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Fetal Diagn Ther 2011;30:174–179

Preschool Neurobehavioral Outcome following Fetal Myelomeningocele Surgery

Danzer E. · Gerdes M. · Bebbington M.W. · Koh J. · Adzick N.S. · Johnson M.P.
The Center for Fetal Diagnosis and Treatment, The Children’s Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, Pa., USA
email Corresponding Author

 goto top of outline Key Words

  • Myelomeningocele
  • Spina bifida
  • Fetal surgery
  • Child Behavior Check List
  • Premature delivery
  • Neurobehavioral outcome

 goto top of outline Abstract

Objective: It was the aim of this study to assess the prevalence of preschool neurobehavioral problems in children following fetal myelomeningocele (fMMC) surgery. Methods: Prior to the Management of Myelomeningocele Study, 30 fMMC patients underwent a standardized neurodevelopmental examination at 5 years of age. The prevalence of behavioral problems was assessed by the Child Behavior Check List (CBCL), which includes a total problem score and 2 broad-band indices (internalizing and externalizing problems). fMMC children were classified as having normal, at-risk or clinically significant scores based on calculated T scores. Results: Twenty-two (73%) fMMC families completed the evaluation. Mean age at delivery following fMMC surgery was 35.5 ± 1.6 weeks. The prevalence of ‘at-risk’ or ‘clinically significant’ scores for internalizing, externalizing and total behavioral problems was similar to general population norms. No difference in overall internalizing (p = 0.19), externalizing (p = 0.54) and total behavioral (p = 0.18) scores was found between non-shunted and shunted fMMC children. However, shunted fMMC children were more likely to experience anxiety and depressive (p = 0.02), pervasive developmental (p = 0.03) and withdrawn (p = 0.06) behavior. Oppositional defiant, attention deficit and hyperactivity problems were not found. No correlation was found between overall neurodevelopmental outcome and abnormal CBCL scores. Conclusions: fMMC surgery and subsequent preterm delivery is not associated with increased behavioral problems, impaired social interactions and restricted behavior patterns. Shunted fMMC children were more likely to have scores in the ‘at-risk’ or ‘clinically significant’ range for multiple CBCL subindices. Early detection of behavioral problems following fMMC surgery provides an opportunity for targeted and timely intervention enabling affected fMMC children to be socially successful.

Copyright © 2011 S. Karger AG, Basel

 goto top of outline References
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 goto top of outline Author Contacts

Mark P. Johnson, MD
The Children’s Hospital of Philadelphia
The Center for Fetal Diagnosis and Treatment, 5th Floor Wood Center
34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399 (USA)
Tel. +1 215 590 747, E-Mail johnsonma@email.chop.edu

 goto top of outline Article Information

Received: April 12, 2011
Accepted after revision: June 7, 2011
Published online: September 8, 2011
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 3, Number of References : 27

 goto top of outline Publication Details

Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)

Vol. 30, No. 3, Year 2011 (Cover Date: November 2011)

Journal Editor: Gratacós E. (Barcelona)
ISSN: 1015-3837 (Print), eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT

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