Fetal open spinal dysraphism repair through a mini-hysterotomy: Influence of gestational age at surgery on children's ability to walk.

Autor: Peralta CFA; Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil.; Fetal Medicine Unit, Pro Matre Paulista (Maternity Hospital-Grupo Santa Joana), São Paulo, Brazil.; Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil.; Fetal Medicine Unit, CETRUS-São Paulo Ultrasound Training Center, São Paulo, Brazil., Botelho RD; Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil.; Fetal Medicine Unit, Pro Matre Paulista (Maternity Hospital-Grupo Santa Joana), São Paulo, Brazil.; Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil., Imada V; Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil.; Department of Neurosurgery, Pro Matre Paulista (Maternity Hospital-Grupo Santa Joana), São Paulo, Brazil., Lamis F; Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil.; Department of Neurosurgery, Pro Matre Paulista (Maternity Hospital-Grupo Santa Joana), São Paulo, Brazil., Antunes DRV; Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil., Nani F; Department of Anesthesiology, Pro Matre Paulista (Maternity Hospital-Grupo Santa Joana), São Paulo, Brazil., Balsalobre AGB; Department of Anesthesiology, Pro Matre Paulista (Maternity Hospital-Grupo Santa Joana), São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Prenatal diagnosis [Prenat Diagn] 2021 Dec; Vol. 41 (13), pp. 1634-1642. Date of Electronic Publication: 2021 Oct 26.
DOI: 10.1002/pd.6051
Abstrakt: Objective: To analyze the impact of gestational age (GA) at the time of fetal open spinal dysraphism (OSD) repair through a mini-hysterotomy on the ability of children to walk.
Methods: Children who underwent in utero repair of OSD and had formal neurological assessment after 2.5 years of age were compared regarding their ability to walk in relation to pre-surgical predictors.
Results: Sixty-nine children fulfilled the inclusion criteria. Among them, 63.7% (44/69) were able to walk with or without orthesis. Fetal OSD correction performed earlier in gestation (from 19.7 to 26.9 weeks) was associated with a higher probability of walking with or without orthesis (p = 0.033). The median GA at delivery was 35.3 weeks. Multivariate binary logistic regression showed that the upper anatomical level of the OSD ( L5) (p < 0.004; OR: 10.31 [95% CI: 2.07-51.28]) and GA at the time of fetal surgery (p = 0.026; OR = 0.68 [95% CI: 0.48-0.95]) were independent predictors of the postnatal ability to walk with or without orthesis.
Conclusion: Fetuses with OSD who were operated on earlier in pregnancy (range: 19.7-26.9 weeks), were more likely to walk with or without orthesis.
(© 2021 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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