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New Study Shows Children
With Spina Bifida Fare Better With In Utero Surgery
Part Five of Five By Dave Andrusko I did not read, or read about, a study published online Wednesday in the New England Journal of Medicine until after I had been steered to a report on "ABC News Tonight" that same evening (http://abcnews.go.com/Health/w_ParentingResource/spina-bifida-babies-face-outlook-surgery-womb/story?id=12877182). Anchor Diane Sawyer enthusiastically introduced a story about the study which proved the benefits of correcting spina bifida while the baby is in his or her mother's womb, rather than waiting until after birth. A smiling Sawyer said, "We have medical news now. the result of a surgical experiment so promising, so profound the limits were lifted on the experiment so everyone could benefit. It involves surgery in the womb with tiny instruments, microscopic skill and dexterity on a devastating birth defect that affects 1,500 newborns every year. And Deborah Roberts reports on the news tonight that could led to other life- changing surgery for babies before they are born." Like you, I was vaguely aware that fetal surgery has been going on for a long time, particularly in cases of spina bifida, but that there were concerns that it might pose risks to unborn child and mother. Spina bifida happens when the spine of the baby fails to close during the first few months of pregnancy. It can be associated with brain and nerve damage, including paralysis. Typically, prompt surgery after birth can prevent further harm but it cannot reverse the nerve damage that has already taken place. "By the end of 2002, more than 230 spina bifida operations had been done, but some doctors remained skeptical," is the way the Associated Press (AP) described the situation. "So the National Institutes of Health launched a big study that year at Vanderbilt, the Philadelphia hospital and the University of California, San Francisco. Other hospitals agreed not to do the surgery while the research was under way." Half of 158 babies had surgery in utero (between 19 and 25 weeks) and half after delivery, according to the study in the New England Journal of Medicine. "By the time they turned a year old, 40 percent in the fetal surgery group needed a drainage tube, or shunt, in the brain, compared with 82 percent in the standard surgery group," according to the AP. "The fetal surgery group scored higher on combined tests of mental development and motor skills at 2½ years, though there was no difference in cognitive function alone." In addition, "Forty-two percent of the toddlers in the fetal surgery group could walk without crutches or other support versus 21 percent in the other group." Furthermore, a year out babies who'd had surgery before birth . They found that after one year, those who had surgery before birth were less likely to need follow-up surgeries than infants who had surgery after birth--30 percent less likely. Researchers also found that 80% of babies who had fetal surgery were born prematurely (as compared with 15% in the after-delivery group)--on average about a month and a half early. "A third of the mothers who had the operation had thinning in the wall of their uterus, a complication that requires cesarean delivery in the future," the AP reported. Dr. Scott Adzick, chief of surgery at Children's Hospital of Philadelphia, was first author of the study. "This is a big breakthrough," he told ABC News' Lara Salahi. "For the first time we can show a clear cut benefit, treating a non life threatening malformation by repairing it before birth." One of the children featured on the broadcast who had previously undergone in utero surgery was Sean Mulligan. Now 10, Sean walks without the help of crutches or a wheelchair. "That's the gratifying thing," said Adzick, who was Sean's surgeon."Not statistics and all that sort of stuff, but seeing the impact of that operation on that kid." "I don't think it gets better than that." Please send your comments to daveandrusko@gmail.com. If you like, join those who are following me on Twitter at http://twitter.com/daveha. |