title: Factors associated with the timeliness of postnatal surgical repair of spina bifida.
abstract: OBJECTIVE
  Clinical guidelines recommend repair of open spina bifida (SB) prenatally or within the first days of an infant's life. We examined maternal, infant, and health care system factors associated with time-to-repair among infants with postnatal repair.
  
  
  METHODS
  This retrospective, statewide, population-based study examined infants with SB born in Florida 1998-2007, ascertained by the Florida Birth Defects Registry. We used procedure codes from hospital discharge records to identify the first recorded myelomeningocele repair (ICD-9 CM procedure code 03.52) among infants with birth hospitalizations. Using Poisson multivariable regression, we examined time-to-repair by hydrocephalus, SB type (isolated [no other coded major birth defect] versus non-isolated), and other selected factors.
  
  
  RESULTS
  Of 199 infants with a recorded birth hospitalization and coded myelomeningocele repair, 87.9 % had hydrocephalus and 19.6 % had non-isolated SB. About 76.4 % of infants had repair by day 2 of life. In adjusted analyses, infants with hydrocephalus were more likely to have timely repair (adjusted prevalence ratio (aPR) = 1.48, 95 % confidence interval (CI) 1.02-2.14) than infants without hydrocephalus. SB type was not associated with repair timing. Infants born in lower level nursery care hospitals with were less likely to have timely repairs (aPR = 0.71, 95 % CI 0.52-0.98) than those born in higher level nursery care hospitals.
  
  
  CONCLUSIONS
  Most infants with SB had surgical repair in the first 2 days of life. Lower level birth hospital nursery care was associated with later repairs. Prenatal diagnosis can facilitate planning for a birth hospital with higher level of nursery care, thus improving opportunities for timely repair.
authors.affiliation: South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC, 29210, USA. radclife@mailbox.sc.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Radcliff
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Cassell
authors.affiliation: Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Laditka
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Judy K
authors.initials: JK
authors.lastname: Thibadeau
authors.affiliation: Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Florida Birth Defects Registry, Tallahassee, Florida, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Correia
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Grosse
authors.affiliation: Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA.
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D018672:Community Health Planning; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery; D008297:Male; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Birth defects; Pediatric surgery; Spina bifida; Timeliness