Demography and management outcome of neural tube defects in a Nigerian tertiary health institution (original) (raw)
Related papers
Pattern and Management of Neural Tube Defect in Cameroon
Open Journal of Modern Neurosurgery
Objectives: The aim of study was to determine the pattern and management of neural tube defects (NTD). Methodology: It was a hospital based descriptive cross-sectional retrospective study on patients who consulted and/or were admitted at the Douala General hospital for neural tube defects from January 2005 to April 2015. Results: A total of forty-nine (49) patients were enrolled. Males constituted 59.8% and females 40.2% giving a sex ratio of 1.5 in favour of males. Most of the parents of the patients (71.5%) had a low socioeconomic status. Myelomeningocele was the most common type (80.4%) followed by 17.4% cases of meningocele and 2.2% cases of lipomeningocele. Three cases (3) of encephaloceles were seen during this period. The commonest site of these defects was the lumbosacral region (47.8%). Other sites included lumbar (19; 41.3%), sacral (3; 6.5%) and thoracolumbar (2; 4.3%) ones. About half of the patients (24; 48.9%) presented with ruptured lesions. Hydrocephalus was also recorded in 65.3% of patients. Talipes equinovarus and talipes calcaneovalgus were the most common associated orthopedic birth defects found. Surgical closure was done for 44 (89.9%) patients. Ventriculoperitoneal shunting was done in 78.1% of those who presented with hydrocephalus. Post-operative complications were more frequent in patients with ruptured lesions (P = 0.001). The most common post-operative complications were wound infections (22; 44.9%) and wound dehiscence (20; 40.8%). Conclusion: Lumbosacral Myelomeningocele was the most common type of NTD in our region. Low socioeconomic status was a common risk factor.
Congenital Myelomeningocele and Hydrocephalus: A Clinical Audit
Congenital Myelomeningocele and Hydrocephalus: A Clinical Audit, 2018
Short Communication IntRoductIon Congenital myelomeningocele (MMC) and hydrocephalus (HCP) are common pediatric neurosurgical conditions in our country, and it is a major contributor to the local burden of surgically treatable diseases. MMC is characterized by a protrusion of the meninges and spinal cord through open vertebral arches, which results in varying degrees of paralysis, mental retardation, bowel and bladder dysfunction, as well as orthopedic disabilities. [1] Significant health disparities exist for the treatment of MMC and HCP in developing countries due to a combination of medical and socioeconomic factors. This clinical audit reviews 74 cases in single tertiary care hospital in Tripoli, Libya. It was conducted by collaboration of neurological surgery and obstetric departments of a tertiary care hospital in Tripoli (Tripoli Medical Center). Our aim was to determine the magnitude of cases and an overview of the current challenges and future directions of neurosurgical care for children with congenital MMC and HCP in Libya. MateRIals and Methods Setting This was a prospective study of 74 cases whose data were collected as per the pre-prepared data sheet in a single tertiary institute in Tripoli (Tripoli Medical Center) from February 2017 and December 2017. Background: Congenital Myelomeningocele and congenital Hydrocephalus are among the most common pediatric neurosurgery diseases in Libya. This paper elucidates the experience of authors in clinical audit of seventy four cases diagnosed as congenital Myelomeningocele and hydrocephalus, in the period of time (Feb 2017 to Dec 2017). Materials and Methods: This was a prospective study of 74 cases whose data were collected as per the pre-prepared data sheet in a single tertiary Institute in Tripoli (Tripoli Medical Center) from February 2017 and December 2017. Results: Management of 74 patients with complete data was analyzed. Of 74 patients, 20 (27%) patients were isolated MMC, 25 (34%) were isolated HCP, and 29 (39%) occurring in association with MMC. From a total of 74 patients, 34 (45%) were male and 40 (54%) were female. Furthermore, 27 (36%) patients delivered as premature infant and 47 (63%) were full term. The method of delivery was by cesarean section in 69 (93%) cases and by normal vaginal delivery in 5 cases (1%). The prenatal diagnosis of MMC and HCP using ultrasound was established in 70 (94%) cases. Head circumference of all cases at the time of delivery was ranged from 33 to 56 cm.The surgical management of all 74 cases after the diagnosis in our neurosurgical department was as follows: Ventriculoperitoneal (VP) shunts inserted in 63 cases (85%). MMC repair was performed in 38 cases (51%). Most patients 55 (74%) were discharged routinely after VP shunt insertion and MMC repair, while 19 (26%) died in hospital. Further, folic acid intake by dose of (0.4 mg) orally was documented in 31 (41%) pregnant women, and 43 (58%) cases were not taken folic acid. The timing of folic acid intake was after the pregnancy was confirmed in all cases. Conclusion: This review demonstrates a single-institute experience and the current challenges in the management of both MMC and HCP in Libya. The Awareness of the mandatory intake of folic in our society is a national call.
Experience in the Early Surgical Management of Myelomeningocele in Zanzibar
World Neurosurgery, 2019
BACKGROUND: Neural tube defects are a large health burden for East African countries. Health strategies in the prevention of this disease include nutritional prophylaxis, prenatal diagnosis, and availability of early neonatal neurosurgery. The main objective of this study is to describe our experience in the early surgical management of neural tube defects in the Zanzibar archipelago.-METHODS: From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of myelomeningocele. We collected variables regarding demographics, maternal health, preoperative imaging, surgical procedures, and complications at follow-up.-RESULTS: We collected data on 19 patients. Mean age was 9.8 AE 18.7 days. Of these patients, 52.6% were male and 47.3% were female; 47.3% patients were from Unguja, 42.0% from Pemba, and 5.2% from mainland Tanzania; 68.4% of all mothers were found to have undergone prenatal ultrasonography and 89.5% of all patients received surgery. Surgical wound infection was present in 29.4% of all surgical patients and 52.9% developed secondary hydrocephalus.-CONCLUSIONS: Neural tube defects are a prevailing condition in East Africa. We believe that more health initiatives should address its prevention, mainly through maternal nutrition. On the basis of our findings, we consider early neonatal neurosurgery as the most important factor in reducing immediate morbidity and mortality.
Neural tube defects in Uganda: follow-up outcomes from a national referral hospital
Neurosurgical Focus
OBJECTIVEChildren with neural tube defects (NTDs) require timely surgical intervention coupled with long-term management by multiple highly trained specialty healthcare teams. In resource-limited settings, outcomes are greatly affected by the lack of coordinated care. The purpose of this study was to characterize outcomes of spina bifida patients treated at Mulago National Referral Hospital (MNRH) through follow-up phone surveys.METHODSAll children presenting to MNRH with NTDs between January 1, 2014, and August 31, 2015, were eligible for this study. For those with a documented telephone number, follow-up phone surveys were conducted with the children’s caregivers to assess mortality, morbidity, follow-up healthcare, and access to medical resources.RESULTSOf the 201 patients, the vast majority (n = 185, 92%) were diagnosed with myelomeningocele. The median age at presentation was 6 days, the median length of stay was 20 days, and the median time to surgery was 10 days. Half of the ...
A Study on clinical profile of neural tube defects in a Tertiary care hospital
Paripex journal of medical research, 2023
Background And Objectives:-Neural tube defects (NTDs) are birth defects of the central nervous system, adversely affecting the development of the brain, spinal cord, and the spinal nerves. Neural tube defects are a group of severe congenital disorders associated with substantial mortality, morbidity, long-term disability, and psychological and economic costs. Aims And Objectives Of The Study: 1. To study clinical profile of neural tube defects. 2. To study complications of neural tube defects. Materials And Methods: After obtaining ethical committee clearance and informed consent from the parents, 30 subjects diagnosed with neural tube defect, were included in the study based on inclusion criteria. A detailed history was taken from each subject's informant including, age, gender, birth details, consanguinity, antenatal visits/investigations, family history of congenital malformations. Clinical examination of each subject was performed. Relevant investigations were done such as ultrasonography, CT and MRI of brain and spine. Among 30 study Results: subject females: male ratio is 3:2, Lower socioeconomic status and consanguineous marriage were statistically significantly associated with neural tube defect with p value of 0.0001 and 0.020 respectively. Lack of Folic acid supplementation was associated with increased risk of neural tube defect with a p value of 0.001 which is statistically significant. In our study, we observed that Myelomeningocele was most common which accounted for 36.6% of cases followed by Spina bifida occulta (20%), Myelomeningocele with diastematomyelia(10%), Encephalocele(10%), Meningocele(6.6%), Diastematomyelia(6.6%), Holoprosencephaly with Tethered spinal cord(3.3%), Lipomeningomyelocele(3.3%), Anencephaly (3.3%). Within the constraints of the present study, it can be Conclusion: concluded Folic acid supplementation is helps to prevent neural tube defects. Neural tube defects are more prevalent in consanguineously married couple and lower socioeconomic status.
Childs Nervous System, 2007
Introduction Prenatal diagnosis of myelomeningocele (MMC) has permitted a better planning for optimum management of the disease. More recently, it has allowed for a possible intrauterine repair of the spinal defect. Objective To describe neurosurgical outcome in children with myelomeningocele and follow-up at a referral center in Fetal Medicine. Patients were characterized for the development of a protocol suitable for fetal surgery, and fetuses who were possible candidates for intrauterine surgery were identified. Materials and methods A retrospective descriptive analysis was performed of 98 cases of fetal myelomeningocele, seen at CAISM-UNICAMP, from January 1994 to December 2002, identifying cases with a possible indication for fetal surgery. Results Mean gestational age at diagnosis was 29 weeks (17–39); level of lesion was above the sacral region in 92.84%; association with hydrocephalus occurred in 78.57%. During clinical course, 82.5% of patients had neurogenic bladder and 60% had neural and mental deficits. Potential intrauterine repair rate was 11.57%, using criteria from the protocol developed in our service. Conclusion Myelomeningocele is associated with severe and frequent sequelae. In virtually 12% of our cases, fetal surgery could have been offered as a therapeutic option.
2021
Background: Neural Tube Defects (NTDs) are the world's second most common birth defects after cardiovascular defects. In developing countries like Zambia, these defects are unrecognized and under reported. Despite the administration of folic acid, there have been incidences of NTDs though no local literature points out the frequency of these defects. In order to make informed interventions and programmatic decisions that will achieve significant reductions in patients with NTDs, local studies are needed. There is a need to describe the burden of NTDs and identify gaps in available NTD data. Therefore, the aim of this study is to determine the frequency and distribution of Neural Tube Defects (NTDs) at Arthur Davison Children Hospital (ADCH). Methods: A cross sectional retrospective study was conducted to review medical records of children aged 1 day to 5 years who attended ADCH between 2018 and 2020 w. All children that were attended to during the study period were included in the study provided they meet the inclusion criteria. Data was collected using a data extraction sheet and descriptive analysis was done using Statistical Package for Social Science (SPSS) version 16. Results: A total of 52 patients with NTDs were identified from October 2018 to May 2020 patients' registers, which constituted the study sample. The sample had more boys 61.5% than girls 38.5% female with the majority 78.8% aged between one day to twenty-eight days. The majority of the children were from Copperbelt province with 88.5%, while the minority were from Muchinga province 1.9%. However the majority of children were from Ndola district 61.5% and the minority from Mpika district 1.9%.The study showed that many children (96.2%) presented with Spinal Bifida (SB) and lastly encephalocele (3.8%). Myelomeningocele was the most common type of SB (21.2%). Hydrocephalus was the most common associated anomaly (19.2%) while the least associated anomaly was Microcephaly (3.8%). Conclusion: The study showed that the majority of children were from Ndola district on the Copperbelt province and most children were admitted between day one and twenty eight days after birth. SB was the most common type of NTDs, and among these, those with myelomeningocele were the majority. Hydrocephalus was the most common associated impairment with majority of patients not undergoing any surgical interventions. The findings from this record review suggest that management of children with NTDs in Zambia is faced with challenges such as late presentation. This is consistent with literature which indicates that developing countries have higher incidences of children with NTDs and yet are faced with many challenges related to prevention and management.
International Journal of Neurologic Physical Therapy
Background: Neural tube defects (NTDs) are one of the commonest malformations with worldwide prevalence of 1-3 per1000 live births. They are resulted by failure of neural tube to close during neurulation in 21-28 embryonic days and it's a multi-factorial in etiology. Currently in Zambia there is no published data regarding NTDs at Arthur Davison Children Hospital (ADCH). Therefore this study was used to assess the frequency and distribution of NTDs at ADCH and will serve as base line reference for further studies. Method: A descriptive retrospective study was conducted to review medical records of children aged 1 day to 5 years who attended ADCH between September 2018 and May 2020. Results: During the study period, there were 2365 patients admitted at the health institution. NTDs were present in 52 cases, giving a prevalence of 0.022 thus 22/1000 births congenital anomalies of this kind observed at the institution were identified from October 2018 to May 2020 patients' registers, which constituted the study sample. The sample had more boys (61.5%) than girls (38.5%) female with the majority (78.8%) aged between one day to twenty-eight days. The Majority of the children were from Copperbelt province with 88.5%, while the minority were from Muchinga province (1.9%). However the majority of children were from Ndola district (61.5%) and the minority from Mpika district (1.9%). The study showed that many children (96.2%) presented with Spinal Bifida (SB) and lastly encephalocele (3.8%). Myelomeningocele was the most common type of SB (21.2%). Hydrocephalus was the most common associated anomaly (19.2%) while the least associated anomaly was Microcephaly (3.8). Conclusion: The study showed that the majority of children were from Ndola district on the Copperbelt province and most children were admitted between day one and twenty eight days after birth. SB was the most common type of NTDs, and among these, those with myelomeningocele were the majority. Hydrocephalus was the most common associated impairment with majority of patients not undergoing any surgical interventions.
Introduction: Several congenital malformations affect developing fetuses, among which Neural tube defect (NTD) is most common. Folic acid supplementation brought decline in the incidence of NTDs. The present study aims at finding the incidence of NTDs in a tertiary care hospital and compares the results with the similar Indian studies published earlier. Materials and Methods: The study was done at Chettinad Hospital & Research Institute (CHRI), Kelambakkam. The total number of deliveries was recorded for a period of five years from 2009 to 2013. Fetuses which were still born with neural defect were collected and observed in detail externally for the sex, type of NTD and other associated anomalies. Indian studies published between 1987 and 2014 reporting the incidence of NTDs among the births occurred were retrieved from the Internet and their various observations were used for comparison. R esults: The number of deliveries conducted between 2009 and 2013 at CHRI was 3220. Of these, babies born with NTDs were nine (5 males and 4 females). The incidence of fetuses with meroanencephaly, holoanencephaly, craniorachischisis, encephalocele and myelocele were 0.62, 0.62, 0.93, 0.31 and 0.31 per 1000 births respectively. Overall incidence of NTDs in the present study was 2.79/1000 births. Fetuses with NTDs also had the following anomalies – Club foot, cleft lip and palate and exomphalos. C onclusion: Comparing the results with the previous studies it is clearly evident that the incidence of NTDs have significantly reduced from 11.42/1000 births to 2.79/1000 births. In most of the previous studies NTDs had a female preponderance whereas present study has a male preponderance.In older studies, spina bifida was the most common NTDs followed by anencephaly. But in the present study anencephaly was the common NTD than spina bifida. Incidence of NTDs has reduced due to various reasons like prenatal screening for fetal anomalies and folic acid supplementation.
Surgical Treatment of Neural Tube Defects
Spina Bifida and Craniosynostosis - New Perspectives and Clinical Applications, 2021
Neural tube defects (NTDs) are developmental pathologies associated with undesirable lifelong consequences. Incidence of these pathologies differs between countries and regions depending on socio-economic and healthcare quality. It is also influenced by folic acid and zinc supplementation. Genetic factors influence probability of NTD, increasing risk of defect in siblings up to 3–8%. Estimated incidence in United States is 3–4/10000 live births, and worldwide incidence increases on about 10/10000 live births. Despite various types and localizations of spina bifida, in all of them neural tissue is in danger. This can lead to various types of neurologic disorders. Not only due to direct damaging of spinal cord and nerve roots but also other parts of central nervous system are also endangered by disturbed prenatal development. Other consequences as orthopedic abnormalities, bladder, and bowel dysfunction influence quality of life. Surgical therapy is often the only possibility to prese...