Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Fetal surgery for spina bifida shows early benefits in leg function, fewer shunts

26.09.2003


Physicians at the Children’s Hospital of Philadelphia have reported encouraging short-term outcomes in fetal surgery for the birth defect spina bifida. Among the benefits were a reduced need for a shunt to divert excess fluid from the brain, the reversal of a potentially devastating neurologic condition called hindbrain herniation, and better-than-expected neurologic function in the infants’ legs.



Mark Johnson, M.D., and colleagues from Children’s Hospital’s Center for Fetal Diagnosis and Treatment reported on the outcomes of 50 fetal surgeries for spina bifida in the September issue of the American Journal of Obstetrics and Gynecology.

The fetal surgeries were performed at Children’s Hospital between 1998 and 2002. The mean gestational age of the fetuses undergoing the surgery was 23 weeks, and their mean gestational age at birth was 34 weeks.


Of the 50 fetuses, three died from complications following premature delivery. Of the remaining 47 infants, all had reversal of the hindbrain herniation, and 20 infants (43 percent) required a shunt – compared to an 85 percent rate of shunting, found in another study, for infants with spina bifida who had surgery after birth. Twenty-four of the infants (57 percent of the surviving 47) had better neurologic leg function than predicted, based on the level of the spina bifida lesion.

Hindbrain herniation occurs when a portion of the brain protrudes through the base of the skull into the spinal column. If the tissue blocks the flow of cerebrospinal fluid within the brain, excess fluid may accumulate and cause increased pressure within the brain. The protruding hindbrain tissue may also injure nerves in the spinal cord. In all the fetuses, hindbrain herniation was present before the surgery, but resolved after the surgery.

However, the authors caution that long-term studies are needed to further evaluate leg function, bladder and bowel function, and neurodevelopment beyond the infant period.

Spina bifida is the most common birth defect of the central nervous system, affecting 1 in 2,000 live births. A developmental failure early in pregnancy leaves an opening in part of the bone and tissue covering the fetus’s spinal cord. The most common and most severe form of spina bifida is myelomeningocele, which may cause the child to suffer leg paralysis, lack of bowel and bladder control, and fluid pressure on the brain (hydrocephaly).

Surgery currently performed on newborns with open spina bifida lesions requires closing tissue over the defect to protect the spinal tissue. However, previous studies have suggested that neurological injury may occur before or during birth. To prevent that injury, physicians at Children’s Hospital have performed surgery for spina bifida on the fetus prior to birth.

Performing the surgical closure of the spina bifida lesion in mid-pregnancy, between 20 and 25 weeks’ gestation, may prevent the progressive neurological injury which occurs during the later part of pregnancy, according to the authors. They added that the potential benefits must be balanced against the risk of preterm delivery, and the surgical risks to the mother. "Following the fetal surgery, mothers remain in the Philadelphia area so we can monitor them closely until they deliver," said Dr. Johnson.

Dr. Johnson and his co-authors note in the study that they followed a "highly selected" population. The team did not operate on fetuses in whom fetal ultrasound detected irreversible neurologic damage, nor on fetuses in which the spina bifida defect occurred at a spinal level that would not be expected to cause neurological damage.

Because the current study reports only on short-term outcomes, longer-term studies are important in evaluating fetal surgery for spina bifida. The Children’s Hospital of Philadelphia is currently participating in a multicenter, randomized clinical trial of the procedure, sponsored by the National Institutes of Health. That trial, which runs from 2002 through 2006, will compare the long-term outcomes of prenatal versus postnatal spina bifida repair.

In addition to Dr. Johnson, co-authors of the study, all from the Center For Fetal Diagnosis and Treatment at The Children’s Hospital of Philadelphia, are N. Scott Adzick, M.D., surgeon-in-chief and director of the Center; Leslie N. Sutton, M.D., chief of Neurosurgery; Natalie Rintoul, M.D.; Timothy M. Crombleholme, M.D.; Alan W. Flake, M.D.; Lori J. Howell, R.N., M.S.; Holly L. Hedrick, M.D., and R. Douglas Wilson, M.D.


Founded in 1855 as the nation’s first pediatric hospital, The Children’s Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by U.S.News & World Report and Child magazine. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 381-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19. Children’s Hospital operates the largest pediatric healthcare system in the U.S. with more than 40 locations in Pennsylvania, New Jersey and Delaware.

John Ascenzi | EurekAlert!
Further information:
http://www.chop.edu/

More articles from Health and Medicine:

nachricht Penn vet research identifies new target for taming Ebola
12.01.2017 | University of Pennsylvania

nachricht The strange double life of Dab2
10.01.2017 | University of Miami Miller School of Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

Im Focus: How to inflate a hardened concrete shell with a weight of 80 t

At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).

Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...

Im Focus: Bacterial Pac Man molecule snaps at sugar

Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.

The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

Nothing will happen without batteries making it happen!

05.01.2017 | Event News

 
Latest News

Water - as the underlying driver of the Earth’s carbon cycle

17.01.2017 | Earth Sciences

Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

17.01.2017 | Materials Sciences

Smart homes will “LISTEN” to your voice

17.01.2017 | Architecture and Construction

VideoLinks
B2B-VideoLinks
More VideoLinks >>>