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Children's Hospital of Philadelphia reports on 100 recent fetal surgeries for spina bifida
Date:8/26/2014

indbrain herniation), and improved the children's outcomes, including their ability to walk at 30 months of age.

CHOP's center was one of the three fetal surgery programs that participated in the randomized MOMS trial, and has been performing fetal myelomeningocele (fMMC) repairs since 1998. In total, CHOP has performed over 1,175 fetal surgeries for a range of birth defects, the largest number of any hospital in the world.

The current study draws on a cohort from all patients referred to CHOP for potential fMMC repair between January 2011 and March 2014. Of 587 total referrals, the program designated 139 to be candidates for the fetal surgery, and 100 mothers completed the surgery.

The mothers' average age, race or ethnic group and body mass index were very similar between the MOMS patients and the current cohort. The two groups also had similar rates of preterm labor and membrane separation--two complications of the fetal surgery.

The current cohort had a decreased incidence of preterm premature rupture of membranes (PPROM) compared to the MOMS group: 32 percent compared to 46 percent. The average operative times were also significantly shorter (78.5 minutes vs. 105 minutes), which may reflect the experience and improved efficiency of the operative team. There was also a decreased incidence of pulmonary edema (2 percent vs. 6 percent), which the study team said may be attributable to their practice modifications such as guidelines for fluid intake. One other improved measure in the CHOP cohort was a decrease in the transfusion rate at the time of cesarean delivery (3 percent compared to 9 percent in the MOMS trial), possibly due to modified techniques and the care team's depth of experience.

Early neonatal MRIs showed that 71 percent of the infants had no evidence of hindbrain herniation, in which part of the cerebellum (hindbrain) protrudes through the opening in the base of the skull into the spinal canal and obstru
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Contact: Ashley Moore
moorea1@email.chop.edu
267-426-6071
Children's Hospital of Philadelphia
Source:Eurekalert

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