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Developmental outcomes of children with myelomeningocele: prenatal predictors
S J Coniglio1, S M Anderson, J E Ferguson
1Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville, USA.
Insights
Prenatal ultrasound findings of ventriculomegaly and lesion level in myelomeningocele predict cognitive development. Worsening ventriculomegaly correlates with lower cognitive scores, while lower lesion levels indicate better outcomes.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Prenatal Diagnostics
Background:
- Myelomeningocele is a complex congenital condition affecting neural development.
- Prenatal detection allows for early assessment of potential neurodevelopmental outcomes.
- Understanding predictive factors is crucial for clinical management and parental counseling.
Purpose of the Study:
- To determine cognitive developmental outcomes in children with prenatally detected myelomeningocele.
- To investigate if ventriculomegaly severity and lesion level predict cognitive development.
Main Methods:
- Prenatal ultrasounds were reviewed to assess ventriculomegaly (atrial width > 10 mm) and lesion level (thoracic to sacral).
- Cognitive developmental quotients were assessed using a modified Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale.
- Correlation analyses were performed to link prenatal findings with cognitive outcomes.
Main Results:
- Children with moderate to severe ventriculomegaly had significantly lower mean cognitive developmental quotients (74.0) compared to those with absent to mild ventriculomegaly (90.3).
- A negative correlation was found between the degree of ventriculomegaly and cognitive developmental quotient (r = -0.43, p < 0.025).
- A positive correlation was observed between lower lesion levels and higher cognitive developmental quotients (r = 0.50, p < 0.01).
Conclusions:
- Ventriculomegaly severity, assessed prenatally, predicts early cognitive development in myelomeningocele patients.
- Lower anatomic lesion levels are associated with more favorable cognitive outcomes.
- Clinicians should exercise caution due to significant variance in individual developmental quotients.
Objective:
The purpose of the current investigation was to determine cognitive developmental outcomes for a cohort of children with prenatally detected myelomeningocele and to determine whether the variables of (1) severity of ventriculomegaly and (2) anatomic level of lesion were predictive of cognitive development.
Study Design:
Prenatal ultrasonographic examinations were reviewed by a single perinatologist to determine the degree of ventriculomegaly and the anatomic level of the lesion. Ventriculomegaly was defined as a lateral ventricular atrial width > 10 mm. Anatomic level of lesion was defined as (1) thoracic, (2) high lumbar, (3) midlumbar, (4) low lumbar-high sacral, or (5) sacral. Cognitive developmental quotients for surviving children were determined by one of two developmental pediatricians with use of a modified version of the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale, a measure of visual-motor and language abilities.
Results:
The mean cognitive developmental quotient for subjects with absent to mild ventriculomegaly was 90.3 (range 54 to 120, SD 17.4), whereas the mean cognitive developmental quotient for those with moderate to severe ventriculomegaly was 74.0 (range 65 to 100, SD 17.1) (p < 0.01). There was a negative correlation between the degree of ventriculomegaly and the cognitive developmental quotient (r = -0.43, p < 0.025) and a positive correlation between the level of the lesion and the cognitive developmental quotient (r = 0.50, p < 0.01).
Conclusions:
The degree of ventriculomegaly determined on high-resolution prenatal ultrasonography is predictive of early cognitive development in children with myelomeningocele, with worsening ventriculomegaly being associated with lower cognitive developmental quotients. The anatomic level of the lesion also has predictive value, with lower level lesions being associated with more favorable cognitive outcomes. However, because of the high degree of variance in developmental quotients within the two ventriculomegaly groups, we advise clinicians to use caution in the interpretation and use of our data.