Postoperative Ultrasound as a Predictor of Newborn Function and Ambulation after Open Fetal Myelomeningocele Repair

被引:1
作者
Buskmiller, Cara [1 ]
Pribble, Chase [2 ]
Buchanan, Christopher Quinn [2 ]
Fisher, Allan [2 ]
机构
[1] Univ Texas Hlth Sci Ctr Houston UTHlth, Dept Obstet Gynecol & Reprod Sci, McGovern Med Sch, 6431 Fannin,Suite MSB 3-262, Houston, TX 77030 USA
[2] St Louis Univ, Dept Obstet Gynecol & Womens Hlth, St Louis, MO 63103 USA
关键词
Neural tube defect; Myelomeningocele; Fetal surgery; Prognosis; Neonatal outcome; SPINA-BIFIDA; IN-UTERO; HINDBRAIN HERNIATION; LEG MOVEMENTS; MODEL;
D O I
10.1159/000512046
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: Function of the lower extremities after prenatal myelomeningocele (MMC) repair is best assessed with ambulatory function at 30-36 months of age, but parents often ask about function before this milestone. Lower extremity movement can be assessed by ultrasound (US) and at the newborn exam (NE), but correlation between US, NE, and ambulation is not firmly established. Methods: This was a retrospective correlation study of fetuses that underwent open prenatal MMC repair at SSM Cardinal Glennon Fetal Care Institute, St. Louis, MO, between January 2011 and June 2017. Movement at the ankles, knees, and hips was assessed by US after open repair on postoperative days (PODs) 0-5 and at 32 weeks gestation. NE was performed by physical therapy or neurosurgery within the first month of life, and pediatric follow-up between 30 and 36 months of age was obtained to document ambulation. Results: Forty-two fetuses were included. Joint movement seen on US varied by POD: it was present on POD 1 in 7% of fetuses and 62% by POD 5. Degree of ventriculomegaly, lesion level, and lesion length did not have a significant effect on US, NE, or ambulation. Knee movement on POD 3 correlated with knee movement at NE (k = 0.58, p < 0.01), but only later knee movement correlated with ambulation (k = 0.28-0.46, p = 0.01). Hip movement at 32 weeks was the only single joint assessment that correlated with NE and ambulation (k = 0.45 and 0.46, p = 0.03 and 0.01, respectively). Conclusion: Lower extremity movement increases between POD 1 and POD 5 in fetuses after open fetal MMC repair. Knee and hip movement on US at 32 weeks correlates with ambulation at 30-36 months. These data may inform counseling, and direct therapy and spark prospective investigations.
引用
收藏
页码:128 / 133
页数:6
相关论文
共 13 条
  • [1] A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele
    Adzick, N. Scott
    Thom, Elizabeth A.
    Spong, Catherine Y.
    Brock, John W., III
    Burrows, Pamela K.
    Johnson, Mark P.
    Howell, Lori J.
    Farrell, Jody A.
    Dabrowiak, Mary E.
    Sutton, Leslie N.
    Gupta, Nalin
    Tulipan, Noel B.
    D'Alton, Mary E.
    Farmer, Diana L.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2011, 364 (11) : 993 - 1004
  • [2] Correction of hindbrain herniation and anatomy of the vermis after in utero repair of myelomeningocele in sheep
    Bouchard, S
    Davey, MG
    Rintoul, NE
    Walsh, DS
    Rorke, LB
    Adzick, NS
    [J]. JOURNAL OF PEDIATRIC SURGERY, 2003, 38 (03) : 451 - 458
  • [3] THE PARALYSIS ASSOCIATED WITH MYELOMENINGOCELE - CLINICAL AND EXPERIMENTAL-DATA IMPLICATING A PREVENTABLE SPINAL-CORD INJURY
    HEFFEZ, DS
    ARYANPUR, J
    HUTCHINS, GM
    FREEMAN, JM
    [J]. NEUROSURGERY, 1990, 26 (06) : 987 - 992
  • [4] Hunt GM, 1997, DEV MED CHILD NEUROL, V39, P568
  • [5] EARLY FETAL LEG MOVEMENTS IN MYELOMENINGOCELE
    KORENROMP, MJ
    VANGOOL, JD
    BRUINESE, HW
    KRIEK, R
    [J]. LANCET, 1986, 1 (8486) : 917 - 918
  • [6] CREATION OF MYELOMENINGOCELE IN-UTERO - A MODEL OF FUNCTIONAL DAMAGE FROM SPINAL-CORD EXPOSURE IN FETAL SHEEP
    MEULI, M
    MEULISIMMEN, C
    YINGLING, CD
    HUTCHINS, GM
    HOFFMAN, KM
    HARRISON, MR
    ADZICK, NS
    [J]. JOURNAL OF PEDIATRIC SURGERY, 1995, 30 (07) : 1028 - 1033
  • [7] IN-UTERO SURGERY RESCUES NEUROLOGICAL FUNCTION AT BIRTH IN SHEEP WITH SPINA-BIFIDA
    MEULI, M
    MEULISIMMEN, C
    HUTCHINS, GM
    YINGLING, CD
    HOFFMAN, KM
    HARRISON, MR
    ADZICK, NS
    [J]. NATURE MEDICINE, 1995, 1 (04) : 342 - 347
  • [8] Hindbrain herniation develops in surgically created myelomeningocele but is absent after repair in fetal lambs
    Paek, BW
    Farmer, DL
    Wilkinson, CC
    Albanese, CT
    Peacock, W
    Harrison, MR
    Jennings, RW
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2000, 183 (05) : 1119 - 1123
  • [9] Myelomeningocele: A review of the epidemiology, genetics, risk factors for conception, prenatal diagnosis, and prognosis for affected individuals
    Shaer, Catherine M.
    Chescheir, Nancy
    Schulkin, Jay
    [J]. OBSTETRICAL & GYNECOLOGICAL SURVEY, 2007, 62 (07) : 471 - 479
  • [10] Sival DA, 2003, EUR J PEDIATR SURG, V13, pS29