Factors Influencing Outcomes After Myelomeningocele Repair in Children
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Factors Affecting the Outcomes in Children Post-Myelomeningocoele Repair in Northeastern Peninsular Malaysia
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Badrisyah Idris
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The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Factors Affecting the Outcomes in Children Post-Myelomeningocoele Repair in Northeastern Peninsular Malaysia
Year: 2011
Copyright (license): CC BY 4.0
Summary of article contents:
Introduction
Myelomeningocoele (MMC) is a severe congenital disorder of the central nervous system characterized by an exposure of the spinal cord and/or meninges due to a bone defect. Children surviving MMC often face lifelong disabilities resulting from neurological defects and surgical interventions. This study aimed to evaluate various factors that impact outcomes, particularly ambulatory and sphincter function, following surgical repair in children with MMC.
Impact of Hydrocephalus on Functional Outcomes
One significant finding from the study was the strong association between hydrocephalus and functional outcomes, particularly ambulatory status. Children who exhibited intact motor function at L3 and below, as well as those with deep tendon reflexes, demonstrated higher rates of ambulation post-surgery. Approximately 81% of children remained ambulant at 18 months, with hydrocephalus and the presence of a cerebrospinal fluid shunt emerging as influential predictors. Conversely, a disturbing 83% of the children exhibited urinary incontinence, while 42.9% experienced faecal incontinence, highlighting a substantial challenge in sphincter control that correlates with low lesion levels.
Conclusion
This study illustrates the multifactorial nature of outcomes for children with myelomeningocoele following surgical repair. Various parameters, including the presence of hydrocephalus and the child's motor function level at the time of assessment, play critical roles in dictating ambulatory and sphincter functions. Given the potential for ongoing neurological deterioration as these children grow, consistent monitoring using the Spina Bifida Neurological Scale (SBNS) is essential to manage their developmental trajectories effectively. A multidisciplinary approach is paramount in ensuring optimal care and facilitating functional independence for affected individuals.
FAQ section (important questions/answers):
What is myelomeningocele (MMC) and its common outcomes?
Myelomeningocele (MMC) is a congenital disorder of the central nervous system characterized by exposure of the nervous system due to a vertebral defect. Common outcomes include life-long disabilities, affecting ambulatory and sphincter functions in children.
What factors influence ambulatory status in children with MMC?
Key factors influencing ambulatory status in children with MMC post-surgery include the presence of hydrocephalus, intact motor function at L3 and below, presence of deep tendon reflexes, and insertion of a cerebrospinal fluid shunt.
How does hydrocephalus relate to sphincter function in MMC?
In children with MMC, hydrocephalus is significantly associated with poor sphincter control. Findings in the study show a high percentage of urinary and fecal incontinence among those with hydrocephalus.
What was the surgical outcome of MMC repair in the study?
The study found that 5% had normal neurological function post-repair, while the majority had varying degrees of ambulatory ability and continence issues. A multidisciplinary approach is recommended for effective management.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Factors Influencing Outcomes After Myelomeningocele Repair in Children”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Study (Studying):
The term 'Study' refers to the systematic investigation conducted in the context of children with myelomeningocele (MMC). It highlights the retrospective chart review approach used to evaluate the impacts of surgical interventions, factors affecting ambulatory and sphincter functions, and the importance of data-driven conclusions in pediatric care.
2) Repair:
Repair signifies the surgical procedure undertaken to close the defect present in children with MMC. This process is critical for minimizing further neurological damage, promoting healthy development, and enhancing the quality of life. Effective repair strategies can influence long-term outcomes regarding ambulatory and sphincter functions in affected children.
3) Surface:
Surface pertains to the measurement of lesion sizes in relation to the total body surface area, essential in determining the appropriate surgical intervention. This quantification helps classify the severity of MMC and guides clinician decisions regarding repair techniques and potential complications, emphasizing the role of precise metrics in surgical outcomes.
4) Life:
Life encompasses the ongoing challenges faced by children with MMC, highlighting the importance of medical interventions and support throughout their development. It underscores the need for multidisciplinary care in improving quality of life and addressing the long-term disabilities associated with this congenital condition, emphasizing holistic approaches toward patient health.
5) Labour (Labor):
Labor, in this context, relates to the broader implications of birth and maternal factors related to pregnancy and delivery in children with MMC. Understanding the influence of labor dynamics on the outcomes for these children can inform clinical practices, particularly in managing women with high-risk pregnancies related to neural tube defects.
6) Birth:
Birth signifies the critical moment of a child's entry into the world, particularly for those with MMC. It is during this time that initial assessments are undertaken, and decisions regarding surgical interventions are made. The management of MMC at birth, such as the timing of repairs, can affect long-term neurological outcomes.
7) Post:
Post indicates the period following surgical intervention for MMC. This timeframe is crucial for monitoring recovery, neurological function, and potential complications. Assessing outcomes using tools like the Spina Bifida Neurological Scale during this phase allows healthcare providers to track progress, address issues proactively, and adapt care plans accordingly.
8) Table:
Table refers to the structured data presentation in the study, summarizing key findings and factors associated with MMC, its surgical treatment, and outcomes. Tables serve as vital tools for visualizing complex data, facilitating comparative analysis, and enhancing comprehension of relationships between different variables pertinent to patient outcomes.
9) Pur:
Poor underscores the challenges faced by many children with MMC regarding ambulatory status and sphincter control. This term reflects the significant prevalence of disabilities and incontinence issues among these individuals, emphasizing the need for comprehensive care strategies aimed at improving their functional independence and overall quality of life.
10) Male:
Male denotes a demographic aspect in the study, highlighting the gender distribution of MMC cases. Understanding these statistics is important for recognizing potential differences in how MMC may present in boys versus girls, ultimately affecting treatment approaches and how pediatric healthcare services target and deliver care to this population.
11) Northern India:
Northern India refers to a geographic context that underscores the relevance of evaluating MMC in this region. The potential environmental and genetic factors influencing the incidence of neural tube defects. Documenting the prevalence and outcomes specific to this area supports targeted health initiatives and reinforces the need for localized healthcare research.
12) Perception:
Perception relates to the understanding and awareness of both healthcare providers and families regarding the implications of MMC. It underscores the context in which families navigate treatment decisions, the psychological impact of disability on individuals, and the importance of education in shaping expectations for the lived experiences of affected children.
13) Discussion:
Discussion is an integral part of the study, providing critical interpretation of the findings. This section connects results to existing literature, allowing for a broader understanding of MMC's treatment and management. It encourages dialogue about potential improvements in care and explores future directions for research and clinical practice.
14) Teaching:
Teaching pertains to the educational efforts aimed at healthcare professionals and families regarding the management of MMC. This word emphasizes the importance of knowledge transfer for improving clinical outcomes, advancing surgical techniques, and fostering holistic approaches in the ongoing care of children diagnosed with this condition.
15) Grafting:
Grafting refers to a surgical technique that may be employed in the context of repairing large myelomeningocele lesions. Understanding when and how to utilize grafting is vital for achieving optimal closure of defects and minimizing potential complications. This highlights the intricacies involved in pediatric neurosurgery for MMC treatment.
16) Quality:
Quality relates to the assurance of effective care and outcomes for children with MMC. It emphasizes the need for high standards in treatment protocols, post-operative care, and ongoing management to enhance life quality for affected individuals. Quality improvement efforts are essential for addressing the long-term impacts of this condition.
17) Science (Scientific):
Science emphasizes the empirical and evidence-based approaches taken in understanding and managing MMC. It highlights the advancements in neurosurgery, neonatal care, and rehabilitation strategies that stem from rigorous scientific research and clinical trials, underscoring the importance of continued exploration in improving care for affected populations.
18) India:
India signifies the broader geographic and cultural context within which the study was conducted, affecting prevalence rates, healthcare access, and treatment outcomes for conditions like MMC. Understanding regional differences informs tailored healthcare strategies and enhances awareness of specific challenges faced by families in managing this congenital condition.
19) Kumar:
Kumar is a common name referenced in the study concerning research on MMC. It represents contributors to the body of knowledge regarding the condition's epidemiology, treatment, and outcomes. Acknowledging the work of individuals in this field reflects the collaborative nature of advancing pediatric healthcare and improving clinical practices.
20) Death:
Death refers to the severe outcomes associated with untreated or poorly managed MMC, particularly in relation to hydrocephalus. Understanding the mortality risks linked to this condition encourages proactive interventions and reinforces the critical necessity for timely surgical repairs, thorough post-operative monitoring, and comprehensive care to prevent life-threatening complications.
21) Hadi:
Hadi is noted as a contributor to studies on MMC, indicating research from particular regional perspectives. The mention of this name highlights the importance of diverse contributions to the overall understanding of neural tube defects, fostering collaborative efforts and cross-regional research that inform clinical practices and enhance patient care.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Factors Influencing Outcomes After Myelomeningocele Repair in Children’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Child, Early childhood, Spinal Cord, Environmental factor, Patient management, Multivariate analysis, Lesion size, Neurosurgery, Significant association, Cesarean delivery, Motor function, Neural tube defect, Multidisciplinary team approach, Cerebrospinal Fluid, Deep tendon reflexes, Sphincter function, Hospital stay, Mode of delivery, Urinary Incontinence, Surgical repair, Ambulatory status, Faecal incontinence, Hydrocephalus, Multidisciplinary team, Parental age, Skin necrosis, Ambulatory function, Neurological function, Spina bifida, Hydrocephalus complications, Intracranial Pressure, Ventriculoperitoneal shunt, Wound complications, Surgical complication, Sphincter control, Neurological deterioration, Myelomeningocoele, Cerebrospinal fluid shunt, Anatomical level, Functional level, Delivery mode, Multiple logistic regression, Functional independence, Grade I, Grade II, Odds ratios ORs, Shunt complications, Spinal cord function, Orthopaedic management, Multiple factors, MMC, Lesion, Lumbar lesions, Ambulation status.