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Child's Nervous System
Published in: Child's Nervous System 7/2020

Open Access 01-07-2020 | Septicemia | Original Article

A perspective in the management of myelomeningocoele in the KwaZulu-Natal Province of South Africa

Authors: M. N. Mnguni, B. C. Enicker, T. E. Madiba

Published in: Child's Nervous System | Issue 7/2020

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Abstract

Background

Myelomeningocoele (MMC) is common in the developing world. The purpose of this study was to investigate the clinical characteristics and management of myelomeningocoele and to identify factors contributing to outcomes.

Methods

This was a retrospective, observational study of consecutive children diagnosed with MMC managed in the Paediatric Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. Multiple logistic regression analysis identified clinical characteristics, demographics and surgical variables that were associated with outcome.

Results

A total of 309 children were managed during this period (M:F 1.3:1). The most common sites were lumbar, lumbo-sacral and sacral. Mean age at surgical repair was 4.7 ± 15.6 months. Two hundred and eight children had ventriculomegaly, of whom 158 had symptomatic hydrocephalus, requiring CSF diversion. Fifty-eight (21%) patients developed wound sepsis, of whom 13 (22%) developed meningitis (p = 0.001). The time to wound sepsis was 9.5 ± 3.6 days. The commonest organism isolated was Staphylococcus aureus followed by MRSA. Thirty-two patients (23%) developed shunt malfunction and three (11%) developed ETV malfunction. Twenty children (9%) demised during the admission period. Death was associated with meningitis (p < 0.0001), and meningitis itself was associated with wound sepsis (p < 0.0001). Hospital stay was 20.4 ± 16 days. Wound sepsis (p = 0.002) and meningitis (p < 0.0001), respectively, were associated with prolonged hospital stay.

Conclusion

There was a slight male preponderance and hydrocephalus occurred in two thirds of cases. Wound sepsis and meningitis were associated poor outcomes.
Literature
1.
Fieggen K, Stewart C (2014) Aetiology and antenatal diagnosis of spina bifida. S Afr Med J 104(3):218CrossRef
2.
Fieggen G, Fieggen K, Stewart C et al (2014) Spina bifida: a multidisciplinary perspective on a many-faceted condition. S Afr Med J 104(3):212–217CrossRef
3.
Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D'Alton ME, Farmer DL, MOMS Investigators (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364(11):993–1004CrossRef
4.
Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA (2001) Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg 34(3):114–120CrossRef
5.
Mulinare J, Cordero JF, Erickson JD, Berry RJ (1988) Periconceptional use of multivitamins and the occurrence of neural tube defects. Jama 260(21):3141–3145CrossRef
6.
Githuku JN, Azofeifa A, Valencia D et al (2014) Assessing the prevalence of spina bifida and encephalocele in a Kenyan hospital from 2005–2010: implications for a neural tube defects surveillance system. Pan Afr Med J 18:60PubMedPubMedCentral
7.
Yi Y, Lindemann M, Colligs A, Snowball C (2011) Economic burden of neural tube defects and impact of prevention with folic acid: a literature review. Eur J Pediatr 170(11):1391–1400CrossRef
8.
Flores A, Vellozzi C, Valencia D, Sniezek J (2014) Global burden of neural tube defects, risk factors, and prevention. Indian J Community Health 26(Suppl 1):3PubMedPubMedCentral
9.
Statistics SA. Census 2011, Statistics South Africa, 2012
10.
Arslan M, Eseoglu M, Gudu BO et al (2011) Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate. Turk Neurosurg 21(3):397–402PubMed
11.
Demir N, Peker E, Gülşen İ, Ağengin K, Tuncer O (2015) Factors affecting infection development after meningomyelocele repair in newborns and the efficacy of antibiotic prophylaxis. Childs Nerv Syst 31(8):1355–1359CrossRef
12.
Neves N, Noleto M, Ribeiro V (2017) Prevalence of and risk factors for surgical site infections in patients with myelomeningocoele. Revista SOBECC 22(1):10–16CrossRef
13.
Crimmins D, Hayward R, Thompson D (2005) Reducing shunt placement rate in myelomeningocele patients (abstr). Childs Nerv Syst 21:828–829
14.
de la Cruz R, Millán JM, Miralles M, Muñoz MJ (1989) Cranial sonographic evaluation in children with meningomyelocele. Childs Nerv Syst 5(2):94–98CrossRef
15.
Machado HR, de Oliveira RS (2004) Simultaneous repair of myelomeningocele and shunt insertion. Childs Nerv Syst 20(2):107–109CrossRef
16.
Schroeder HK, Nunes JC, Madeira L, Moritz JLW, Walz R, Linhares MN (2012) Postsurgical infection after myelomeningocele repair: a multivariate analysis of 60 consecutive cases. Clin Neurol Neurosurg 114(7):981–985CrossRef
17.
Marreiros H, Loff C, Calado E (2015) Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review. J Spinal Cord Med 38(5):626–640CrossRef
18.
Padayachy L, Ochieng D (2014) Perinatal management of spina bifida. S Afr Med J 104(3):219–221CrossRef
19.
Morgado T, Figaji A (2014) Hydrocephalus in spina bida. S Afr Med J 104(4):315CrossRef
20.
Tamburrini G, Frassanito P, Iakovaki K, Pignotti F, Rendeli C, Murolo D, di Rocco C (2013) Myelomeningocele: the management of the associated hydrocephalus. Childs Nerv Syst 29(9):1569–1579CrossRef
21.
Radmanesh F, Nejat F, Khashab ME, Ghodsi SM, Ardebili HE (2009) Shunt complications in children with myelomeningocele: effect of timing of shunt placement. J Neurosurg Pediatr 3(6):516–520CrossRef
22.
Northrup H, Volcik KA (2000) Spina bifida and other neural tube defects. Curr Probl Pediatr 30(10):317–332CrossRef
23.
Rodrigues ABD, Krebs VLJ, Matushita H, de Carvalho WB (2016) Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst 32(4):675–680CrossRef
24.
McGirt MJ, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36(7):858–862CrossRef
25.
Caldarelli M, Di Rocco C, La Marca F (1996) Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 12(12):748–754CrossRef
26.
Khan F, Shamim MS, Rehman A, Bari ME (2013) Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients. Childs Nerv Syst 29(5):791–802CrossRef
27.
Khan F, Rehman A, Shamim MS, Bari ME (2015) Factors affecting ventriculoperitoneal shunt survival in adult patients. Surg Neurol Int 6:25CrossRef
28.
Öktem I, Menkü A, Özdemir A (2008) When should ventriculoperitoneal shunt placement be performed in cases with myelomeningocele and hydrocephalus? Turk Neurosurg 18(4):387–391PubMed
29.
Health Do (2001) Policy guidelines for the management and prevention of genetic disorders. Birth Defects and Disabilities, Department of Health Pretoria
30.
Adzick NS (2010) Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention. Seminars in fetal and neonatal medicine; 2010. Elsevier, Amsterdam, pp 9–14
31.
De Wals P, Tairou F, Van Allen MI et al (2007) Reduction in neural-tube defects after folic acid fortification in Canada. N Engl J Med 357(2):135–142CrossRef
32.
Rabiu T, Tiamiyu L, Awoyinka B (2012) Awareness of spina bifida and periconceptional use of folic acid among pregnant women in a developing economy. Childs Nerv Syst 28(12):2115–2119CrossRef
33.
Rabiu TB, Adeleye AO (2013) Prevention of myelomeningocele: African perspectives. Childs Nerv Syst 29(9):1533–1540CrossRef
34.
Africa PoS. Choice on Termination of Pregnancy Act.; 1996
35.
Mweshi M, Amosun S, Ngoma M, Nkandu E (2011) Managing children with spina bifida in sub-Saharan Africa: the Zambian experience? Med J Zambia 38(1):13–23
Metadata
Title
A perspective in the management of myelomeningocoele in the KwaZulu-Natal Province of South Africa
Authors
M. N. Mnguni
B. C. Enicker
T. E. Madiba
Publication date
01-07-2020
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 7/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-020-04506-9

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