Tuesday, October 6, 2020

Prenatal predictors of motor function in children with open spina bifida

Corroenne R, Yepez M, Pyarali M, Johnson RM, Whitehead WE, Castillo HA, Castillo J, Mehollin-Ray AR, Espinoza J, Shamshirsaz AA, Nassr AA, Belfort MA, Sanz Cortes M. Prenatal predictors of motor function in children with open spina bifida: a retrospective cohort study. BJOG. 2020 Sep 25. doi: 10.1111/1471-0528.16538. Epub ahead of print. PMID: 32975898.


Objectives: To identify predictors for intact motor function (MF) at birth and at 12 months of life in babies with prenatally versus postnatally repaired open spina bifida (OSB). 

Design: Retrospective cohort study SETTING: Texas Children's Hospital, 2011 to 2018 POPULATION: Patients who underwent either prenatal or postnatal OSB repair METHODS: Prenatal MF of the lower extremities was evaluated by ultrasound following a metameric distribution at the time of diagnosis (US1), 6 weeks postoperatively (or 6 weeks after initial evaluation in postnatally repaired cases) (US2), and at the last US before delivery (US3). At birth and 12 months, MF was assessed clinically. Intact MF (S1) was defined as the observation of plantar flexion of the ankle. Results from logistic regression analysis are expressed as Odds-ratio[95% confidence interval, p-value]. 

Results: 127 patients were included [93 prenatal repair (51 fetoscopic, 42 open-hysterotomy repair); 34 postnatal repair]. In the prenatal repair group, predictors for intact MF at birth and 12 months included: absence of clubfeet (11.3[3.2-39.1], p<0.01 and 10.8[2.4-47.6], p<0.01), intact MF at US1 (19.7[5-76.9], p<0.01 and 8.7[2-38.7], p<0.01), at US2 (22[6.5-74.2], p<0.01 and 13.5[3-61.4], p<0.01) and at US3 (13.7[3.4-55.9], p<0.01 and 12.6[2.5-64.3], p<0.01) and having a flat lesion (11.2[2.4-51.1], p<0.01 and 4.1[1.1-16.5], p=0.04). In the postnatal repair group, the only predictor of intact MF at 12 months was having intact MF at birth (15.2[2-113.3], p=0.03). 

Conclusion: Detection of intact MF in-utero from mid-gestation to delivery predicts intact MF at birth and at 12 months in babies who undergo prenatal OSB repair. 

Courtesy of:  https://www.mdlinx.com/journal-summary/prenatal-predictors-of-motor-function-in-children-with-open-spina-bifida-a-retrospective-cohort/72uvTE3QW4lGdTF9RGlIXL

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