Philadelphia, Pa. – Researchers at The Children’s Hospital of Philadelphia have completed the first study comparing the location on the spine of the birth defect spina bifida with the rate of shunting — the surgical placement of a drainage tube. The research showed that infants with spina bifida are more likely to require a shunt when the birth defect is located higher on the spine. The shunt carries excess spinal fluid away from the child’s brain to prevent a life-threatening buildup of pressure.
The researchers, led by Leslie N. Sutton, M.D., director of Neurosurgery at Children’s Hospital, reported on 297 children at Children’s Hospital who received surgery shortly after birth to close spina bifida lesions. Overall, 81 percent of the infants required shunts. “Our study confirmed the previous widespread impression of neurosurgeons that spina bifida defects closer to the head correspond to a higher incidence of shunting,” said Dr. Sutton. The research is published in the March issue of Pediatrics.
In spina bifida, the most common birth defect of the central nervous system, a developmental failure early in pregnancy leaves an opening in part of the bone and tissue covering the fetus’s spinal cord. Depending on the severity of the defect, the newborn may suffer paralysis, bowel and bladder problems, and fluid pressure on the brain.
Surgery performed on newborns with open spina bifida lesions requires closing tissue over the defect to protect the spinal tissue. However, previous studies have suggested that neurological injury may occur before or during birth. To prevent that injury, physicians at The Center for Fetal Diagnosis and Treatment at The Children’s Hospital of Philadelphia have performed surgery for spina bifida on the fetus prior to birth.
In a previously published study, Dr. Sutton and his colleagues showed that only one of nine surviving patients who underwent fetal spina bifida surgery required a shunt within 6 months of surgery. In contrast, 81 percent of the 297 infants followed in the current study, all of whom had surgery after birth, required shunts. “Our current study provides outcome data that will be important for comparison purposes when a clinical trial evaluates the effectiveness of fetal surgery for spina bifida,” said Dr. Sutton.
In addition to correlating shunt incidence with the level of the spinal defect, the current study also compared the infants’ functional level – their degree of paralysis, with their bony level – the location of the missing vertebra as viewed on X-ray images. The researchers found the two types of measurements generally corresponded with each other except at the lowest level of the spine, the sacral vertebrae, which are at hip level. In these cases, children were more likely to have shunts when lesions were identified by bony level rather than by functional level.
“In addition to helping design a future trial of fetal surgery, our findings provide physicians more information with which to counsel parents of infants with spina bifida about their child’s prognosis,” said Dr. Sutton.
Co-authors of the study with Dr. Sutton, all from Children’s Hospital, are Natalie E. Rintoul, M.D.; Anne M. Hubbard, M.D.; Brian Cohen, Ph.D.; Jeanne Melchionni, R.N.; Patrick S. Pasquariello, M.D.; and N. Scott Adzick, M.D.
Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by a comprehensive Child magazine survey. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 381-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19. For more information, visit http://www.chop.edu.
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