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Prenatal surgery more effective in treating Spina Bifida

A recent study indicates that prenatal surgery to address a form of spina bifida results in better outcomes for the infant compared to postnatal surgery. However the study also indicated that the prenatal surgery was not effective in all cases and that it carried increased risk of other complications including premature birth and an increased risk of death to the mother.

The study included patients with a form of spina bifida known as myelomeningocele. This occurs when there is a gap in the spine through which the spinal cord extrudes. Infants born with this type of spina bifida have a death rate of about 10% and those that survive face major disabilities. These can include paralysis of the lower body, bladder problems and fluid on the brain. Approximately one in 3,000 children has this form of spina bifida.

Postnatal surgery to address this condition is not uncommon, but often there is already significant nerve damage and other complications by the time the surgery is performed. The first prenatal surgery of this type was performed in 1997 and early data showed positive results for many babies, but the data also indicated significant risks. The new study, known as Management of Myelomeningocele Study (MOMS), sought to provide more clarity on the benefits and risks of the procedure compared to postnatal surgery.

Among the infants in the study, the infants that had the prenatal surgery were only half as likely to need a shunt to relieve fluid on the brain as those who had the postnatal surgery. The prenatal group was eight times as likely to have normally positioned brainstems and by 30 months nearly twice as many infants from the prenatal group walked without crutches or other assistive devices.

Once these results became clear, the researchers ended the study early so that those infants in the postnatal group could have access to the prenatal surgery.

Source: New York Times "Success of Spina Bifida Study Opens Fetal Surgery Door" PAM BELLUCK February 9, 2011

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