Quality of life in children with myelomeningocele undergoing intrauterine repair and postnatal surgery.

CONTEXT: Myelomeningocele (MMC) is the most common congenital neural tube defect, affecting multiple organs and significantly impacting survival and quality of life. Intrauterine MMC repair reduces the need for ventricular shunting and increases independent ambulation rates.

OBJECTIVE

To evaluate the quality of life in children with MMC who underwent intrauterine versus postpartum repair.

DESIGN

A cross-sectional study utilized the PedsQL questionnaire, administered to guardians of children aged 2-7 years.

SETTING

Sarah Hospital-Rio de Janeiro.

PARTICIPANTS

This study included 28 children who underwent intrauterine myelomeningocele repair and 65 who underwent postpartum repair.

OUTCOME MEASURES: The statistical tests were logistic regression and Pearson correlation coefficient.

RESULTS

The intrauterine group showed greater ambulation likelihood (P=0.007) and a functional level mainly in lumbar and sacral regions, compared to thoracic and lumbar functional levels in the the postpartum group (P=0.004). Hydrocephalus was present in 89.3% (25) of the intrauterine group and 100% (65) of those in the postnatal group (P=0.025). Ventriculoperitoneal (VP) shunting was required in 49.2% (12) of the intrauterine group and 60.0% (52) in the postpartum group (P=0.001). Clean intermittent catheterization was performed in 82.2% (25) of children with intrauterine repair and 81.5% (53) of those with postpartum repair (P=0.945). Prematurity was higher in the intrauterine group (OR 10.25; 95% CI 3.17-33.10). Guardians reported better quality of life in physical (P=0.035), social (P=0.035), psychosocial domains (P=0.019), and total score (P=0.016) for the intrauterine group.

CONCLUSION

Intrauterine repair was associated with better health-related quality of life outcomes.