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Sleep in infants with myelomeningocele—an opportunity to improve outcomes?

Journal of Perinatology volume 39, pages 1325–1326 (2019)Cite this article

Myelomeningocele is the most severe form of spina bifida. Exposure of the spinal cord through a defect in the spine is associated with neurologic deficits below the level of the lesion. In addition, the commonly associated hindbrain herniation (Chiari II malformation) causes significant disability due to resultant cranial nerve and cerebellar dysfunction, as well as abnormalities of the respiratory center in the medulla, and is often accompanied by hydrocephalus.

The Management of Myelomeningocele Study (MOMS) demonstrated that fetal surgery for myelomeningocele can reduce the risk for postnatal hydrocephalus and improve motor outcomes [1]. Yet, none of the prenatal clinical factors measured in MOMS predicted the Bayley-II mental development index (MDI) and the MDI at age 30 months was the same in the fetal and postnatal surgery groups (almost one standard deviation below population means: 89.5 ± 15.0 versus 86.2 ± 18.1, p = 0.22) [2]. As such, neurocognitive challenges are expected for most children with myelomeningocele, even if they had fetal repair of the spinal defect.

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  1. Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA

    Renée A. Shellhaas

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  1. Renée A. Shellhaas
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Correspondence to Renée A. Shellhaas.

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The author has no conflict of interest related to this work. Dr. Shellhaas receives research funding from NIH, PCORI, and the Pediatric Epilepsy Research Foundation. She receives royalties from UpToDate for authorship of topics related to neonatal seizures. She has served as a consultant for Proctor & Gamble.

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Shellhaas, R.A. Sleep in infants with myelomeningocele—an opportunity to improve outcomes?. J Perinatol 39, 1325–1326 (2019). https://doi.org/10.1038/s41372-019-0468-9

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