Myelomeningocele newborn management: time for parental decision.
We retrospectively reviewed a process whereby parents were afforded additional time to decide the initial managements of their newborn with myelomeningocele. Of 110 newborn referrals, 52 (47%) had early surgery within the first 48 hours, 32 (29%) had delayed surgery between 3-7 days, 12 (11%) had late surgery from 7 days to 10 months, and 14 (13%) had no surgery, per parental request. There were no significant differences among the early, delayed or late surgery groups in mortality where 92%, 94% and 100% respectively were alive at 10 months, or the morbidity of worsening paralysis, ventriculitis or developmental delay. Our data suggest, therefore that there is no urgency or emergency for surgical intervention in the initial management of newborns with myelomeningocele. Rather, there is time to fully discuss issues with parents and obtain a better-informed consent for or against surgical management.
D003657:Decision Making; D006548:Hernia, Diaphragmatic / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007231:Infant, Newborn; D008016:Life Change Events; D008588:Meningocele / Q000150:complications / Q000401:mortality / Q000601:surgery*; D010243:Paralysis / Q000209:etiology; D010290:Parents / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology; D013997:Time Factors