The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes
Natalie E Rintoul1, Roberta L Keller2, William F Walsh3
1Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, rintoul@email.chop.edu.
Introduction:
The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in The New England Journal of Medicine in 2011.
Objective:
Neonatal outcomes for the complete trial cohort (N = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator.
Methods:
Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed.
Results:
Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage.
Conclusion:
The benefits of prenatal surgery outweigh the complications of prematurity.
