Short Term Audit of Outcomes of Children With Neural Tube Defect Repair in a Tertiary Care Center

Introduction: Neural tube defects is typically a disabling condition that results in neurologic, orthopedic, and urologic morbidity. Early diagnosis, surgical intervention and rehabilitation can prevent further neurological damage as well as improve the quality of life as well as ultimate outcome in patients with NTD. Closure of neural tube defects is a common neurosurgical procedure but outcome is highly variable and dependant on multiple factors. The aim of this study was to study outcomes and to identify predictors morbidity of surgically treated NTDs. Aim: Short term audit of outcomes of children with neural tube defect repair in a tertiary care center. Results: A total of 60 babies were included in this study. The median age at admission is 30 days with range from Day 2 -270 of life. Forty-two (70%) of the babies were male and 18 (30%) were female. The median size of swelling at admission was 5cm with range from 2 to 11 cm. Location of swelling were cervical in 4 (6.66%), upper thoracic in 1 (1.66%), dorso-lumbar in 11 (18.33%), lumbar in 22 (36.66%), lumbo-sacral in 19 (31.66%) and sacral in 3 (5%). Weakness in lower limbs was present in 22 (36.66%) patients preoperatively. Neurogenic bladder and bowel along with bilateral CTEV were present in 8 (13.33%) of patients. CSF discharge from swelling was present in 10 (16.66%) patients preoperatively. Preoperative hydrocephalous was present in 15 (25%) patients. Arnold Chiari malformation was present in 18 (30%) patients. Post operatively, wound infection was present in 19 (31.66%), CSF leak was present in 10 (16.66%), new neurological decit developed in 11 (18.33%) and new hydrocephalous developed in 9 (15%) patients. Out of total 60 patients, ventriculo-peritoneal shunt was placed in 22(36.66%) for hydrocephalous. The median length of postoperative stay was 10 days with range from 4 to 28 days. Re-admissions were required in 17 (28.33%) patients and 2 (3.33%) patients were expired due to sepsis and aspiration pneumonia. Conclusion: Neural tube defect is a congenital disorder with signicant morbidity. Early diagnosis, surgical intervention and rehabilitation can prevent further neurological damage as well as improve the quality of life as well as ultimate outcome in patients with NTD. There is considerable delay in surgical management in the majority of cases, requiring concentrated efforts for early surgical management of neonates with NTD to reduce the morbidity and improve the ultimate outcome