title: Fetal myelomeningocele surgery: preschool functional status using the Functional Independence Measure for children (WeeFIM).
abstract: OBJECTIVE
  To study preschool functional status in children following fetal myelomeningocele (fMMC) surgery.
  
  
  METHODS
  Prior to the NICHD-MOMS trial, 30 fMMC underwent standardized neurodevelopmental examination at 5 years of age. Functional status was determined with the Functional Independence Measure (WeeFIM), which assesses self-care, mobility, and cognitive independence.
  
  
  RESULTS
  Evaluations were completed in 26 (87%). Mean cognitive (93.0 ± 21.9), self-care (66.5 ± 23.9), mobility (82.3 ± 19.5), and total (77.9 ± 20.3) functional quotient of fMMC children were significantly lower than age-matched population norms (P < 0.01). Complete caregiver independence was achieved by 22 (84%), 10 (38%), 16 (62%), and 15 (58%) fMMC children for cognition, self-care, mobility, and total functional outcome, respectively. Cognitive, mobility, and total independence were higher in non-shunted than shunted fMMC children (P = 0.02, P = 0.02, and P < 0.01, respectively) and in fMMC children with average neurodevelopmental scores (P < 0.001, P = 0.01, and P < 0.01, respectively). Self-care independence tended to be higher in the non-shunted group and in fMMC children with normal neurodevelopmental outcome (P = 0.07 and P = 0.09, respectively).
  
  
  CONCLUSIONS
  The majority of fMMC children achieved cognitive and mobility independence, but continue to require significant assistance in self-care. Non-shunted and fMMC children with normal neurodevelopmental outcome were more likely to be independent in daily living activities. Better understanding of the extent of functional limitations following fMMC surgery will allow for more effective early interventions geared toward maximizing independence in everyday tasks in all environments.
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
authors.forename: Enrico
authors.initials: E
authors.lastname: Danzer
authors.forename: Marsha
authors.initials: M
authors.lastname: Gerdes
authors.forename: Michael W
authors.initials: MW
authors.lastname: Bebbington
authors.forename: Jamie
authors.initials: J
authors.lastname: Koh
authors.forename: Scott N
authors.initials: SN
authors.lastname: Adzick
authors.forename: Mark P
authors.initials: MP
authors.lastname: Johnson
mesh_terms: D000203:Activities of Daily Living; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology*; D004185:Disability Evaluation; D046128:Fetal Therapies / Q000009:adverse effects; D005333:Fetus / Q000601:surgery; D006801:Humans; D007360:Intelligence; D008591:Meningomyelocele / Q000150:complications* / Q000601:surgery*; D009483:Neuropsychological Tests; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects