MADRID, 9 Feb. (EUROPA PRESS) –
New findings show that fetal surgery to repair spina bifida adds to a growing body of research claiming the benefits of prenatal spinal repair and conferring physical improvements that extend into infancy, researchers report in the journal ‘JAMA Pediatrics’.
Researchers found that children who had undergone fetal surgery for myelomeningocele, the most serious form of spina bifida, were more likely than those who received postnatal repair to walk independently, go up and down stairs, and perform care tasks personal such as using a fork, washing hands, and brushing teeth. They also had stronger leg muscles and walked faster than children who had spina bifida surgery after birth.
“This study shows that the benefits of fetal surgery for spina bifida extend beyond early childhood and into the first decade of a child’s life,” notes N. Scott Adzick, chief surgeon at Children’s Hospital of Philadelphia ( CHOP), director of CHOP’s Center for Fetal Diagnosis and Treatment and a co-author of the study.
“This is especially important because of concerns raised earlier that the benefits of fetal surgery may diminish over time,” he continues. “Contrary to those concerns, there appears to be a long-term benefit of neural protection in utero.” .
Spina bifida is a birth defect that occurs when an area of the spine does not form properly, leaving a section of the spinal cord and spinal nerves exposed through an opening in the back. The condition often produces weakness or paralysis below the defect location, leading to the inability to walk without assistance and loss of bladder and bowel control in many children.
To assess the long-term physical outcomes of patients who underwent fetal surgery for spina bifida, the researchers evaluated participants from the landmark ‘Management of Myelomeningocele Study’ (MOMS), which was co-led by researchers from CHOP, Vanderbilt University Medical Center and the University of California, along with the data coordination center at the George Washington University Center for Biostatistics and published in 2011 in the ‘New England Journal of Medicine’.
That study compared the outcomes of traditional prenatal and postnatal myelomeningocele repair at 12 and 30 months and showed that prenatal repair can offer significant benefits. Babies with spina bifida who had fetal surgery were less likely to need a shunt for the buildup of cerebrospinal fluid in the brain. They were also able to walk better two and a half years after surgery than those operated on after birth and had better motor function overall.
Researchers studied nearly all MOMS children when they were of school age, and in 2020 they published the overall results of MOMS2: Pediatric Myelomeningocele Management Study Follow-up.
Focusing primarily on neurocognitive outcomes and motor skills, the researchers found that up to ten years after surgery, children who had received prenatal repair showed better gross and fine motor skills. They also continued to need fewer referrals, surgeries, and catheterizations and reported a better quality of life.
In separate analyzes, they demonstrated better control over bladder and bowel movements. Children who underwent fetal surgery were almost six times more likely to go to the bathroom alone than those who had surgery after birth.
In MOMS2, the researchers evaluated the children at a comprehensive study visit when the child was between 5 and 10 years old. The children underwent a physical examination and an assessment of the functioning of motor, self-care and recreational skills.
Patients were assessed for physical abilities, such as being able to sit upright independently and, for those who could walk, being able to perform skills such as jumping, going up and down stairs, and standing on one foot.
Of the 183 families enrolled in the MOMS trial, 154 children received the physical functioning assessment as part of MOMS2. Those in the fetal surgery group performed a higher percentage of age-appropriate self-care skills (90.8%) compared to children in the postpartum repair group (85.5%) and were better able to complete tasks such as using a fork, brush teeth, and wash and dry hands.
Children who underwent fetal surgery were also 70% more likely to walk independently, at higher speeds and with a better walking style, and were more adept at advanced motor skills such as going up and down stairs compared to children in the postnatal repair group.
Those in the fetal surgery group were also more than twice as likely to walk without leg braces compared to children in the postnatal repair group.
“These data are important in demonstrating that fetal surgery for spina bifida improves mobility well into school age, but the implications of these results are even more profound,” notes first author Amy J. Houtrow of the Division of Chief Pediatric Rehabilitation Medicine at UPMC Children’s Hospital in Pittsburgh.
“When children can move independently and interact with their peers, it dramatically changes the way they relate to the world. Better mobility facilitates socialization and improves their overall quality of life,” he emphasizes. more independence with self-care skills at school age means they are more likely to be independent as adults. “
As a pioneer in the field, CHOP began performing fetal surgery for spina bifida in 1998, three years after CHOP launched the Center for Fetal Diagnosis and Treatment. Since then, the Center has continued to improve the technique and publish on the practice, leading to significant advances.
“When we began performing fetal surgery more than two decades ago, we did so in the hope that the procedure would improve the lives of children and their families,” recalls Dr. Adzick. “As we continue to improve the technique, shortening the times of surgery and increasing gestational age at birth, we are encouraged by these results, which show the lasting benefits of fetal surgery. “
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