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Early management and decision making for the treatment of myelomeningocele
Insights
Early intervention for infants with myelomeningocele significantly impacts outcomes. Vigorous treatment offers the best chance of survival, while supportive care alone resulted in high mortality rates in this study.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Spina Bifida Research
Background:
- Established a program for early selection and treatment of infants with myelomeningocele in 1977.
- Focused on evaluating treatment approaches for this congenital condition.
Observation:
- Over a 5-year period, 69 infants were evaluated.
- 36 infants were recommended for early, vigorous treatment.
- 33 infants were recommended for supportive care only.
Findings:
- All 24 infants receiving only supportive care died within 189 days (mean 37 days).
- Infants receiving early vigorous treatment had better survival outcomes (implied).
- Multidisciplinary team involvement is crucial for effective management.
Implications:
- Early, aggressive treatment is critical for improving survival rates in myelomeningocele.
- Ongoing support and follow-up are essential for infants receiving supportive care.
- Ethical considerations necessitate careful management strategies in pediatric care.
Abstract:
A program for early selection and treatment of the infant with myelomeningocele was developed at the University of Oklahoma Health Sciences Center in 1977. Over a 5-year period, 69 babies were evaluated, 36 babies were recommended for early vigorous treatment. Of the 33 babies for whom only supportive care was recommended, five were initially treated at the parents' request, two underwent delayed vigorous treatment, one was subsequently treated by "crisis management," one moved and did not return for follow-up, and 24 received only supportive care. All 24 babies died between 1 to 189 days of age (mean 37 days). The involvement of several physicians and paramedical support personnel is considered essential for this approach of early selection and treatment. Continued support and regular follow-up is necessary for any baby who receives only supportive care. Parents retain legal custody. Although ethical concerns make any approach difficult, the method presented is considered to be the best alternative available at this time.