Prenatal myelomeningocele repair tied to better function
The benefits of prenatal repair of myelomeningocele persist into school age, according to a study published online Feb. 8 in JAMA Pediatrics.
Amy J. Houtrow, M.D., Ph.D., from the University of Pittsburgh Medical Center, and colleagues assessed whether participants who had prenatal repair for myelomeningocele have better physical functioning at 5 to 10 years than those with postnatal repair. This prespecified secondary analysis included data for 154 children (78 postnatal repair and 76 prenatal repair) who participated in the Management of Myelomeningocele Study Follow-Up.
The researchers found that children in the prenatal repair group were more competent with self-care skills and were commonly community ambulators per the Modified Hoffer Classification (51.3 percent prenatal versus 23.1 percent postnatal; adjusted relative risk for sex, 1.70). Additionally, prenatal repair was associated with faster time on the 10-m walk test, better gait quality, and higher-level mobility skills. Having a motor function level worse than their anatomic lesion level was less likely in the prenatal repair group (adjusted relative risk, 0.44).
“These data are important for demonstrating that fetal surgery for spina bifida improves mobility well into school age, but the implications of these results are even more profound,” Houtrow said in a statement. “When children are able to move around independently and interact with their peers, it dramatically changes the way they engage with the world. Better mobility makes socializing easier and improves their overall quality of life. Additionally, demonstrating more independence with self-care skills at school-age means they are more likely to be independent as adults.”