Background: The optimal time to closure of a newborn with a myelomeningocele has been the focus of a number of evaluations. The Timing of primary surgery has received significant attention due to its relationship to repair-site infection that can lead to increased morbidity and prolonged hospital stays. It is on this basis that recommendations have utilized 48 - 72 hours post birth as ideal time of closure. This is not only prevent infection at the site but also prevent ventriculitis and neural structure damage. We therefore, hypothesized an increase in wound infection rates in those patients with delays in myelomeningocele repair. Methods: We retrospectively reviewed the records of 103 children with myelomeningocele treated between 2016 and 2023. At discharge the patients were followed up at the post-operative clinic visit 2 weeks later. Children were assigned to 1 of 2 groups, those who underwent primary neurosurgical repair within 72 hours of delivery (Group 1) and those undergoing repair after 72 hours (Group 2). We compared the infection rates. Results: 103 children who underwent myelomeningocele repair were identified, with a median time from birth to treatment of 1 day. Eight (7.8 %) patients were noted to have post-repair surgical site complications. There was no significant difference in rates of infection between Group 1 and Group 2 repair times. The presence of infection was associated increased length of stay when compared to neonates without infection. Conclusion: In children with myelomeningocele, the timing of primary neurosurgical repair appears not to have a significant impact on surgical site infection. Closure of the spinal lesion within the first 72 hours of life may be more favorable for neural damage prevention. These results suggest that early myelomeningocele repair may not impart significantly on the rate of wound-site infection.
References
[1]
Schroeder, H.K., Nunes, J.C., Madeira, L., Moritz, J.L.W., Walz, R. and Linhares, M.N. (2012) Postsurgical Infection after Myelomeningocele Repair: A Multivariate Analysis of 60 Consecutive Cases. Clinical Neurology and Neurosurgery, 114, 981-985. https://doi.org/10.1016/j.clineuro.2012.02.034
[2]
Finger, T., Schaumann, A., Pennacchietti, V., Bührer, C., Thomale, U.W. and Schulz, M. (2021) Reduced Rates of Infection after Myelomeningocele Closure Associated with Standard Perioperative Antibiotic Treatment with Ampicillin and Gentamicin. Child’s Nervous System, 37, 545-553. https://doi.org/10.1007/s00381-020-04832-y
[3]
Oncel, M.Y., Ozdemir, R., Kahilogullari, G., Yurttutan, S., Erdeve, O. and Dilmen, U. (2012) The Effect of Surgery Time on Prognosis in Newborns with Meningomyelocele. J Korean Neurosurg Soc., 51, 359-362. https://doi.org/10.3340/jkns.2012.51.6.359
Maugeri, R., Graziano, F., Basile, L., Gulì, C., Giugno, A., Giammalva, G.R., et al. (2017) Trends in Reconstructive Neurosurgery. Springer, Cham, 124 p. http://link.springer.com/10.1007/978-3-319-39546-3
[6]
Attenello, F.J., Tuchman, A., Christian, E.A., Wen, T., Chang, K.E., Nallapa, S., et al. (2016) Infection Rate Correlated with Time to Repair of Open Neural Tube Defects (Myelomeningoceles): An Institutional and National Study. Child’s Nervous System, 32, 1675-1681. https://doi.org/10.1007/s00381-016-3165-4
[7]
Smyth, B.T., Piggot, J., Forsythe, W.I. and Merrett, J.D. (1974) A Controlled Trial of Immediate and Delayed Closure of Myelomeningocele. The Journal of Bone & Joint, 56-B, 297-304. https://doi.org/10.1302/0301-620X.56B2.297
[8]
Tarcan, T., Önol, F.F., Ilker, Y., Alpay, H., Şimşěk, F. and Özek, M. (2006) The Timing of Primary Neurosurgical Repair Significantly Affects Neurogenic Bladder Prognosis in Children with Myelomeningocele. Journal of Urology, 176, 1161-1165. https://doi.org/10.1016/j.juro.2006.04.042
[9]
Wakoya, R. and Afework, M. (2023) Burden of Neural Tube Defects and Their Associated Factors in Africa: A Systematic Review and Meta-Analysis. International Journal of Pediatrics, 2023, Article ID: 9635827. https://doi.org/10.1155/2023/9635827
[10]
Onyia, E., Chikani, M., Mezue, W., Uche, E., Iloabachie, I., Matthew, M., et al. (2018) Myelomeningocele in Nigeria: Has There Been any Change with Improved Neurosurgery Care? International Journal of Sciences: Basic and Applied Research, 32, 64-74.
[11]
Kural, C., Solmaz, I., Tehli, O., Temiz, C., Kutlay, M., Daneyemez, M.K. and Izci, Y. (2015) Evaluation and Management of Lumbosacral Myelomeningoceles in Children. The Eurasian Journal of Medicine, 47, 174-178. https://doi.org/10.5152/eurasianjmed.2015.138
[12]
Sogoba, Y., Diallo, S., Amadou, I., Sogoba, B., Diallo, M., Kamaté, B., Mariko, D., Oumar, C., Kisito, Q., Diall, H., Diakité, L., Diallo, S., Maiga, B., Traoré, F., Sacko, K., Diallo, O., Kanikomo, D. and Maiga, Y. (2021) Demographic and Clinical Characteristics of 63 Children with Myelomeningoceles. Open Journal of Modern Neurosurgery, 11, 59-64. https://doi.org/10.4236/ojmn.2021.112007
[13]
Reynolds, R.A., Bhebhe, A., Garcia, R.M., Chen, H., Bonfield, C.M., Lam, S., Sichizya, K. and Shannon, C. (2021) Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia. World Neurosurgery, 145, e332-9. https://doi.org/10.1016/j.wneu.2020.10.069
[14]
Gohar, R., Rehman, L., Bokhari, I., Ahmed, T., Ahmed, S. and Mumtaz, D. (2023) Incidence of Post-Operative Cerebrospinal Fluid Leak in Patients Operated for Spinal Dysraphism. Pakistan Journal of Neurological Surgery, 27, 187-192.
[15]
Daibu, U., Koko, A.M. and Usman, B. (2023) Post-Operative Cerebrospinal Fluid Leak: Single-Continuous versus Double-Breasted Dural Repair of Myelomeningocele. Egyptian Journal of Neurosurgery, 38, Article No. 55. https://doi.org/10.1186/s41984-023-00240-x
[16]
Lobo, G.J. and Nayak, M.V.-Y. (2018) Plasty or Primary Repair Closure of Myelomeningocele: Our Experience. Journal of Pediatric Neurosciences, 13, 398-403. https://doi.org/10.4103/JPN.JPN_40_18
[17]
Shehu, B.B., Ameh, E.A. and Ismail, N.J. (2000) Spina Bifida Cystica: Selective Management in Zaria, Nigeria. Annals of Tropical Paediatrics, 20, 239-242. https://doi.org/10.1080/02724936.2000.11748142
[18]
Khan, M.I., Ullah, W., Ishfaq, M., Khan, B.Z. and Ali, M. (2016) Short Term Complications of Myelomeningocele Repair. An experience in Neurosurgery Department Lady Reading Hospital Peshawar. Pakistan Journal of Neurological Surgery, 20, 94-99.
[19]
James, H.E. and Lubinsky, G. (2005) Terminal Myelocystocele. Journal of Neurosurgery, 103, 443-445. https://doi.org/10.3171/ped.2005.103.5.0443
[20]
Rab, A. (2013) Prenatal Diagnosis and Further Clinical Characteristics of Spina Bifida. Asian Pacific Journal of Reproduction, 2, 52-57. https://doi.org/10.1016/S2305-0500(13)60117-7
[21]
Alatise, O.I., Adeolu, A.A., Komolafe, E.O., Adejuyigbe, O. and Sowande, O.A. (2006) Pattern and Factors Affecting Management Outcome of Spina Bifida Cystica in Ile-Ife, Nigeria. Pediatric Neurosurgery, 42, 277-283. https://doi.org/10.1159/000094062
[22]
Oludele Adebayo, B. (2023) Hydrocephalus Associated with Myelomeningocele. Frontiers in Hydrocephalus. IntechOpen. https://doi.org/10.5772/intechopen.110535
[23]
Cherian, J., Staggers, K.A., Pan, I.W., Lopresti, M., Jea, A. and Lam, S. (2016) Thirty-Day Outcomes after Postnatal Myelomeningocele Repair: A National Surgical Quality Improvement Program Pediatric Database Analysis. Journal of Neurosurgery: Pediatrics, 18, 416-422. https://doi.org/10.3171/2016.1.PEDS15674
