Ambulation after in‐utero fetoscopic or open neural tube defect repair: predictors for ambulation at 30 months

Objectives To compare the ambulatory status of a cohort of children who had undergone prenatal repair of an open neural tube defect (ONTD) using one of two different methods (fetoscopic or open hysterotomy) with that of a cohort who had undergone postnatal repair, and to identify the best predictors...

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Veröffentlicht in:Ultrasound in obstetrics & gynecology 2024-08, Vol.64 (2), p.203-213
Hauptverfasser: Sanz Cortes, M., Corroenne, R., Pyarali, M., Johnson, R. M., Whitehead, W. E., Espinoza, J., Donepudi, R., Castillo, J., Castillo, H., Mehollin‐Ray, A. R., Shamshirsaz, A. A., Nassr, A. A., Belfort, M. A.
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Sprache:eng
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Zusammenfassung:Objectives To compare the ambulatory status of a cohort of children who had undergone prenatal repair of an open neural tube defect (ONTD) using one of two different methods (fetoscopic or open hysterotomy) with that of a cohort who had undergone postnatal repair, and to identify the best predictors of ambulation at 30 months of age. Methods This was a retrospective review of a cohort of children who underwent ONTD repair either prenatally (n = 110), by fetoscopic surgery (n = 73) or open hysterotomy surgery (n = 37), or postnatally (n = 51), in a single tertiary hospital between November 2011 and May 2023. The cohort comprised a consecutive sample of cases who had undergone ONTD repair in‐utero following Management of Myelomeningocele Study (MOMS) trial criteria and cases who had undergone postnatal repair, meeting the same criteria, which were also followed up after birth at the same institution. Motor function assessment by ultrasound was recorded at referral, 6 weeks after prenatal repair, or after referral in postnatally repaired cases, and at the last ultrasound scan before delivery. Clinical examinations to assess motor function at birth and at 12 months were retrieved from records. Intact motor function was defined as first sacral myotome (S1) motor function. Ambulatory status data at each follow‐up visit were collected. The proportion of children who were able to walk independently after 30 months of age was compared between those who had undergone fetoscopic vs open prenatal surgery and between prenatal (by either fetoscopic or open surgery) and postnatal ONTD repair. Logistic regression analyses were performed to identify predictors for independent ambulation. Results After 30 months, the proportion of infants who were able to walk independently was higher in prenatally vs postnatally repaired cases (51.8% vs 15.7%, P 
ISSN:0960-7692
1469-0705
1469-0705
DOI:10.1002/uog.27589