Do routine antibiotics change the myelomeningocele infection rate? A case series

Myelomeningocele (MMC) is the most common type of congenital spinal malformation, typically requiring surgical intervention. While prenatal repair is increasingly favored, postnatal repair remains the standard in many settings. This study aims to evaluate the antibiotics prescribed to neonates with MMC and their correlation with central nervous system (CNS) infection rates following postnatal surgical repair.

A retrospective cohort study was conducted, including newborns who underwent postnatal MMC repair between August 2017 and June 2021 at the Children's Hospital of Goiânia. The study examined variables related to the pregnancy and birth periods, as well as anatomical and neurosurgical factors. Neonates were categorized into four groups based on the time interval between birth and surgical repair (within 24, 48, 72 h, and beyond 72 h) and were evaluated for CNS infection rates.

A total of 38 neonates were included, with 24.32% diagnosed with CNS infections post-surgery. Notably, 22.86% of mothers did not receive prenatal care. Cesarean section was the predominant mode of delivery, accounting for 77.78% of cases. The average time from birth to surgery was 67 h. At admission, 73.68% of MMC cases presented with a rupture of the MMC membrane, and 78.94% of newborns received intravenous antibiotics. The mean surgical time was 60 min, with 78.94% of surgeries performed by experienced surgeons.

Timely surgical intervention and the use of prophylactic antibiotics are critical in reducing CNS infection rates in neonates undergoing postnatal MMC repair. Delays in surgery and the lack of antibiotic prophylaxis were associated with higher infection rates, whereas factors such as delivery mode and surgeon experience had less impact on infection outcomes. These findings highlight the need for standardized care protocols and improved prenatal care to optimize neonatal outcomes.