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Updated: May 29, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Preschool neurobehavioral outcome following fetal myelomeningocele surgery
Enrico Danzer1, Marsha Gerdes, Michael W Bebbington
1Center for Fetal Diagnosis and Treatment, The Children’s Hospital of Philadelphia and The University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4388, USA.
Insights
Fetal myelomeningocele (fMMC) surgery did not increase behavioral issues in children. However, shunted fMMC patients showed higher risks for certain neurobehavioral problems, necessitating early detection and intervention for social success.
Area of Science:
- Pediatric Surgery
- Neurodevelopmental Disorders
- Behavioral Pediatrics
Background:
- Fetal myelomeningocele (fMMC) surgery aims to improve outcomes for affected infants.
- Understanding the neurobehavioral profile of children post-fMMC surgery is crucial for long-term care.
Purpose of the Study:
- To assess the prevalence of neurobehavioral problems in preschool-aged children who underwent fMMC surgery.
Main Methods:
- A cohort of 30 children undergoing fMMC surgery were evaluated at 5 years of age using the Child Behavior Check List (CBCL).
- Neurobehavioral problems were categorized as normal, at-risk, or clinically significant based on CBCL T scores.
- Comparisons were made between shunted and non-shunted fMMC children, and correlations with overall neurodevelopmental outcome were examined.
Main Results:
- The prevalence of 'at-risk' or 'clinically significant' behavioral problems in fMMC children was comparable to general population norms.
- No significant differences in overall internalizing, externalizing, or total behavioral scores were observed between shunted and non-shunted fMMC children.
- Shunted fMMC children demonstrated a higher likelihood of anxiety, depression, pervasive developmental, and withdrawn behaviors.
Conclusions:
- fMMC surgery and resulting preterm delivery are not linked to increased behavioral issues or social interaction deficits.
- Shunted fMMC children are more prone to specific neurobehavioral challenges, highlighting the need for specialized monitoring.
- Early identification of behavioral problems in fMMC patients allows for timely interventions to support social success.
Objective:
It was the aim of this study to assess the prevalence of preschool neurobehavioral problems in children following fetal myelomeningocele (fMMC) surgery.
Methods:
Prior to the Management of Myelomeningocele Study, 30 fMMC patients underwent a standardized neurodevelopmental examination at 5 years of age. The prevalence of behavioral problems was assessed by the Child Behavior Check List (CBCL), which includes a total problem score and 2 broad-band indices (internalizing and externalizing problems). fMMC children were classified as having normal, at-risk or clinically significant scores based on calculated T scores.
Results:
Twenty-two (73%) fMMC families completed the evaluation. Mean age at delivery following fMMC surgery was 35.5 ± 1.6 weeks. The prevalence of 'at-risk' or 'clinically significant' scores for internalizing, externalizing and total behavioral problems was similar to general population norms. No difference in overall internalizing (p = 0.19), externalizing (p = 0.54) and total behavioral (p = 0.18) scores was found between non-shunted and shunted fMMC children. However, shunted fMMC children were more likely to experience anxiety and depressive (p = 0.02), pervasive developmental (p = 0.03) and withdrawn (p = 0.06) behavior. Oppositional defiant, attention deficit and hyperactivity problems were not found. No correlation was found between overall neurodevelopmental outcome and abnormal CBCL scores.
Conclusions:
fMMC surgery and subsequent preterm delivery is not associated with increased behavioral problems, impaired social interactions and restricted behavior patterns. Shunted fMMC children were more likely to have scores in the 'at-risk' or 'clinically significant' range for multiple CBCL subindices. Early detection of behavioral problems following fMMC surgery provides an opportunity for targeted and timely intervention enabling affected fMMC children to be socially successful.
