Congenital Heart Disease and Myelomeningocele in the Newborn: Prevalence and Mortality.

Myelomeningocele (MMC) and congenital heart disease (CHD) are independent risk factors for increased morbidity and mortality in the newborn period and each can require significant operations shortly after birth. Few studies have examined the impact of these combined lesions. We sought to examine the incidence of CHD in patients with MMC, and to evaluate length of stay (LOS), hospital charges, and mortality. Using the Texas Inpatient Public Use Data File, ~ 6.9 million newborn records between 1/1999 and 12/2016 were examined. Hospitalizations were classified as MMC without CHD (n = 3054), CHD without MMC (n = 72,266), and MMC with CHD (n = 171). The birth prevalence of CHD with MMC was 0.3/10,000 live hospital births, with 5% of patients with MMC having CHD, and 0.2% of those with CHD having MMC. There was increased LOS in patients with both MMC and CHD (median 15 days, IQR 5-31), compared to CHD without MMC (median 6 days, IQR 2-20) and MMC without CHD (median 8 days, IQR 1-14) and higher total hospital charges (median $95,007, IQR $26,731-$222,660) compared to CHD without MMC (median $27,726, $6463-$118,370) and MMC without CHD (median $40,066, IQR $5744-$97,490). Mortality was significantly higher in patients with MMC and CHD (22.2% compared to 3.1% in MMC without CHD and 4.1% in CHD without MMC). Significance remained when limiting for patients without genetic conditions or additional major birth defects. MMC with CHD in the newborn compared to either CHD or MMC alone is associated with longer LOS, higher charges, and increased mortality.

Review on myelomeningocele management and its current status in Saudi Arabia.

Major approaches have emerged in the field of myelomeningocele (MMC) management. The prevalence of MMC in Kingdom of Saudi Arabia is 0.44-1.46/1000 births. Nine point seven percent of pregnant Saudi women take folic acid before conception; MMC is estimated to result in 1,417,500 Saudi Riyals (SAR) in lifetime costs per patient. Abortion should be performed cautiously in Muslim countries; another option may be the intrauterine foetal surgical repair of MMC, which has better neuromotor outcomes and reduces the need for ventriculoperitoneal shunt, albeit with a higher risk of obstetric complications. Seven years after intrauterine foetal surgery emerged, there is a need to establish this service in Kingdom of Saudi Arabia. A multidisciplinary approach is required for MMC patients; surgical closure should be carried out within 72 hours after birth to reduce the risk of infection. Advancing MMC care allows patients to survive to adulthood, and action must be taken to improve the quality of MMC care in Kingdom of Saudi Arabia.

Evaluating the cost-effectiveness of prenatal surgery for myelomeningocele: a decision analysis.

OBJECTIVE: To determine whether prenatal myelomeningocele repair is a cost-effective strategy compared to postnatal repair. METHODS: Decision-analysis modeling was used to calculate the cumulative costs, effects and incremental cost-effectiveness ratio of prenatal myelomeningocele repair compared with postnatal repair in singleton gestations with a normal karyotype that were identified with myelomeningocele between T1 and S1. The model accounted for costs and quality-adjusted life years (QALYs) in three populations: (1) myelomeningocele patients; (2) mothers carrying myelomeningocele patients; and (3) possible future siblings of these patients. Sensitivity analysis was performed using one-way, two-way and Monte Carlo simulations. RESULTS: Prenatal myelomeningocele repair saves $ 2 066 778 per 100 cases repaired. Additionally, prenatal surgery results in 98 QALYs gained per 100 repairs with 42 fewer neonates requiring shunts and 21 fewer neonates requiring long-term medical care per 100 repairs. However, these benefits are coupled to 26 additional cases of uterine rupture or dehiscence and one additional case of neurologic deficits in future offspring per 100 repairs. Results were robust in sensitivity analysis. CONCLUSION: Prenatal myelomeningocele repair is cost effective and frequently cost saving compared with postnatal myelomeningocele repair despite the increased likelihood of maternal and future pregnancy complications associated with prenatal surgery.

Surgical treatment of myelomeningocele: year 2000 hospitalization, outcome, and cost analysis in the US.

OBJECTIVE: To review cases of surgical repair for myelomeningocele (MMC) using a large inpatient database from the year 2000. MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) database with 7.45 million patient admissions for 2000 was retrospectively studied for the first 5 procedure diagnosis of MMC repair (ICD-9 CM procedure code 0352) and ages of less than 1 year. Eighty-eight patient stays were identified. Patient demographic data, length of stay, immediate disposition at the time of discharge, hospital information, and total cost for the hospitalization were determined. CONCLUSION: Myelomeningocele repair is mostly performed in large teaching institutions in small numbers. The majority gets to go home at discharge. It is surprising to note that only 35% also required VP shunt placement during the same hospitalization.

Costos de atención en pacientes con mielomeningocele en los Institutos de Rehabilitación Infantil Teletón / Attention costs of patients with myelomeningocele in Pediatric Rehabilitation Institutes (Teletón)

Objetivo: Estimar la magnitud y estructura de los costos derivados de las atenciones otorgadas el año 2004 a los niños portadores de mielomeningocele atendidos en los Institutos Teletón de Chile. Pacientes y Métodos: Estudio de costos para el total de 1 376 niños con mielomeningocele atendidos el año 2004; se determinó el número de las prestaciones profesionales, cirugías, silla de ruedas, órtesis, día cama y de apoyo clínico y mediante técnicas contables se calculó sus costos. El costo total por niño/año se obtuvo de la suma del costo anual promedio/niño de cada tipo de atención otorgada, ponderada por cobertura. Resultados: Se atendieron 1 376 niños, 55 por ciento mujeres, 48,3 por ciento de 6 a 13 años, y 67 por ciento del nivel de extrema pobreza. El costo promedio total anual por niño fue de $ 724 418, correspondiendo el 62,4 por ciento a diversas atenciones profesionales del área de la salud. Conclusión: El costo anual promedio de la rehabilitación integral por niño con mielomeningocele en los Institutos Teletón Chile fue de $ 724 418. Esta cifra no contempla costos indirectos ni de atenciones de salud fuera del ámbito de la rehabilitación de otros centros.

A multicentre study of the hospital care of 1500 patients with myelomeningocele.

The purpose of this paper is to describe the medical attention that is given to patients affected by myelomeningocele in Spain. We have used information extracted from the 'Multicentre study of patients suffering from spina bifida in Spain'. This material was collected between 1986 and 1988 from experiences with 1500 patients all over our country. 52.9% of the patients were male, and 47% female, and of the total number, 72.2% were under 15 years of age. Most of these patients attended public hospitals (78.5%) and on average each one had been admitted about seven times. The cost of hospitalisation of the sample has been assessed. Urology, orthopaedic surgery and rehabilitation are the specialties most involved. The most frequent complications were those related to the urinary system (66.1%).

Cost of skin care in the myelomeningocele population.

This study was undertaken to illustrate the magnitude of the skin breakdown problem in children with myelomeningocele. Seventy-five of the 650 spina bifida patients treated at the Newington Children's Hospital during a 13-year period comprised our final study group. The criterion for inclusion was hospitalization solely for treatment of skin breakdown. Multiple parameters were reviewed. Skin breakdown remains prevalent in this patient population, despite significant improvements in patient care. These improvements are readily demonstrated by (a) an increase in age at time of admission, (b) a significant reduction in average length of hospital stay, and (c) more aggressive admission policies with earlier operative intervention. More than two million dollars and the equivalent of 17 years in hospital days were needed to treat these patients during the 13-year study period.