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Prenatal predictors of motor function in children with open spina bifida: a retrospective cohort study
R Corroenne1, M Yepez1, M Pyarali1
1Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA.
Insights
Intact motor function detected before birth predicts good outcomes at birth and 12 months for babies with open spina bifida (OSB) undergoing prenatal repair. Postnatal repair outcomes depend on initial motor function at birth.
Area of Science:
- Neurology
- Pediatric Surgery
- Fetal Medicine
Background:
- Open spina bifida (OSB) is a complex birth defect requiring surgical intervention.
- Predicting motor function (MF) outcomes is crucial for managing patients with OSB.
- Comparing prenatal versus postnatal repair strategies is essential for optimizing care.
Purpose of the Study:
- To identify predictors of intact motor function (MF) at birth and 12 months in infants with OSB.
- To compare predictors between prenatally and postnatally repaired OSB cases.
- To evaluate the role of in utero ultrasound assessments in predicting postnatal MF.
Main Methods:
- Retrospective cohort study of 127 infants with OSB who underwent either prenatal or postnatal repair.
- Prenatal MF assessed via ultrasound at diagnosis (US1), 6 weeks post-repair (US2), and before delivery (US3).
- Clinical MF assessment at birth and 12 months; intact MF defined as plantar flexion of the ankle.
Main Results:
- For prenatal repair, absence of clubfeet and intact MF at all ultrasound assessments (US1, US2, US3) predicted intact MF at birth and 12 months.
- A "flat lesion" was also a predictor of intact MF in the prenatal repair group.
- For postnatal repair, only intact MF at birth predicted intact MF at 12 months.
Conclusions:
- In utero detection of intact motor function from mid-gestation through delivery is a strong predictor of postnatal outcomes in prenatally repaired OSB.
- These findings highlight the importance of prenatal assessment for predicting motor function in OSB patients.
- The study suggests different predictive factors for prenatally versus postnatally repaired OSB.
Objective:
To identify predictors for intact motor function (MF) at birth and at 12 months of life in babies with prenatally versus postnatally repaired open spina bifida (OSB).
Design:
Retrospective cohort study.
Setting:
Texas Children's Hospital, 2011-2018.
Population:
Patients who underwent either prenatal or postnatal OSB repair.
Methods:
Prenatal MF of the lower extremities was evaluated by ultrasound following a metameric distribution at the time of diagnosis (US1), 6 weeks postoperatively (or 6 weeks after initial evaluation in postnatally repaired cases) (US2) and at the last ultrasound before delivery (US3). At birth and at 12 months, MF was assessed clinically. Intact MF (S1) was defined as the observation of plantar flexion of the ankle. Results from logistic regression analysis are expressed as odds ratios (95% confidence intervals, P values).
Results:
A total of 127 patients were included: 93 with prenatal repair (51 fetoscopic; 42 open hysterotomy repair) and 34 with postnatal repair. In the prenatal repair group, predictors for intact MF at birth and at 12 months included: absence of clubfeet (OR 11.3, 95% CI 3.2-39.1, P < 0.01; OR 10.8 95% CI 2.4-47.6, P < 0.01); intact MF at US1 (OR 19.7, 95% CI 5.0-76.9, P < 0.01; OR 8.7, 95% CI 2.0-38.7, P < 0.01); intact MF at US2 (OR 22, 95% CI 6.5-74.2, P < 0.01; OR 13.5, 95% 3.0-61.4, P < 0.01); intact MF at US3 (OR 13.7, 95% CI 3.4-55.9, P < 0.01; OR 12.6, 95% CI 2.5-64.3, P < 0.01); and having a flat lesion (OR 11.2, 95% CI 2.4-51.1, P < 0.01; OR 4.1, 95% CI 1.1-16.5, P = 0.04). In the postnatal repair group, the only predictor of intact MF at 12 months was having intact MF at birth (OR 15.2, 95% CI 2.0-113.3, P = 0.03).
Conclusions:
The detection of intact MF in utero from mid-gestation to delivery predicts intact MF at birth and at 12 months in babies who undergo prenatal OSB repair.
Tweetable Abstract:
Detection of intact motor function in utero predicts intact motor function at birth and at 1 year in fetuses who undergo prenatal OSB repair.
