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Fetal myelomeningocele surgery: preschool functional status using the Functional Independence Measure for children
Enrico Danzer1, Marsha Gerdes, Michael W Bebbington
1The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Insights
Children who underwent fetal myelomeningocele (fMMC) surgery showed lower functional status, particularly in self-care. Non-shunted children and those with normal neurodevelopmental outcomes had better independence in daily activities.
Area of Science:
- Pediatric Surgery
- Neurodevelopmental Pediatrics
- Rehabilitation Medicine
Background:
- Fetal myelomeningocele (fMMC) surgery is a complex intervention aimed at improving outcomes for affected infants.
- Assessing long-term functional status is crucial for understanding the impact of fMMC repair and guiding supportive care.
Purpose of the Study:
- To evaluate the preschool functional status of children who underwent fetal myelomeningocele (fMMC) surgery.
- To identify factors influencing functional independence in this population.
Main Methods:
- A cohort of 30 children who underwent fMMC surgery prior to the NICHD-MOMS trial were assessed at 5 years of age.
- Functional status was measured using the Functional Independence Measure for Children (WeeFIM), evaluating self-care, mobility, and cognitive domains.
Main Results:
- Children with fMMC demonstrated significantly lower cognitive, self-care, and mobility functional quotients compared to population norms.
- While most achieved cognitive and mobility independence, a substantial proportion required assistance with self-care tasks.
- Independence in cognitive, mobility, and total function was higher in non-shunted children and those with average neurodevelopmental scores.
Conclusions:
- The majority of children post-fMMC surgery achieve independence in cognition and mobility but require significant self-care support.
- Surgical approach (shunted vs. non-shunted) and neurodevelopmental outcome are associated with daily living independence.
- Understanding functional limitations post-fMMC surgery is key for developing targeted early interventions to enhance independence.
Objective:
To study preschool functional status in children following fetal myelomeningocele (fMMC) surgery.
Material And Methods:
Prior to the NICHD-MOMS trial, 30 fMMC underwent standardized neurodevelopmental examination at 5 years of age. Functional status was determined with the Functional Independence Measure (WeeFIM), which assesses self-care, mobility, and cognitive independence.
Results:
Evaluations were completed in 26 (87%). Mean cognitive (93.0 ± 21.9), self-care (66.5 ± 23.9), mobility (82.3 ± 19.5), and total (77.9 ± 20.3) functional quotient of fMMC children were significantly lower than age-matched population norms (P < 0.01). Complete caregiver independence was achieved by 22 (84%), 10 (38%), 16 (62%), and 15 (58%) fMMC children for cognition, self-care, mobility, and total functional outcome, respectively. Cognitive, mobility, and total independence were higher in non-shunted than shunted fMMC children (P = 0.02, P = 0.02, and P < 0.01, respectively) and in fMMC children with average neurodevelopmental scores (P < 0.001, P = 0.01, and P < 0.01, respectively). Self-care independence tended to be higher in the non-shunted group and in fMMC children with normal neurodevelopmental outcome (P = 0.07 and P = 0.09, respectively).
Conclusion:
The majority of fMMC children achieved cognitive and mobility independence, but continue to require significant assistance in self-care. Non-shunted and fMMC children with normal neurodevelopmental outcome were more likely to be independent in daily living activities. Better understanding of the extent of functional limitations following fMMC surgery will allow for more effective early interventions geared toward maximizing independence in everyday tasks in all environments.
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