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Children who had surgery before birth had a 93% chance of walking unaided by school age compared to 80% in the traditional surgery group. The percentage of children in the first and second groups who needed further surgery to place a shunt in the brain to relieve fluid accumulation in the brain (a condition called hydrocephalus) was 49% and 85% respectively. Shunt replacements were required by 47% and 70% of children in the first and second groups, respectively. A motor skill assessment also showed that the first group had on average higher scores.
The children in the first group were almost 6 times more likely to be able to visit the bathroom on their own compared to those operated on after birth, which shows their far better degree of bladder and bowel control. The number of catheterizations required was less in the first group. Quality of life was superior for both the children and their families, and overall stress levels were reduced, in the first group.
Parameters which are not significantly affected by prenatal vs postnatal surgery include independent living skills, including communication skills, skills of daily living and social skills. Implications
Co-author N. Scott Adzick describes his reaction to the findings: “It is extremely gratifying to see that the positive results from the initial MOMS trial endure into childhood. Fetal surgery is a complex and serious procedure and should only be done by experienced teams. Research needs to continue to refine the technique in a way that will improve outcomes even further."
Researcher Menachem Miodovnik sums up the implications of this study: “Prenatal surgery for myelomeningocele carries benefits and risks, compared to traditional postnatal surgery. This study provides important information for physicians with patients who are considering prenatal surgery.” Adzick goes on to say: “These findings add to the growing body of literature demonstrating the benefits of prenatal surgery for spina bifida. Providers should take these findings into account when counseling expectant mothers to ensure that families considering prenatal surgery for their fetus understand the potential risks and benefits.”
At present, the fetal surgery for meningomyelocele at centers of excellence has continued to improve technically, becoming shorter while the pregnancy continues for longer after the intrauterine procedure, preventing many preterm births. Journal reference:
Houtrow AJ, Thom EA, Fletcher JM, Burrows PK, Adzick NS, Thomas NH, Brock III JW, Cooper T, Lee H, Bilaniuk L, Glenn OA, Pruthi S, MacPherson C, Farmer DL, Johnson MP, Howell LJ, Gupta N, Walker WO. "Prenatal Repair of Myelomeningocele and School-Age Functional Outcomes," Pediatrics, online January 24, 2020.
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