93 versus 80 percent), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 versus 85), and had lower rates of hindbrain herniation (60 versus 87 percent), fewer shunts placed for hydrocephalus (49 versus 85 percent), and fewer shunt revisions (47 versus 70 percent). Significantly higher mean quality of life z scores and lower mean family impact scores were reported by parents of children who were repaired prenatally.

"Providers should consider these findings when counseling expectant mothers to ensure that families considering prenatal surgery for their fetus understand the potential risks and benefits," the authors write.

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