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Posted at 5:00 PM ET, 02/ 9/2011

Study: Womb surgery for spina bifida beneficial

By Rob Stein

Performing surgery on babies with the most severe form of spina bifida when they are still in the womb doubles the chance that they will be able to walk, according to a federally funded study released Wednesday.

The study, which involved 158 mothers carrying babies with spina bifida, found that sealing up their defective spinal cords before they were born also significantly reduced the chances they would need to a tube known as a shunt surgically implanted to drain fluid from their brains.

"This is a very promising and quite an exciting result," said Diana Farmer of the University of California, San Francisco, one of three centers that conducted the study.

Based on the findings, published in a paper released early online by The New England Journal of Medicine, the researchers told reporters during a briefing Tuesday that expectant parents who find out their babies have spina bifida should consider the operation.

"Families need to know that this is one option that is in the armamentarium," Farmer said.

Other experts hailed the findings, saying it could encourage the development of other procedures that could be used to treat fetuses in the womb for other conditions.

"The possibility of surgical repair of fetal anomalies in utero has long tantalized obstetricians and pediatric surgeons." wrote Joe Leigh Simpson of Florida International University in Miami and Michael F. Greene of Massachusetts General Hospital in an editorial accompanying the study.They called the study a "major step in the right direction."

Spina bifida is the most common birth defect of the central nervous system. About 1,500 babies are born each year with the most severe form of the condition treated in the study, known as myelomeningocele. It occurs when part of the spinal column does not close around the spinal cord. Babies born with this condition often suffer a host of severe, lifelong disabilities, including paralysis that renders them dependent on crutches or wheelchairs, bladder and bowel problems and excessive fluid buildup in the brain that can lead to cognitive impairments. Women can reduce their risk for having babies with spina bifida by increasing their intake of folic acid.

Surgeons have long inserted the spinal cord back into the spinal column and sealed the spinal column after babies with spina bifida are born. In the new study--the first to carefully evaluate a fetal operation for a non-life-threatening condition--surgeons painstakingly performed the two-hour procedure while the baby was still in the womb between about 19 and 26 weeks into the pregnancies.

Researchers had planned to test the approach on 200 babies. But the study was stopped early in December when the results appeared to be so promising. After an average of 21/2 years after the surgery, about 42 percent of those who got the surgery in the womb could walk, compared to about 21 percent of those who got the surgery after they were born.

The surgery did, however, have some risks. The mothers who underwent the procedure were more likely to experience ruptured membranes and deliver their babies prematurely. Babies born prematurely were more likely to experience breathing problems. All women who had the surgery would have to give birth to any future babies by Caesarean section. But overall, the procedure appeared to be beneficial, officials said.

"On balance, infants and moms who underwent fetal surgery did better than those who had surgery after birth," said Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which funded the study.

The study, known as Management of Myelomeningocele Study or MOMS, was conducted at The Children's Hospital in Philadelphia, Vanderbilt University in Nashville and the University of California, San Francisco. Statisticians at George Washington University analyzed the data.

In their editorial, Simpson and Greene cautioned that the results may not be as good as other, less experienced hospitals start trying the operation. In addition, they worried that couples who do not elect to terminate a pregnancy when they find out their baby has spina bifida might "feel pressured 'to do everything possible' and hence may be inclined to interpret even marginal benefit favorably."

"It is also human nature to overestimate the likely benefit for one's own fetus and to underestimate the associated risks," they wrote.

As a result, it is important that parents receive careful counseling before making a decision about whether to try the operation, the pair wrote.

By Rob Stein  | February 9, 2011; 5:00 PM ET
Categories:  Parenting, Pregnancy, Reproductive Health, Women's Health  
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