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