PEDIATRICS Vol. 72 No. 4 October 1983, pp. 450-458
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Early Management and Decision Making for the Treatment of Myelomeningocele

Richard H. Gross MD1, Alan Cox MD1, Ruth Tatyrek MSW1, Michael Pollay MD1, and William A. Barnes MD1

1 From the Departments of Orthopaedic Surgery, Pediatrics, Neurosurgery, and Urology, University of Oklahoma Health Sciences Center, and Department of Social Service, Oklahoma Children's Memorial Hospital, Oklahoma City

A program for early selection and treatment of the infant with myelomeningocele was developed at the University of Oklahoma Health Sciences Center in 1977. Over a 5-year period, 69 babies were evaluated, 36 babies were recommended for early vigorous treatment. Of the 33 babies for whom only supportive care was recommended, five were initially treated at the parents' request, two underwent delayed vigorous treatment, one was subsequently treated by "crisis management," one moved and did not return for follow-up, and 24 received only supportive care. All 24 babies died between 1 to 189 days of age (mean 37 days). The involvement of several physicians and paramedical support personnel is considered essential for this approach of early selection and treatment. Continued support and regular follow-up is necessary for any baby who receives only supportive care. Parents retain legal custody. Although ethical concerns make any approach difficult, the method presented is considered to be the best alternative available at this time.

Key Words: myelomeningocele

Submitted on December 3, 1982
Accepted on January 25, 1983




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