Fetal repair of spina bifida may lead to better outcomes

Over the past decade, the rise of fetal surgery has allowed many medical concerns discovered before birth to be repaired in utero. Whether prenatal repair leads to better outcomes than standard of care timed repairs has been an open question. An investigation in JAMA Pediatrics looks into whether prenatal repair of myelomeningocele leads to better results than postnatal repair.¹

The investigators recruited the participants of the Management of Myelomeningocele Study for a follow-up randomized clinical trial. The follow-up trial was carried out at the same clinical sites as the initial study. Families who could not travel to one of the sites were given home visits. Trained examiners evaluated each child for self-care skills neurologic function, mobility of the child, and physical characteristics. Outcomes for physical functioning were compared between children who had undergone prenatal repair and those who had postnatal repair.

A total of 152 children who had an average age of 7.4 years were included in the study: 78 had postnatal repair and 76 had prenatal repair. The examiners found that the children who had prenatal repair were more competent with self-care skills when compared to those with a postnatal repair (mean [SD] percentage of maximum FRESNO Scale score, 90.8% [9.6%] vs 85.5% [17.6%]). They were also commonly ambulators per the Modified Hoffer Classification (51.3% prenatal vs 23.1% postnatal; adjusted relative risk [aRR] for sex, 1.70; 95% CI, 1.23-2.34). When given movement tests, the children with prenatal repair were found to have better gait quality (adjusted mean difference for home distances of 5 m, 1.71; 95% CI, 1.14-2.54), perform higher-level mobility skills (adjusted mean difference for motor total, 5.70; 95% CI, 1.97-11.18), and to perform the 10-m walk test 1 second faster (difference in medians, 1.0; 95% CI, 0.3-1.7) than children who had received the standard postnatal repair. Additionally, children with prenatal repairs were less likely to have a motor function level that was worse than their anatomic lesion level (aRR, 0.44; 95% CI, 0.25-0.77).

The investigators found that the benefits of prenatal repair that had been noted in the initial Management of Myelomeningocele Study at age 30 months continued to school age. The findings also continue to confirm that prenatal repair of myelomeningocele leads to better outcomes in children.

Reference

1. Houtrow A, MacPherson C, Jackson-Coty J, et al. Prenatal repair and physical functioning among children with myelomeningocele. JAMA Pediatr. February 8, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.5674