Factors associated with the timeliness of postnatal surgical repair of spina bifida
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Factors associated with the timeliness of postnatal surgical repair of spina bifida

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  • Alternative Title:
    Childs Nerv Syst
  • Personal Author:
  • Description:
    Purpose

    Clinical guidelines recommend repair of open spina bifida (SB) prenatally or within the first days of an infant’s life. We examined maternal, infant, and health care system factors associated with time-to-repair among infants with postnatal repair.

    Methods

    This retrospective, statewide, population-based study examined infants with SB born in Florida 1998–2007, ascertained by the Florida Birth Defects Registry. We used procedure codes from hospital discharge records to identify the first recorded myelomeningocele repair (ICD-9 CM procedure code 03.52) among infants with birth hospitalizations. Using Poisson multivariable regression, we examined time-to-repair by hydrocephalus, SB type (isolated [no other coded major birth defect] versus non-isolated), and other selected factors.

    Results

    Of 199 infants with a recorded birth hospitalization and coded myelomeningocele repair, 87.9 % had hydrocephalus and 19.6 % had non-isolated SB. About 76.4 % of infants had repair by day 2 of life. In adjusted analyses, infants with hydrocephalus were more likely to have timely repair (adjusted prevalence ratio (aPR) = 1.48, 95 % confidence interval (CI) 1.02–2.14) than infants without hydrocephalus. SB type was not associated with repair timing. Infants born in lower level nursery care hospitals with were less likely to have timely repairs (aPR = 0.71, 95 % CI 0.52–0.98) than those born in higher level nursery care hospitals.

    Conclusions

    Most infants with SB had surgical repair in the first 2 days of life. Lower level birth hospital nursery care was associated with later repairs. Prenatal diagnosis can facilitate planning for a birth hospital with higher level of nursery care, thus improving opportunities for timely repair.

  • Subjects:
  • Source:
    Childs Nerv Syst. 32(8):1479-1487.
  • Pubmed ID:
    27179533
  • Pubmed Central ID:
    PMC5007061
  • Document Type:
    Journal Article
  • Funding:
    CC999999/Intramural CDC HHS/United States
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