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Neural Tube Defects (NTD)
The following data represents evaluations, procedures and outcomes from December 2011 through the end of December 2022.
Patients evaluated for NTD
- 68 - 2022
- 577 - Total
Fetal NTD Repair
Open fetal procedures
- 0 - 2022
- 44 - Total
Fetoscopic procedures
- 28 - 2022
- 140 - Total
Fetal NTD repair outcomes
| Fetal Myelomeningocele (fMMC) repair cases | All fetoscopic cases (n=140) | Fetoscopic 3 Layer Closure (n=102) | All open cases (n= 44) | MOMs trial* (n=78) |
|---|---|---|---|---|
| Gestational Age at Surgery | ||||
| Median [range] | 25.3 [22.9-26.9] | 25.1 [24.0-26.4] | 24.8 [21.3-25.9] | --- |
| Mean | 25.2 ± 0.6 | 25.1 ± 0.5 | 24.6 ± 1.2 | 23.6 ±1.4 |
|
Prenatal/Neonatal Demise | 2/139 (1.4%) | 2/101 (2%) | 1/44 (2%) | 2/78 (3%) |
| Delivery outcomes Number of patients delivered | (n=137)1 | (n=99)1 | (n=44) | (n=78) |
| Gestational Age at Delivery | ||||
| Median [range] | 37.4 [25.1-40.9] | 37.1 [25.1-40.9] | 35.8 [26.4-37.9] | --- |
| Mean | 36.4 ± 3.4 | 36.3 ± 3.5 | 35.1 ± 2.7 | 34.1 ± 3.1 |
|
Preterm Premature Rupture of Membranes | 46/137 (29%) | 36/99 (31%) | 9/44 (20%) | 36/78 (46%) |
| Preterm Delivery | ||||
| less than 37 weeks gestation | 59/137 (43%) | 45/99 (31%) | 27/44 (61%) | 62/78 (79%) |
| less than 30 weeks gestation | 8/137 (6%) | 6/99 (3%) | 4/44 (9%) | 10/78 (13%) |
Vaginal Delivery | 71/137 (52%) | 50/99 (49%) | 0/44 (0%) | 0/78 (0%) |
| Birthweight | ||||
| Median [range] | 2885 [755-4545] | 2875 [755-4545] | 2613 [624-3635] | --- |
| Mean | 2823 ± 768 | 2834 ± 773 | 2518 ± 663 | 2383 ± 688 |
|
Treatment for Hydrocephalus at 12 months or less | 37/96 (40%)3 | 22/71 (31%)3 | 12/38 (32%)2 | 31/78 (40%) |
Overall rate of treatment for hydrocephalus for all fetoscopic & open fMMC cases: 49/134 (37%) Results reflect available outcomes data from 12 / 2011 to 12 / 2022 | ||||
1. Excludes 2 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. Not every center defines walking independently in the same manner. Here at Texas Children's Fetal Center we take a conservative approach when classifying walking status. We have looked at every child who has had a fetoscopic repair to determine their primary method of daily ambulation at 30 months or above. Many children are able to take a few steps independently, but when we classify a child as walking independently, that reflects their primary method of ambulation in their daily life. 85% of our fetoscopic patients are able to walk, whether it be independently, with orthotics and/or devices like a walker.
TCH Fetoscopic results - 30 Months and older | MOMs trial results - 30 Months and older | ||||
Walking Status | Count | Percentage | Walking Status | Count | Percentage |
Walking – any form | 60 | 87% | Walking – any form | 44 | 71% |
Walking – independent of braces or walker | 17 | 25% | Walking – independent of braces or walker | 26 | 42% |
Walking – with orthotics | 24 | 25% | Walking – with orthotics or devices | 18 | 29% |
Walking – with devices | 19 | 28% | |||
None – wheelchair dependent | 9 | 13% | None – wheelchair dependent | 18 | 29% |
Total # of patients with available information | 69 |
| 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.