Does the timing of surgery affect short-term prognosis in newborn infants with meningomyelocele?

Abstract

Objective: To investigate the effect of postnatal primary repair surgery time on short-term (first 30 days) prognosis in neonates with meningomyelocele (MMC).Methods: The records of meningomyelocele patients treated at Adana City Training and Research Hospital between June 30, 2015 and August 1, 2019 were retrospectively reviewed. Demographic and clinical characteristics, surgical time, hospitalization and antibiotic duration, complications and associated anomalies were recorded.Results: Data of 41 patients were evaluated. The patients were divided into two groups according to the time of surgery. There were 18 patients in the early surgery (≤3 days) group and 23 patients in the late surgery (>3 days) group. There was no difference between groups in terms of birth weight, gestational week, head circumference, sex and type of delivery (p>0.05). The length of hospitalization was 17.2 ± 8.2 in the early surgery group and 24.8 ± 16.1 in the late surgery group (p>0.05). Antibiotic duration was 11.8 ± 7.6 in the early surgery group and 13.8 ± 10.1 in the late surgery group (p>0.05). There was no difference between the two groups between the average size of the MMC sac (5.4±1.1 vs 6.1±2.3, p>0.05). The number of patients with postoperative complications in early surgery group was 8 (44.4%) and in late surgery group was 7 (30.4%), and the number of patients reoperated in the first 30 days in early surgery group was 5 (27.7%) and in late surgery group was 6 (26.1%). The number of patients requiring ventriculoperitoneal shunt (VPS) was 9 (50%) in the early surgery group and 13 (56.5%) in the late surgery group. Surgical complications minor-major dehiscences, CSF leakage, local infection, meningitis and ventriculitis are not statistically different between the groups (p>0.05).Conclusion: Although postnatal early surgical intervention in MMC positively affects short-term outcomes, short-term prognosis is also determined by the presence of associated anomalies, VPS placement time, and rupture of the sac.