Profound Near Fatal Respiratory Dysfunction in a Neonate With Meningomyelocele: A Narrative With Neurosurgical...

Area of Science:

• Neurology
• Pediatric Surgery
• Respiratory Medicine

Background:

• Myelomeningocele, a severe form of spina bifida, is rarely associated with autonomic dysfunction.
• Arnold-Chiari Type II malformation and congenital hydrocephalus are common comorbidities in myelomeningocele patients.

Observation:

• A neonate with myelomeningocele repair presented with profound respiratory compromise, including apnoeic episodes requiring intubation and ventilation.
• The patient also had an incidental choroid plexus papilloma, necessitating foramen magnum decompression.
• Despite multiple neurosurgical interventions, respiratory distress persisted, leading to prolonged intensive care unit stay and overnight ventilation via tracheostomy.

Findings:

• The neonate exhibited severe apnoeic-hypoxic episodes, indicating significant autonomic dysfunction secondary to myelomeningocele.
• A correlation was observed between urinary tract infections and increased apnoeic episodes, suggesting bladder irritation as a potential trigger for autonomic dysreflexia.
• Cognitive development remained age-appropriate despite the severity of respiratory compromise.

Implications:

• This case underscores the importance of multidisciplinary care in managing complex pediatric cases involving myelomeningocele and respiratory compromise.
• Understanding the interplay between surgical history, autonomic dysfunction, and respiratory distress is crucial for optimizing patient outcomes.
• Further investigation into the link between bladder irritation and autonomic dysreflexia in this population is warranted.