Introduction: Newborns with a myelomeningocele are often brought to the operating room for surgical repair within the first few days of life. Wound infection in this population may represent a devastating outcome in the immature nervous system. No studies have evaluated infection as a function of surgical timing at a national level. We hypothesized an increase in wound infection in those patients with delays in myelomeningocele repair when evaluated from a national database.
Methods: Newborns with myelomeningocele and time to repair were obtained from non-overlapping abstracts of the 2000-2010 Kids Inpatient Database (KID) and Nationwide Inpatient Sample (NIS). Poisson multivariable regression analyses assessed the effect of time to repair on infection and routine discharge rates. Secondary outcomes of interest assessed predictive factors of > 2 days until repair. Local treatment outcomes and times to transfer were evaluated at Children’s Hospital of Los Angeles (CHLA) for comparison for the years 2004 to 2014.
Results: We identified 3,775 cases of repaired myelomeningocele with 19% of patients receiving repair after 2 or more days. Infection was noted in 681 (18%) patients. There was no significant difference in rates of infection between same day and one-day wait times (p =0.22). Wait times of two (RR=1.65,[1.23, 2.22],p<0.01) or more days (RR=1.88,[1.39, 2.54],p<0.01) experienced a 65% increase in rates of infection compared to same day procedures. Prolonged wait time was 32% less likely at facilities with increased myelomeningocele repair volume (RR=0.68,[0.56 0.83],p<0.01). CHLA identified 95 cases of myelomeningocele repair, with an median time from birth to treatment of 1 day. Six (6%) cases were noted to have inpatient wound breakdown or infection.
Conclusions: Myelomeningocele repair, when delayed more than one day after birth, is associated with increased rates of infection. High volume centers are associated with fewer delays in procedure. Though constrained by limitations of a national coded database, results suggest appropriate attention to timely myelomeningocele repair to decrease infection rate.
Patient Care: Illumination of factors contributing to infections in the open neural tube defect cohort
Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the importance of time to myelomeningocele repair upon subsequent infection, 2) Discuss, in small groups, risk factors for infection in this cohort, and 3) Identify effective methods to prevent infections in this population.