skip to main content
Idioma:

The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes

Farmer, Diana L. ; Thom, Elizabeth A. ; Brock, John W. ; Burrows, Pamela K. ; Johnson, Mark P. ; Howell, Lori J. ; Farrell, Jody A. ; Gupta, Nalin ; Adzick, N. Scott

American journal of obstetrics and gynecology, 2018-02, Vol.218 (2), p.256.e1-256.e13 [Periódico revisado por pares]

United States: Elsevier Inc

Texto completo disponível

Citações Citado por
  • Título:
    The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes
  • Autor: Farmer, Diana L. ; Thom, Elizabeth A. ; Brock, John W. ; Burrows, Pamela K. ; Johnson, Mark P. ; Howell, Lori J. ; Farrell, Jody A. ; Gupta, Nalin ; Adzick, N. Scott
  • Assuntos: Adult ; and hip movement ; ankle ; Child Development ; Child, Preschool ; Female ; fetal surgery ; Fetal Therapies ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; knee ; long-term follow-up ; Male ; Management of Myelomeningocele Study ; Meningomyelocele - complications ; Meningomyelocele - diagnosis ; Meningomyelocele - surgery ; motor outcomes ; myelomeningocele ; Neurodevelopmental Disorders - etiology ; Neurodevelopmental Disorders - prevention & control ; postnatal motor function ; Pregnancy ; Prospective Studies ; shunt ; Single-Blind Method ; Treatment Outcome ; ventricular size ; ventriculomegaly
  • É parte de: American journal of obstetrics and gynecology, 2018-02, Vol.218 (2), p.256.e1-256.e13
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-News-2
    ObjectType-Feature-3
    content type line 23
  • Descrição: Previous reports from the Management of Myelomeningocele Study demonstrated that prenatal repair of myelomeningocele reduces hindbrain herniation and the need for cerebrospinal fluid shunting, and improves motor function in children with myelomeningocele. The trial was stopped for efficacy after 183 patients were randomized, but 30-month outcomes were only available at the time of initial publication in 134 mother-child dyads. Data from the complete cohort for the 30-month outcomes are presented here. Maternal and 12-month neurodevelopmental outcomes for the full cohort were reported previously. The purpose of this study is to report the 30-month outcomes for the full cohort of patients randomized to either prenatal or postnatal repair of myelomeningocele in the original Management of Myelomeningocele Study. Eligible women were randomly assigned to undergo standard postnatal repair or prenatal repair <26 weeks gestation. We evaluated a composite of mental development and motor function outcome at 30 months for all enrolled patients as well as independent ambulation and the Bayley Scales of Infant Development, Second Edition. We assessed whether there was a differential effect of prenatal surgery in subgroups defined by: fetal leg movements, ventricle size, presence of hindbrain herniation, gender, and location of the myelomeningocele lesion. Within the prenatal surgery group only, we evaluated these and other baseline parameters as predictors of 30-month motor and cognitive outcomes. We evaluated whether presence or absence of a shunt at 1 year was associated with 30-month motor outcomes. The data for the full cohort of 183 patients corroborate the original findings of Management of Myelomeningocele Study, confirming that prenatal repair improves the primary outcome composite score of mental development and motor function (199.4 ± 80.5 vs 166.7 ± 76.7, P = .004). Prenatal surgery also resulted in improvement in the secondary outcomes of independent ambulation (44.8% vs 23.9%, P = .004), WeeFIM self-care score (20.8 vs 19.0, P = .006), functional level at least 2 better than anatomic level (26.4% vs 11.4%, P = .02), and mean Bayley Scales of Infant Development, Second Edition, psychomotor development index (17.3% vs 15.1%, P = .03), but does not affect cognitive development at 30 months. On subgroup analysis, there was a nominally significant interaction between gender and surgery, with boys demonstrating better improvement in functional level and psychomotor development index. For patients receiving prenatal surgery, the presence of in utero ankle, knee, and hip movement, absence of a sac over the lesion and a myelomeningocele lesion of ≤L3 were significantly associated with independent ambulation. Postnatal motor function showed no correlation with either prenatal ventricular size or postnatal shunt placement. The full cohort data of 30-month cognitive development and motor function outcomes validate in utero surgical repair as an effective treatment for fetuses with myelomeningocele. Current data suggest that outcomes related to the need for shunting should be counseled separately from the outcomes related to distal neurologic functioning.
  • Editor: United States: Elsevier Inc
  • Idioma: Inglês
Links
Voltar para lista de resultados
Ir para página anteriorAnterior Resultado  5 AvançarIr para próxima página

  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

Buscando em bases de dados remotas. Favor aguardar.