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Erschienen in: Child's Nervous System 4/2018

13.12.2017 | Original Paper

Trends in incidence and long-term outcomes of myelomeningocele in British Columbia

verfasst von: Taylor North, Alexander Cheong, Paul Steinbok, Julia AE Radic

Erschienen in: Child's Nervous System | Ausgabe 4/2018

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Abstract

Purpose

Myelomeningocele is typically a disabling condition that results in neurologic, orthopedic, and urologic morbidity. The aim of this study was to examine the trends over time in both incidence and outcomes of myelomeningocele (MMC) in British Columbia (BC).

Methods

A retrospective chart review was performed of all children with MMC followed in the British Columbia Children’s Hospital (BCCH) Spinal Cord Clinic between 1971 and 2016. The incidence of new MMC cases and the long-term outcomes of MMC were compared between two 10-year cohorts. The first cohort comprised children born with MMC between 1971 and 1981, and the second cohort comprised children born with MMC between 1996 and 2006.

Results

A total of 309 children with MMC were followed in the BCCH Spinal Cord Clinic between 1971 and 2016. There were 101 and 46 children with MMC in the two-time cohorts, respectively. Between the earlier and later cohorts, there was a significant difference in the following: MMC incidence [2.5/10,000 births vs 1.1/10,000 births, respectively (p = 0.0002)], mortality [18 vs 0% (p = 0.0009)], and the proportion of cases repaired in under 48 h [56 vs 98% (p < 0.0001)]. For surviving children, the proportion of children attending special classes was significantly different between the earlier and later cohorts [16 vs 46%, respectively (p = 0.0002)], whereas all other outcome measures, including the proportion with hydrocephalus, kyphoscoliosis, Chiari II surgery, bowel and bladder continence, recreation participation, obesity, and ambulation, were not significantly different.

Conclusions

In BC, the incidence of new cases of MMC has decreased between 1971 and 2016, while the probability of survival for these patients has increased. Despite earlier and more universal post-natal repair, long-term outcomes have not improved significantly over time. Future research should focus on developing ways of reducing disability and improving quality of life for MMC patients and their families.
Literatur
2.
Zurück zum Zitat Boulet SL, Yang Q, Mai C, Kirby RS, Collins JS, Robbins JM, Meyer R, Canfield MA, Mulinare J, National Birth Defects Prevention N (2008) Trends in the postfortification prevalence of spina bifida and anencephaly in the United States. Birth Defects Res A Clin Mol Teratol 82:527–532CrossRefPubMed Boulet SL, Yang Q, Mai C, Kirby RS, Collins JS, Robbins JM, Meyer R, Canfield MA, Mulinare J, National Birth Defects Prevention N (2008) Trends in the postfortification prevalence of spina bifida and anencephaly in the United States. Birth Defects Res A Clin Mol Teratol 82:527–532CrossRefPubMed
3.
Zurück zum Zitat Centers for Disease C, Prevention (2009) Racial/ethnic differences in the birth prevalence of spina bifida—United States, 1995–2005. MMWR Morb Mortal Wkly Rep 57:1409–1413 Centers for Disease C, Prevention (2009) Racial/ethnic differences in the birth prevalence of spina bifida—United States, 1995–2005. MMWR Morb Mortal Wkly Rep 57:1409–1413
11.
Zurück zum Zitat De Wals P, Tairou F, Van Allen MI, Lowry RB, Evans JA, Van den Hof MC, Crowley M, SH U, Zimmer P, Sibbald B, Fernandez B, Lee NS, Niyonsenga T (2008) Spina bifida before and after folic acid fortification in Canada. Birth Defects Res A Clin Mol Teratol 82:622–626CrossRefPubMed De Wals P, Tairou F, Van Allen MI, Lowry RB, Evans JA, Van den Hof MC, Crowley M, SH U, Zimmer P, Sibbald B, Fernandez B, Lee NS, Niyonsenga T (2008) Spina bifida before and after folic acid fortification in Canada. Birth Defects Res A Clin Mol Teratol 82:622–626CrossRefPubMed
12.
Zurück zum Zitat Van Allen MI, Boyle E, Thiessen P, McFadden D, Cochrane D, Chambers GK, Langlois S, Stathers P, Irwin B, Cairns E, MacLeod P, Delisle MF, Uh SH (2006) The impact of prenatal diagnosis on neural tube defect (NTD) pregnancy versus birth incidence in British Columbia. J Appl Genet 47(2):151–158. https://doi.org/10.1007/BF03194615 CrossRefPubMed Van Allen MI, Boyle E, Thiessen P, McFadden D, Cochrane D, Chambers GK, Langlois S, Stathers P, Irwin B, Cairns E, MacLeod P, Delisle MF, Uh SH (2006) The impact of prenatal diagnosis on neural tube defect (NTD) pregnancy versus birth incidence in British Columbia. J Appl Genet 47(2):151–158. https://​doi.​org/​10.​1007/​BF03194615 CrossRefPubMed
13.
Zurück zum Zitat Ray JG, Vermeulen MJ, Boss SC, Cole DE (2002) Declining rate of folate insufficiency among adults following increased folic acid food fortification in Canada. Can J Public Health 93(4):249–253PubMed Ray JG, Vermeulen MJ, Boss SC, Cole DE (2002) Declining rate of folate insufficiency among adults following increased folic acid food fortification in Canada. Can J Public Health 93(4):249–253PubMed
14.
Zurück zum Zitat De Wals P, Rusen ID, Lee NS, Morin P, Niyonsenga T (2003) Trend in prevalence of neural tube defects in Quebec. Birth Defects Res A Clin Mol Teratol 67:919–923CrossRefPubMed De Wals P, Rusen ID, Lee NS, Morin P, Niyonsenga T (2003) Trend in prevalence of neural tube defects in Quebec. Birth Defects Res A Clin Mol Teratol 67:919–923CrossRefPubMed
21.
Zurück zum Zitat Antiel RM, Flake AW, Johnson MP, Khalek N, Rintoul NE, Lantos JD, Curlin FA, Tilburt JC, Feudtner C (2017) Specialty-based variation in applying maternal-fetal surgery trial evidence. Fetal Diagn Ther 42:210–217 Antiel RM, Flake AW, Johnson MP, Khalek N, Rintoul NE, Lantos JD, Curlin FA, Tilburt JC, Feudtner C (2017) Specialty-based variation in applying maternal-fetal surgery trial evidence. Fetal Diagn Ther 42:210–217
Metadaten
Titel
Trends in incidence and long-term outcomes of myelomeningocele in British Columbia
verfasst von
Taylor North
Alexander Cheong
Paul Steinbok
Julia AE Radic
Publikationsdatum
13.12.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Child's Nervous System / Ausgabe 4/2018
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-017-3685-6

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