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Fetal Diagnosis and Therapy, 48(2), 128-133, 2020

Postoperative Ultrasound as a Predictor of Newborn Function and Ambulation after Open Fetal Myelomeningocele Repair

Cara Buskmiller , Chase M. Pribble , Christopher Quinn Buchanan

Author affiliations (2)
  • Department of Obstetrics, Gynecology, and Women’s Health, St. Louis University, St. Louis, MO, USA ROR
  • Department of Obstetrics, Gynecology, and Women's Health, St. Louis University, St. Louis, Missouri, USA.
DOI10.1159/000512046 PMID33333535
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Abstract

Objective

Function of the lower extremities after prenatal myelomeningocele (MMC) repair is best assessed with ambulatory function at 30-36 months of age, but parents often ask about function before this milestone. Lower extremity movement can be assessed by ultrasound (US) and at the newborn exam (NE), but correlation between US, NE, and ambulation is not firmly established.

Methods

This was a retrospective correlation study of fetuses that underwent open prenatal MMC repair at SSM Cardinal Glennon Fetal Care Institute, St. Louis, MO, between January 2011 and June 2017. Movement at the ankles, knees, and hips was assessed by US after open repair on postoperative days (PODs) 0-5 and at 32 weeks gestation. NE was performed by physical therapy or neurosurgery within the first month of life, and pediatric follow-up between 30 and 36 months of age was obtained to document ambulation.

Results

Forty-two fetuses were included. Joint movement seen on US varied by POD: it was present on POD 1 in 7% of fetuses and 62% by POD 5. Degree of ventriculomegaly, lesion level, and lesion length did not have a significant effect on US, NE, or ambulation. Knee movement on POD 3 correlated with knee movement at NE (k = 0.58, p < 0.01), but only later knee movement correlated with ambulation (k = 0.28-0.46, p = 0.01). Hip movement at 32 weeks was the only single joint assessment that correlated with NE and ambulation (k = 0.45 and 0.46, p = 0.03 and 0.01, respectively).

Conclusion

Lower extremity movement increases between POD 1 and POD 5 in fetuses after open fetal MMC repair. Knee and hip movement on US at 32 weeks correlates with ambulation at 30-36 months. These data may inform counseling, and direct therapy and spark prospective investigations.

Topics

Pregnancy > Fetal Surgery > Myelomeningocele RepairPregnancy > Prenatal Diagnosis > Ultrasound AssessmentGeneral OB/GYN > Neonatal Outcomes > Neurodevelopmental Follow-up
fetal myelomeningocele repair postoperative ultrasound ambulation, prenatal spina bifida surgery lower extremity function prediction, open fetal MMC repair newborn motor outcomes, postoperative ultrasound joint movement fetal surgery, knee hip movement correlation ambulation myelomeningocele, prenatal myelomeningocele repair 30 month ambulatory outcomes, fetal surgery lower extremity assessment postoperative day, Buskmiller fetal myelomeningocele repair ultrasound prediction, retrospective correlation study prenatal neural tube defect repair, newborn exam motor function after fetal spina bifida surgery
PMID 33333535 33333535 DOI 10.1159/000512046 10.1159/000512046

Cite this article

Cara Buskmiller, Pribble, C., Buchanan, C. Q., & Fisher, A. (2021). Postoperative Ultrasound as a Predictor of Newborn Function and Ambulation after Open Fetal Myelomeningocele Repair. Fetal diagnosis and therapy, 48(2), 128-133. https://doi.org/10.1159/000512046

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