title: Short-term prognostic factors in myelomeningocele patients.
abstract: OBJECTIVE
  Patients with myelomeningocele have a high mortality and neurological disabilities that are correlated with the anatomical characteristics of the defect and with the development of acquired complications. The challenge in the postnatal management of myelomeningocele (MMC) is the early recognition of cases at risk for complications in order to establish individualized treatment strategies. This study aims to identify short-term prognostic markers for newborns with MMC. Anatomical characteristics of the spinal defect and technical aspects of the neurosurgical correction were analyzed for this purpose.
  
  
  METHODS
  A retrospective cohort study was conducted in 70 patients with MMC born between January 2007 and December 2013. Features of MMC anatomy and neurosurgical treatment were analyzed for the following outcomes: neonatal resuscitation, length of hospital stay, need for ventricular shunt, wound dehiscence, wound infection, central nervous system infection, and sepsis.
  
  
  RESULTS
  Large MMC was associated with central nervous system (CNS) infection, wound complications, and longer hospital stay. Patients with thoracic MMC required longer hospital stay. Surgical repair performed after 48 h of life increased in 5.72 times the risk of CNS infection. Absence of antenatal hydrocephalus was a favorable prognostic marker.
  
  
  CONCLUSIONS
  Extent of the spinal cord defect and the time of surgical correction influenced the short-term outcomes of patients with myelomeningocele. Extensive lesions were associated with higher rates of CNS infections, surgical wound complications, and prolonged hospital stay. Interventions performed within 48 h after birth significantly reduced occurrence of CNS infections. Absence of antenatal hydrocephalus was associated with fewer complications in the first days of life.
authors.affiliation: Discipline of Pediatrics, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil. andre@clinicadutrarodrigues.com.br.|, Alameda Joaquim Eugênio de Lima, 881-Jardim Paulista, São Paulo, SP, Conjunto 101, 01403-001, Brazil. andre@clinicadutrarodrigues.com.br.
authors.forename: Andre Broggin Dutra
authors.identifier: http://orcid.org/0000-0001-5969-9627
authors.initials: AB
authors.lastname: Rodrigues
authors.affiliation: Discipline of Pediatrics, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Vera Lucia Jornada
authors.initials: VL
authors.lastname: Krebs
authors.affiliation: Division of Neurosurgery, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Hamilton
authors.initials: H
authors.lastname: Matushita
authors.affiliation: Discipline of Pediatrics, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Werther Brunow
authors.initials: WB
authors.lastname: de Carvalho
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000628:therapy; D007223:Infant; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D019635:Neurosurgical Procedures / Q000379:methods*; D011296:Prenatal Diagnosis; D013116:Spinal Cord / Q000473:pathology; D013997:Time Factors
keywords: Arnold–Chiari malformation; Hydrocephalus; Myelomeningocele; Neurosurgery; Spina bifida