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Results of selective treatment of spina bifida cystica
Insights
Selective treatment for infants with open spina bifida improved survival rates. Infants with meningocele survived without handicap, while treated myelomeningocele cases showed better outcomes, though some had lasting handicaps.
Area of Science:
- Pediatric Surgery
- Developmental Neurology
Background:
- Open spina bifida presents significant challenges in infant care.
- Historically, treatment approaches varied, impacting survival and quality of life.
Purpose of the Study:
- To prospectively evaluate the outcomes of selective treatment in infants with open spina bifida.
- To assess the impact of treatment selection on survival and handicaps.
Main Methods:
- A prospective study of 120 infants with open spina bifida admitted between 1971 and 1976.
- Categorization of infants based on birth criteria: untreated (adverse criteria), meningocele, and myelomeningocele.
- Active treatment was provided for specific groups, with outcomes followed for 3 to 9 years.
Main Results:
- Seventy-one infants with adverse criteria did not receive treatment and all died, over 90% within 6 months.
- Seven infants with meningocele were treated and survived without handicap.
- Of 42 actively treated myelomeningocele infants, 36 survived; 8 had moderate to severe handicaps, but overall quality of survival was improved.
Conclusions:
- Selective treatment for open spina bifida, particularly for myelomeningocele, can lead to improved survival and quality of life compared to non-selective approaches.
- Parental involvement and informed consent were integral to the decision-making process.
- While selective treatment shows promise, ongoing management of handicaps remains crucial for affected children.
Abstract:
The results of selective treatment in 120 infants with open spina bifida, admitted between May 1971 and December 1976, were prospectively studied. Seventy-one infants had adverse criteria at birth and were not treated. They all died, more than 90% of them within 6 months of birth. Seven had meningocele. All were treated and survived without handicap. Forty-two infants with myelomeningocele were actively treated. Thirty-six survive at follow-up after 3 to 9 years. The quality of survival is much better than when selection was not used but 8 children have moderate or severe handicaps. The parents were fully informed and consulted at every decision-making step; they fully supported the principle of selection and the action taken on behalf of their own child.