Open Fetal Versus Postnatal Repair of Spina Bifida Aperta—A Comparison of Neonatal Outcomes

ABSTRACT Objectives To compare the 30‐day outcomes of infants undergoing fetal versus postnatal repair of open spina bifida (OSB) who met the equivalent eligibility criteria. Method A retrospective study of consecutive patients who underwent OSB repair (2018–2022) by a consistent pediatric neurosurgical team. All met the MOMS trial fetal surgery criteria. Primary outcomes included cerebrospinal fluid (CSF) complications, motor function, wound complications and non‐neurosurgical neonatal complications within 30 days of birth. Results Among 109 myelomeningocele repairs (82 fetal and 27 postnatal), postnatal repairs had higher mean birthweight (3116.8 vs. 2477.8 g; p < 0.01) and gestational age at delivery (38 + 1 vs. 34 + 4 weeks + days; p < 0.01). Neonates with fetal repair were less likely to require hydrocephalus treatment (9% vs. 56%, p < 0.01) or have CSF leak (1% vs. 19%, p < 0.01). Wound infection (5.2% vs. 14.8%; p = 0.10) and dehiscence (2.6% vs. 14.8%; p = 0.09) rates were comparable. Respiratory distress syndrome was more frequent with fetal surgery (43% vs. 4%; p < 0.004), although neonatal intensive care (NICU) admission (34% vs. 26%) and neonatal hospital stay were comparable (fetal repair: 15.2 days ± 2.1 vs. postnatal repair: 14.8 days ± 3.1, p = 0.91). Conclusions Open fetal repair was associated with earlier delivery but with comparable NICU and hospital stay and lower hydrocephalus treatment rate at 1 month of age.