Fetal Surgery Decreases Severity of Brain Defects Among Infants With Spina Bifida
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But the researchers were troubled by some of their findings. Those undergoing fetal surgery were born premature, on average, at 33 weeks. Those without the fetal surgery were born at term, on average at 37 weeks. Fifty percent of the women who underwent surgery had to be hospitalized for preterm labor, compared with 9% who did not have surgery.
The Vanderbilt babies, on average, showed levels of paralysis equal to what was expected without surgery, based on the location of the spinal defect, a finding Noel Tulipan, MD, a pediatric neurologist at Vanderbilt University Medical Center, termed "disappointing." Tulipan, a co-researcher on one of the studies, adds, "The benefit [of surgery] is the reduction of shunt dependence and Chiari malformation [a type of brain defect]."
Whether the babies possess developmental problems is "completely unknown," Tulipan says. The oldest child, who is 2 1/2 years old, "is doing well and seems to have normal intelligence," he says. None of the babies were tested during a return visit to Vanderbilt last spring because they were considered too young. "There were none that were obviously terrible, but we are talking about babies who are on average about 6 months old. We are a long way off before we can present significant data" on their progress.
The Philadelphia group reported on 10 surgeries performed from March 1998 to February 1999. One fetus was born at 25 weeks and died. Of the nine survivors, three were delivered earlier than planned -- at 30 or 31 weeks -- while the remaining six were delivered by cesarean section at 36 or 37 weeks. Four have some paralysis in both legs or feet, two have problems with one leg only, and two appear to have no paralysis. Seven have remained without a shunt; two needed to have a shunt inserted.
"If you can eliminate the need for a shunt, that is a tremendous thing," Sutton says. "It is a lifelong thing. Some will have 30 to 40 surgeries," because shunts malfunction over time, and the shunt site can become infected.