Perineal sensation: an important predictor of long-term outcome in open spina bifida.
OBJECTIVE
To see if perineal sensation in infants with open spina bifida is associated with a better long-term outcome, particularly in terms of survival, renal-related deaths and incontinence.


METHODS
We conducted a prospective cohort study on a complete cohort of 117 consecutive patients with open spina bifida, whose backs were closed non-selectively at birth between 1963 and 1971. A meticulous neurological examination in infancy showed that 33 (28%) of them had perineal sensation, defined as intact sensation to pinprick in at least one dermatome on one side in the saddle area (S2-4). Data recorded within 48 h of birth and during six reviews between 1972 and 2002 were used. Details of deaths were obtained from medical records and from the Office of National Statistics.


RESULTS
By December 2005, 57% (67/117) of the cohort had died. There were 50 survivors with a mean age 38 years (range 35-41). More of those with perineal sensation survived than those without (23/33 v 27/84, p<0.001). This difference was mainly caused by 19 renal deaths in those lacking perineal sensation. Crucially there were no renal-related deaths in those with perineal sensation (0/33 v 19/84, p = 0.003). Among the survivors, those with perineal sensation were more likely than the remainder to be continent of urine and faeces (10/23 v 1/27, p<0.001 and 18/23 v 9/27, p = 0.002 respectively). They were also more likely to be able to walk at least 50 m (11/23 v 5/27, p = 0.027) and never to have had pressure sores (15/23 v 9/27, p = 0.025).


CONCLUSIONS
A simple assessment of perineal sensation in infancy predicts long-term outcome in terms of survival, renal prognosis and incontinence in open spina bifida.
Oakeshott
P
P
Community Health Sciences, St George's, University of London, London, UK. oakeshot@sgul.ac.uk
Hunt
G M
GM
Whitaker
R H
RH
Kerry
S
S
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000401:mortality*; D008297:Male; D009460:Neurologic Examination; D010502:Perineum / Q000503:physiopathology*; D011446:Prospective Studies; D012677:Sensation / Q000502:physiology*; D012684:Sensory Thresholds; D016137:Spina Bifida Cystica / Q000401:mortality / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000401:mortality