title: Neurological level at birth predicts survival to the mid-40s and urological deaths in open spina bifida: a complete prospective cohort study.
abstract: OBJECTIVE
  To conduct a 50-year complete, community-based, prospective cohort study to investigate long-term survival, causes of death, and influence of level of the lesion in treated open spina bifida.
  
  
  METHODS
  The cohort comprised 117 consecutive cases whose backs were closed non-selectively at birth between 1963 and 1971 in Cambridge, UK. In 2013 we surveyed the survivors (n=39, 18 males, 21 females; mean age 46y, range 43-49y) by postal questionnaire and telephone interview. We compared outcomes in those born with a neurological deficit in terms of sensory and motor levels of L1 and above versus L2 and below.
  
  
  RESULTS
  Two-thirds of the cohort (78/117) had died. Causes of death were cardiorespiratory (n=26), neurological (n=24), urological (n=22), or other (n=6). Only the urological deaths were related to level of the lesion: there were none in those with a sensory level of L2 or below (p<0.001). Birth findings also predicted survival: of the 57 infants with a neurological level of L1 or above, only 12% (n=7) survived compared with 55% (30/55) of the remainder (p<0.001).
  
  
  CONCLUSIONS
  The increased mortality in those born with an extensive neurological deficit was mainly due to urological deaths. Neurological level, particularly the sensory level, is the best predictor of long-term outcome and should be assessed routinely at birth.
authors: Population Health Research Institute, St George's, University of London, London, UK.
authors: Pippa
authors: P
authors: Oakeshott
authors: Department of Primary Care and Public Health Sciences, Kings College London, London, UK.
authors: Fiona
authors: F
authors: Reid
authors: Department of Paediatrics, Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia.
authors: Alison
authors: A
authors: Poulton
authors: Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK.
authors: Hugh
authors: H
authors: Markus
authors: Selwyn College, University of Cambridge, Cambridge, UK.
authors: Robert H
authors: RH
authors: Whitaker
authors: Cambridge, UK.
authors: Gillian M
authors: GM
authors: Hunt