Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients
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Publication Date: | 2022 |
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Format: | Article |
Language: | eng |
Source: | Revista brasileira de ginecologia e obstetrícia (Online) |
Download full: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032022000300238 |
Summary: | Abstract Objective To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair. Methods Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic’s medical records. Children were included if they had ≥1 year of postoperative follow-up andmet the criteria for fetal surgery. The children’s data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure. Results Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations. Conclusion Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting. |
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Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patientsmeningomyelocelefetal surgerymyelomeningocelecerebrospinal fluid shuntsspinal dysraphismAbstract Objective To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair. Methods Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic’s medical records. Children were included if they had ≥1 year of postoperative follow-up andmet the criteria for fetal surgery. The children’s data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure. Results Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations. Conclusion Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting.Federação Brasileira das Sociedades de Ginecologia e Obstetrícia2022-03-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032022000300238Revista Brasileira de Ginecologia e Obstetrícia v.44 n.3 2022reponame:Revista brasileira de ginecologia e obstetrícia (Online)instname:Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO)instacron:FEBRASGO10.1055/s-0042-1742404info:eu-repo/semantics/openAccessPeixoto-Filho,Fernando MaiaCervante,Tatiana ProtzenkoBellas,Antonio RosaGomes Junior,Saint ClairLapa,Denise AraújoAcácio,Gregório LorenzoCarvalho,Paulo Roberto Nassar deSá,Renato Augusto Moreira deeng2022-06-23T00:00:00Zoai:scielo:S0100-72032022000300238Revistahttp://www.scielo.br/rbgohttps://old.scielo.br/oai/scielo-oai.phppublicações@febrasgo.org.br||rbgo@fmrp.usp.br1806-93390100-7203opendoar:2022-06-23T00:00Revista brasileira de ginecologia e obstetrícia (Online) - Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO)false |
dc.title.none.fl_str_mv |
Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients |
title |
Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients |
spellingShingle |
Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients Peixoto-Filho,Fernando Maia meningomyelocele fetal surgery myelomeningocele cerebrospinal fluid shunts spinal dysraphism |
title_short |
Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients |
title_full |
Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients |
title_fullStr |
Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients |
title_full_unstemmed |
Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients |
title_sort |
Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients |
author |
Peixoto-Filho,Fernando Maia |
author_facet |
Peixoto-Filho,Fernando Maia Cervante,Tatiana Protzenko Bellas,Antonio Rosa Gomes Junior,Saint Clair Lapa,Denise Araújo Acácio,Gregório Lorenzo Carvalho,Paulo Roberto Nassar de Sá,Renato Augusto Moreira de |
author_role |
author |
author2 |
Cervante,Tatiana Protzenko Bellas,Antonio Rosa Gomes Junior,Saint Clair Lapa,Denise Araújo Acácio,Gregório Lorenzo Carvalho,Paulo Roberto Nassar de Sá,Renato Augusto Moreira de |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Peixoto-Filho,Fernando Maia Cervante,Tatiana Protzenko Bellas,Antonio Rosa Gomes Junior,Saint Clair Lapa,Denise Araújo Acácio,Gregório Lorenzo Carvalho,Paulo Roberto Nassar de Sá,Renato Augusto Moreira de |
dc.subject.por.fl_str_mv |
meningomyelocele fetal surgery myelomeningocele cerebrospinal fluid shunts spinal dysraphism |
topic |
meningomyelocele fetal surgery myelomeningocele cerebrospinal fluid shunts spinal dysraphism |
description |
Abstract Objective To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair. Methods Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic’s medical records. Children were included if they had ≥1 year of postoperative follow-up andmet the criteria for fetal surgery. The children’s data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure. Results Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations. Conclusion Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-03-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032022000300238 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032022000300238 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1055/s-0042-1742404 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia |
publisher.none.fl_str_mv |
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia |
dc.source.none.fl_str_mv |
Revista Brasileira de Ginecologia e Obstetrícia v.44 n.3 2022 reponame:Revista brasileira de ginecologia e obstetrícia (Online) instname:Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO) instacron:FEBRASGO |
instname_str |
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO) |
instacron_str |
FEBRASGO |
institution |
FEBRASGO |
reponame_str |
Revista brasileira de ginecologia e obstetrícia (Online) |
collection |
Revista brasileira de ginecologia e obstetrícia (Online) |
repository.name.fl_str_mv |
Revista brasileira de ginecologia e obstetrícia (Online) - Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO) |
repository.mail.fl_str_mv |
publicações@febrasgo.org.br||rbgo@fmrp.usp.br |
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1754115946149052416 |