The mortality rate after hospital discharge in patients with myelomeningocele decreased after implementation of mandatory flour fortification with folic acid

Abstract

ARTICLEThe mortality rate after hospital discharge in patients with myelomeningocele decreased after implementation of mandatory flour fortification with folic acid Redução da taxa de mortalidade após a alta hospitalar em pacientes com mielomeningocele depois da implementação da fortificação obrigatória das farinhas com ácido fólico Myelomeningocele (MMC), or spina bifida cystica, is the most common neural tube defect, developing between days 21 and 28 after fertilization 1,2 . The lack of a protective lining exposes the neural tissue to gradual destruction due to the deleterious effects of amniotic fluid over the neural plate 3 .The prevalence of MMC varies according to the geographic, racial, and ethnic characteristics of the population being studied, and may differ greatly between different regions of the same continent or country 4,5 . In Brazil, the prevalence of Chiari II malformation (CMII) is estimated to range between 1.4 and 1.5 per 10,000 births 6,7 . The cause of MMC is multifactorial, but folic acid (FA) deficiency is the main risk factor. Chromosomal and genetic abnormalities, maternal hyperthermia during the early stages of pregnancy, use of ABSTRACTObjective: To evaluate the mandatory folic acid fortification of flour on mortality rates after the hospital discharge of children born with myelomeningocele, the most affected age group and the most frequent cause of death. Methods: A retrospective study of 383 children born with myelomeningocele from January 1990 to December 2013 in a high-fetal-risk reference hospital. Results: A total of 39 patients died (10.1%), of which 23 (6%) died after discharge. Most children who died were younger than 12 months of age. The most frequent cause of death was infection of the central nervous system, followed by urinary tract sepsis and infections of the respiratory system. Symptomatic Chiari II malformation was the most frequent comorbidity factor. Conclusion: Although there was no significant difference in infant mortality before and after folic acid fortification, there was a significant reduction in deaths after hospital discharge in babies born after implementation of mandatory folic acid fortification Keywords: meningomyelocele; mortality; folic acid. RESUMOObjetivo: Avaliar a fortificação obrigatória de farinhas com ácido fólico nas taxas de mortalidade após a alta hospitalar de crianças nascidas com mielomeningocele, a faixa etária mais atingida e a causa mais freqüente de morte. Métodos: Estudo retrospectivo de 383 crianças nascidas com mielomeningocele de janeiro de 1990 a dezembro de 2013, em um hospital de referência de alto risco fetal. Resultados: Um total de 39 pacientes morreram (10,1%), dos quais 23 (6%) morreram após a alta. A maioria das crianças que morreram não alcançaram 12 meses de idade. A causa mais frequente de morte foi infecção do sistema nervoso central, seguido por sépsis, infecções do trato urinário e do sistema respiratório. A malformação de Chiari Tipo II foi a comorbidade mais freqüente. Conclusão: Apesar de não haver diferença ...

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