D Diehl1, F Belke1, T Kohl2,3, R Axt-Fliedner2, J Degenhardt2, A Khaleeva2, F Oehmke2, D Faas4, H Ehrhardt4, M Kolodziej5, E Uhl5, A C Windhorst6, B A Neubauer1. 1. Department of Pediatric Neurology, University Hospital Giessen-Marburg, Giessen, Germany. 2. Department of Gynecology and Obstetrics, Justus-Liebig-University Giessen, Giessen, Germany. 3. German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), University of Mannheim (UMM), Mannheim, Germany. 4. Department of Pediatrics and Neonatology, Justus-Liebig-University Giessen, Giessen, Germany. 5. Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany. 6. Institute of Medical Informatics, Justus-Liebig-University Giessen, Giessen, Germany.
Abstract
OBJECTIVE: This observational study reports on the postnatal mortality and 30-month outcome of children who underwent fully percutaneous fetoscopic repair of myelomeningocele (MMC) at a single center in Giessen, Germany. METHODS: Between October 2010 and August 2014, a total of 72 patients underwent fully percutaneous fetoscopic MMC closure at 21 + 0 to 29 + 1 (mean, 23 + 5) weeks' gestation. Of these, 52 (72%) participated in this study; however, 30-month mortality data are available for all 72 children. Children were examined at four timepoints: shortly after birth and at 3 months, 12 months and 30 months of corrected age. The patients underwent age-specific standardized neurological examinations and assessment of leg movements and ambulation at all timepoints. Cognitive and motor development were assessed using the Bayley Scales of Infant Development, second edition (BSID-II), at 30 months. RESULTS: All 72 children survived the intrauterine procedure, however, four (5.6%) infants died postnatally (including two of the 52 comprising the study cohort). Of the 52 patients included in the study, 11.5% were delivered before the 30th week of gestation (mean, 33 + 1 weeks) and, of the survivors, 48.1% had ventriculoperitoneal shunt placement. Of the 50 infants that were alive at 30 months, independent ambulation, without orthosis, was feasible for 46%. At 30 months of follow-up, 46% of children presented with a functional level that was at least two segments better than the anatomical level of the lesion. At 30 months, 70% of the children presented with BSID-II psychomotor development index score of ≥ 70 and 80% with BSID-II mental development index score of ≥ 70. CONCLUSION: Intrauterine repair of MMC by percutaneous fetoscopy shows largely similar outcomes to those reported for open repair, with respect to mortality, prematurity, shunt-placement rates, motor and mental development and free ambulation.
OBJECTIVE: This observational study reports on the postnatal mortality and 30-month outcome of children who underwent fully percutaneous fetoscopic repair of myelomeningocele (MMC) at a single center in Giessen, Germany. METHODS: Between October 2010 and August 2014, a total of 72 patients underwent fully percutaneous fetoscopic MMC closure at 21 + 0 to 29 + 1 (mean, 23 + 5) weeks' gestation. Of these, 52 (72%) participated in this study; however, 30-month mortality data are available for all 72 children. Children were examined at four timepoints: shortly after birth and at 3 months, 12 months and 30 months of corrected age. The patients underwent age-specific standardized neurological examinations and assessment of leg movements and ambulation at all timepoints. Cognitive and motor development were assessed using the Bayley Scales of Infant Development, second edition (BSID-II), at 30 months. RESULTS: All 72 children survived the intrauterine procedure, however, four (5.6%) infants died postnatally (including two of the 52 comprising the study cohort). Of the 52 patients included in the study, 11.5% were delivered before the 30th week of gestation (mean, 33 + 1 weeks) and, of the survivors, 48.1% had ventriculoperitoneal shunt placement. Of the 50 infants that were alive at 30 months, independent ambulation, without orthosis, was feasible for 46%. At 30 months of follow-up, 46% of children presented with a functional level that was at least two segments better than the anatomical level of the lesion. At 30 months, 70% of the children presented with BSID-II psychomotor development index score of ≥ 70 and 80% with BSID-II mental development index score of ≥ 70. CONCLUSION: Intrauterine repair of MMC by percutaneous fetoscopy shows largely similar outcomes to those reported for open repair, with respect to mortality, prematurity, shunt-placement rates, motor and mental development and free ambulation.
Authors: D A Lapa; R H Chmait; Y Gielchinsky; M Yamamoto; N Persico; M Santorum; M M Gil; L Trigo; R A Quintero; K H Nicolaides Journal: Ultrasound Obstet Gynecol Date: 2021-09-13 Impact factor: 8.678
Authors: E Joanne Verweij; Martine C de Vries; Esther J Oldekamp; Alex J Eggink; Dick Oepkes; Femke Slaghekke; Jochem K H Spoor; Jan A Deprest; Jena L Miller; Ahmet A Baschat; Philip L J DeKoninck Journal: Prenat Diagn Date: 2021-04-05 Impact factor: 3.050