Introduction: Myelomeningocele (MMC) is the most common neural tube defect and is the most severe birth defect compatible with survival. The incidence of MMC in western countries is approximately 1:10,000 births. MMC is characterized by a cleft in the vertebral column with a corresponding skin defect leading to exposed meninges and spinal cord. Severe motor and sensory deficits are common. Lack of folate consumption during pregnancy is a known risk factor. Surgical repair of MMC is usually performed during the first days of life. 90% of newborns with MMC will have enlarged ventricles, requiring CSF diversion procedures in most cases. Shunt infection rates are high in this population – 50% versus 5%-15% among other shunt dependent patients.
Methods: Retrospective analysis of the MMC population born in southern Israel between the years 2000-2014.
Results: 44 infants were born with MMC, out of 184,918 total births. The calculated incidence was 2.38:10,000 births. 41 patients (93.2%) belong to the Bedouin community, a subgroup within the Arab minority in Israel. In 37 cases surgical repair of the MMC was performed, after 2.9 days from birth. 7 infants were not operated due to their parents' decision, with average survival of 5.14 days. In 27 cases ventriculo-peritoneal shunt was inserted, after average period of 50.5 days since birth. Shunt infection was noted in 10 cases (37%) after mean time of 61.3 days from shunt insertion. Additional surgical interventions included revision of surgical wound in 3 cases, cord untethering in 3 cases and shunt revision in 5 cases. Mortality rate was 5.4% (2 patients).
Conclusions: The incidence of MMC in southern Israel is high, especially among minorities. Therefore, a better patient education program and preterm surveillance are required. The high survival rates emphasize the need for appropriate network of care for these patients.
Patient Care: Analysis and stratification of the southern Israel MMC population may assist in raising awareness to the consequences of this birth defect, improving patient education program as well as preterm surveillance and help establishing an appropriate network of care for these patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the epidemiology and pathophysiology of myelomenigocele 2) Discuss, in small groups, surgical and ethical issues regarding this pathology 3) Discuss the importance of patient education and preterm surveillance.