Related Experiment Videos
Long-term outcome and complications of children born with meningomyelocele
P Steinbok1, B Irvine, D D Cochrane
1Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Insights
This study assessed long-term outcomes for children with meningomyelocele, finding that over half achieved community ambulation and attended school. Most survivors achieved social continence, highlighting improved functional results.
Area of Science:
- Pediatric Neurosurgery
- Developmental Pediatrics
- Spina Bifida Research
Background:
- Meningomyelocele is a complex birth defect impacting neurological and physical development.
- Long-term functional outcomes and quality of life for affected individuals require comprehensive assessment.
- Early management strategies for meningomyelocele have evolved, necessitating studies on historical cohorts.
Purpose of the Study:
- To evaluate the long-term functional status of children born with meningomyelocele.
- To identify factors correlating with positive functional outcomes in this cohort.
- To analyze the incidence and management of hydrocephalus and shunt complications.
Main Methods:
- Retrospective chart review of 101 children born with meningomyelocele (1971-1981).
- Follow-up assessments to determine functional outcomes, school attendance, and continence.
- Analysis of hydrocephalus prevalence and shunt revision rates.
Main Results:
- Mortality rate was 18% among 83 survivors with a minimum 8.6-year follow-up.
- 53% achieved community ambulation, correlating with quadriceps function.
- 58% attended grade-appropriate normal school; 75% achieved urinary and 86% achieved fecal continence.
- 93% had hydrocephalus, with 85 shunted; half required revision in the first year, with a subsequent ~10% annual risk.
Conclusions:
- Children with meningomyelocele can achieve significant long-term functional independence, including ambulation, school integration, and continence.
- Quadriceps function is a key predictor of ambulation.
- Hydrocephalus management via shunting is common, with a notable rate of early revisions, but risk decreases over time.
Abstract:
The long-term functional outcome of 101 children born with meningomyelocele between 1971 and 1981 was assessed, by a combination of retrospective chart review and follow-up assessments. The children had been managed at birth using a process of nonstandardized selection. Eighty-three of the 101 patients survived after a minimum follow-up of 8.6 years, for a mortality rate of 18%. Forty-four of 83 children (53%) were community ambulators, and this correlated well with the presence of intact quadriceps function. Forty-eight children (58%) attended normal school and were grade-appropriate. Sixty-two of 83 patients (75%) were socially continent of urine, and 71/83 (86%) were socially continent of stool. Hydrocephalus was present in 93 of the 101 children in the study, and 85 children were shunted. Half of the shunted children required a shunt revision in the first year of life, and thereafter the rate of revision decreased, so that after 2 years the risk of revision was approximately 10% per year.