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Neural Tube Defects (NTD)

Neural Tube Defects (NTD)

The following data represents evaluations, procedures and outcomes from December 2011 through the end of 2020.


Patients evaluated for NTD  

  • 55 - 2020
  • 462 - Total

Fetal NTD Repair

Open fetal procedures

  • 0 - 2020
  • 44 - Total

Fetoscopic procedures

  • 15 - 2020
  • 85 - Total

Fetal NTD repair outcomes

Fetal Myelomeningocele
(fMMC) repair cases



 
All fetoscopic
cases
(n=85)
Fetoscopic
3 Layer Closure
(n=48)
All open cases
(n= 44)
MOMs trial*
(n=78)
Gestational Age at Surgery        
Median [range] 25.0 [22.9-26.4] 25.1 [24.0-26.4] 24.8 [21.3-25.9] ---
Mean 25.1 ± 0.6 25.1 ± 0.4 24.6 ± 1.2 23.6 ±1.4
 

Prenatal/Neonatal Demise

1/85 (1%) 1/48 (2%) 1/44 (2%) 2/78 (3%)
Delivery outcomes
Number of patients delivered

(n=83)1

(n=46)1

(n=44)

(n=78)
Gestational Age at Delivery        
Median [range] 38.4 [25.6-40.9] 38.7 [25.6-40.9] 35.8 [26.4-37.9] ---
Mean 37.0 ± 3.2 37.3 ± 2.9 35.1 ± 2.7 34.1 ± 3.1
 

Preterm Premature Rupture of Membranes
(<37 weeks gestation)

22/83 (27%) 12/46 (26%) 9/44 (20%) 36/78 (46%)
Preterm Delivery      
less than 37 weeks gestation 30/83 (36%) 16/46 (35%) 27/44 (61%) 62/78 (79%)
less than 30 weeks gestation 3/83 (4%) 1/46 (2%) 4/44 (9%) 10/78 (13%)

Vaginal Delivery
 

44/83 (52%)
 

24/46 (52%)
 

0/44 (0%)
 

0/78 (0%)
 
Birthweight        
Median [range] 3031 [810-4545] 3280 [810-4545] 2613 [624-3635] ---
Mean 2949 ± 774 3081 ± 759 2518 ± 663 2383 ± 688
 

Treatment for Hydrocephalus at 12 months or less

 24/67 (36%)3 9/30 (30%)3 12/38 (32%)2 31/78 (40%)

Overall rate of treatment for hydrocephalus for all fetoscopic & open fMMC cases: 32/96 (33%)

Results reflect available outcomes data from 12 / 2011 to 12 / 2020
1. Excludes 1 IUFD and 1 pending delivery in the fetoscopic group
2. Excludes 1 demise and 5 lost to follow up in the open group
3. Only includes patients who have reached 12 months of age

Walking Status at 30 months for fetoscopic repair

Below you will find a detailed report for walking status for our fetoscopic cases. We believe that the details regarding walking status as reported here are important to provide to families.

30 Months and older 

Walking Status 

Count 

Percentage 

Walking  any form 

35 

81% 

Walking – independent of braces or walker 

10 

23% 

Walking   with orthotics 

11

26% 

Walking  with devices 

14

33% 

None – wheelchair dependent 

8 

19% 

Total # of patients with available information 

43

  

The table below shows our results for walking status reported in the same manner as the MOMs trial results to allow for comparison. We anticipate our outcomes will continue to improve as more children reach 30 months of age.

30 Months and older 

Walking Status 

Count 

Percentage 

Walking – independently

10 

23% 

Walking – with orthotics or devices

25

58%

None – wheelchair dependent

19%

Total # of patients with available information 

43

  

MOMs trial results - 30 Months and older

Walking Status 

Count 

Percentage 

Walking – independently

26

42%

Walking – with orthotics or devices

18

29%

None – wheelchair dependent

18

29%

Total # of patients with available information 

62

  

*Adzick, S., Thom, E., Spong, C., Brock, J., Burrows, P., Johnson, M.,… Farmer, D. (2011). A randomized trial of prenatal versus postnatal repair of myelomeningocele. New England Journal of Medicine, 364, 993-1004.

Belfort, M., Whitehead, W., Shamshirsaz, A., Bateni, Z., Olutoye, O. O., Olutoye, O.A., …Cass, D. (2017). Fetoscopic open neural tube defect repair: Development and refinement of a two-port, carbon dioxide insufflation technique. Obstetrics and Gynecology, 4, 734-743.