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4 - Effect of operation time on prognosis and defined additional anomalies among neonatal meningomyelocele cases
Ali Bülbül, Emrah Can, Sinan Uslu, Evrim Kıray Baş, Yüksel Şahin, Adem Yılmaz, Asiye Nuhoğlu
Aim: Evaluation of clinical features, prognosis in early period, and effect of operation time in hospitalized neonates diagnosed for meningomyelocele was aimed.
Materyal and Method: All newborns hospitalized with meningomyelocele diagnosis between January 2006 and December 2009 were involved in the study. Clinical features, defective area, existence of additional anomalies, operation time, applied modalities of treatment, morbidity and mortality data were prospectively recorded in neonatal period. Effect of operation time on mortality and morbidity was evaluated.
Results: 40 patients were assessed throughout the study period, 49% of which were female. Mean birth weight, height, head circumference and mother age were found 3280±450 g; 47,3±3,3 cm; 37,4±5,1 cm, and 25,1±5,2 years respectively. Neither of the mothers were supplied folate support in whole group. 70% of the cases were diagnosed for antenatal meningomyelocele. The meningomyelocele was localized in thoracolumbar (6%), cervical (6%) and lumbar (85%) areas. Mean diameter for pouch of meningomyelocele was 5,3±2,5 cm, whereas 70% (n=28) of the babies had dermal defects. Hydrocephaly 50% (n=20), pes equinovarus 18% (n=7), pelvicalicial ectasia 17% (n=6), acetabular dysplasia 7% (n=3), Arnold-Chiari malformation 7% (n=3), and hydronephrosis 7% (n=3) accounted for additional anomalies. Mean time passed for surgical operation was 3.5±2.1 days; mean durations for hospitalization was 10.8±7.2 days, and for antibiotherapy was 7.2±3.2 days. 21 cases were applied autologous graft. Cases operated later than three days were longer hospitalized, they had longer antibiotherapies, and higher complication rates (p 0,04; p 0,02 and p 0,01 respectively) in neonatal period.
Conclusions: Surgical operation of patients diagnosed for meningomyelocele in neonatal period in no more than three days reduces durations for hospitalization and antibiotics usage, and complication rates significantly, as well.
Keywords: Newborn, meningomyelocele, morbidity, time for operation, complication
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