Sleep-Disordered Breathing in Newborns After Myelomeningocele Repair

Area of Science:

• Pediatric Neurology
• Neonatal Medicine
• Sleep Medicine

Background:

• Sleep-disordered breathing (SDB) is a potential contributor to cognitive deficits in children with myelomeningocele.
• Investigating SDB frequency in neonates undergoing fetal versus postnatal myelomeningocele repair is crucial.

Purpose of the Study:

• To determine the incidence and severity of SDB in neonates with myelomeningocele.
• To compare SDB rates between fetal and postnatal myelomeningocele repair groups.

Main Methods:

• A nine-center, prospective, observational study involving 173 neonates with myelomeningocele.
• Polysomnography was performed before hospital discharge to assess SDB severity using the apnea-hypopnea index (AHI).
• Surgical timing (fetal vs. postnatal) and SDB treatment decisions were made by clinical teams.

Main Results:

• Over half of the infants (53%) were diagnosed with SDB (median AHI 22.5).
• Neonate with fetal repair had a higher median AHI (29) compared to postnatal repair (19) in unadjusted analysis (P=.008).
• In adjusted models, prematurity was associated with higher AHI, while surgical timing was not; hindbrain herniation, myelomeningocele level, and shunt need did not predict AHI.

Conclusions:

• SDB is highly prevalent in neonates with myelomeningocele, affecting over 50% of cases.
• Higher SDB severity in the fetal repair group may be linked to increased prematurity rates.
• Routine SDB screening is recommended to optimize neurodevelopmental outcomes in this population.