A new study completed at the SSM Health Cardinal Glennon St. Louis Fetal Care Institute and published in the Journal of Fetal Diagnosis and Therapy discovered that prenatal ultrasound images might provide a further glimpse into the future mobility of babies who undergo fetal surgery for myelomeningocele (MMC), the most severe form of spina bifida.
Spina bifida is a condition where the fetus’ spinal cord fails to close during development. Depending on where the spinal cord defect is, this condition can impact the nervous system, bones, muscles, kidneys and bladder. More severe cases can cause lifelong leg weakness and paralysis. During fetal surgery for spina bifida, the spinal defect is closed before the baby is born, protecting the spine from further damage and stopping leakage of cerebrospinal fluid.
Researchers from the Saint Louis University School of Medicine wanted to learn if there is a way to use ultrasound data to determine whether a baby who undergoes fetal surgery for MMC will be able to walk later in life. To do this, they reviewed ultrasound imagery of babies’ ankle, knee and hip movement after fetal surgery for five days and in the following weeks. Then, they examined the data to see if there was a correlation between the ultrasound data and the results of exams done after the babies were born. These exams were performed within the first month of life, and again when the babies were 2 ½ to 3 years old.
The researchers found that movement of the baby’s ankles and knees soon after fetal surgery (which is done before 26 weeks of pregnancy) correlates with movement at birth, but the early findings of ankle and knee movement (or possibly no movement) doesn’t always correlate with long-term ambulation. However, it was noted that presence or absence of knee and hip movement seen via ultrasound at 32 weeks of pregnancy is related to the baby’s ability to walk without assistance when they reach 2 ½ to 3 years.
As Dr. Cara Buskmiller stated in the article, “Ultrasound can be used as a short-term prognostic tool to approximate expected movement at birth. Ultrasound of the knee and hip at 32 weeks gestation may be helpful in planning therapy for children after open fetal MMC repair.”
“This information will be incredibly helpful for us and parents to prepare for the care of babies and children with spina bifida. It also opens the door for further research on how prenatal imaging can give us a glimpse into the future of these little ones,” says Dr. Christopher Buchanan, a SLUCare maternal-fetal medicine specialist.
The research team, which included Buchanan, SLUCare MFM Dr. Allan Fisher, and Saint Louis University School of Medicine residents Dr. Cara Buskmiller and Dr. Chase Pribble, reviewed data from babies who underwent open fetal surgery for MMC repair at the Cardinal Glennon St. Louis Fetal Care Institute from January 2001 until June 2017.
The complete study, “Postoperative Ultrasound as a Predictor of Newborn Function and Ambulation after Open Fetal Myelomeningocele Repair,” can be reviewed in the December 2020 edition of the Journal of Fetal Therapy and Diagnosis(MMC): https://pubmed.ncbi.nlm.nih.gov/33333535/
