PEDIATRICS Vol. 75 No. 1 January 1985, pp. 58-64
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Management of the Newborn with Myelomeningocele: Time for a Decision-Making Process

Edward B. Charney MD1, Susan C. Weller PhD1, Leslie N. Sutton MD1, Derek A. Bruce MD1, and Luis B. Schut MD1

1 From the Department of Pediatrics, Division of Child Development and Rehabilitation and General Pediatrics, Department of Surgery, Division of Neurosurgery, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia

The relationship between time of surgical intervention and eventual outcome was examined in 110 newborns with myelomeningocele. Numerous earlier reports have cited a significant increase in mortality and morbidity associated with delay of surgery beyond 48 hours. Within the study population of infants, 52 infants (47%) had "early" surgery within the first 48 hours of life, 32 infants (29%) had "delayed" surgery between 3 and 7 days of age, 12 infants (11%) had "late" surgery between 1 week and 10 months of age, and 14 infants (13%) never had surgery by parental decision. Survival rates were similar between those with early, delayed, or late surgery as 92%, 94%, and 100%, respectively, were alive at age 10 months. Also, no significant association existed between time of surgery and development of ventriculitis, developmental delay, or worsening of paralysis. From these observations, it is concluded that there is no urgency in surgical intervention for the initial management of newborns with myelomeningocele. Rather, there is time for comprehensive discussions, counseling, and emotional support for those parents in need of a decision-making process before establishing consent for or against surgical management of their newborn.

Key Words: newborn • myelomeningocele

Submitted on January 23, 1984
Accepted on March 13, 1984




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