Prenatal predictors of ambulation without assistance by 30 months of age in children following prenatal repair of open spina bifida, a systematic review and meta‐analysis

Abstract

ObjectivesWe aimed to investigate prenatal predictors for ambulation without assistance in children following prenatal repair of open spina bifida (OSB).MethodsA systematic search was conducted in three databases until June 2022. We included articles reporting on prenatal repair of open spina bifida (OSB) and ambulation outcomes. The random‐effect model was used. Effect sizes are presented as odds ratio (OR), using the Mantel–Haenszel test, with 95% confidence interval (CI).ResultsFive studies encompassing 460 pregnancies that underwent prenatal repair of OSB of which a total of 234 had data on ambulation and were included. The follow‐up age for all included studies was 30 months. Two studies were open repairs, two were fetoscopic repairs, and one included both open and fetoscopic repairs. Of the 234 included population, ambulation without assistance occurred in 159/234, 68% (95% CI 58, 76), and ambulation with assistance occurred in 75/234, 32% (95% CI 23.6, 41.6). Significant prenatal preoperative predictors that are negatively associated with ambulation without assistance were lateral ventricle (LV) width ≥15 mm (OR: 0.29; 95% CI 0.12, 0.69, I2 = 0.0%; p < 0.0001), lesion level T12‐L2 (OR: 0.22; 95% CI 0.07, 0.7; I2 = 65%, p = 0.01), and severe hindbrain herniation (OR: 0.28; 95% CI 0.1, 0.77; I2 = 0.0%; p = 0.01). Factors including gestational age at surgery (p = 0.5), Myeloschisis (p = 0.4), talipes (p = 0.29), and gestational age at birth (p = 0.95) were not significantly associated with ambulatory status.ConclusionFollowing the prenatal repair of OSB, preoperative factors that are negatively associated with walking without assistance were preoperative LV width ≥15 mm, lesion level T12‐L2, and preoperative severe hindbrain herniation. These results provide pertinent counselling points for parents with pregnancies affected by OSB considering a prenatal repair.