Abstract

BACKGROUND: Parents faced with the choice between postnatal management versus prenatal surgery for spina bifida need to have up-to-date information on outcomes. The aim of this study is to report the long-term physical and neurological outcomes prenatally diagnosed spina bifida managed by a multidisciplinary team from a large tertiary centre. METHODS: A retrospective cohort study of all cases fetal spina bifida managed in a tertiary unit between October 1999 and January 2018. All cases of fetal spina bifida from the local health region were routinely referred to the tertiary unit for further perinatal management. Details on surgical procedures and neonatal neurological outcomes were obtained from institutional case records. RESULTS: During the study period, 241 fetuses with isolated spina bifida were seen in the unit, with 84 (34.9%) women opting to continue with the pregnancy after counselling by multidisciplinary clinicians. After birth, hind brain herniation was observed in 91.5% with only 7 infants requiring surgical decompression. Ventriculo-peritoneal shunt insertion was needed in 64.2% of infants who demonstrated normal or mild cognitive impairment in 85.4% of cases at a mean age of 8yrs. Cumulatively, 40% of infants were walking independently or using minor support and reported normal or mild impairment of bladder or bowel function in 45.4% and 44.5% of infants, respectively. CONCLUSIONS: Neurodevelopmental and neurological outcomes between prenatal versus postnatal repair are similar. As with fetal surgery, conventional postnatal surgery is associated with the reversal of hind brain herniation. Similarly, postnatal ventriculoperitoneal shunts appear to be mainly required in fetuses without evidence of significant fetal ventriculomegaly. This article is protected by copyright. All rights reserved.