Sensory Level and Renal Prognosis in Myelomeningocele

Gm, Hunt; Mc, Bishop; Rh, Whitaker; Pt, Doyle

doi:10.1055/s-2008-1063379

Cited by 5 publications

(7 citation statements)

References 3 publications

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“…But this did not seem to influence the consistent relationship between neurological deficit and urological deaths. However, even though there were none in this cohort, urological‐related deaths have been reported in those with a sacral sensory level …”

Section: Discussionmentioning

confidence: 72%

“…The novel finding that urological deaths reflect the extent of the neurological deficit in infancy has important clinical implications. Those with sensory levels of L1 and above lack normal bladder sensation and function, and are more likely than those with a lower sensory level to have a palpable, poorly emptying bladder and renal damage . They may be unaware of an overfull bladder, or may have detrusor‐sphincter incoordination leading to renal damage because of back‐pressure or even to bladder rupture .…”

Section: Discussionmentioning

confidence: 99%

“…However, even though there were none in this cohort, urological-related deaths have been reported in those with a sacral sensory level. 20…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

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Neurological level at birth predicts survival to the mid‐40s and urological deaths in open spina bifida: a complete prospective cohort study

Oakeshott

Reid

Poulton

et al. 2015

Develop Med Child Neuro

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AimTo conduct a 50-year complete, community-based, prospective cohort study to investigate long-term survival, causes of death, and influence of level of the lesion in treated open spina bifida.MethodThe cohort comprised 117 consecutive cases whose backs were closed non-selectively at birth between 1963 and 1971 in Cambridge, UK. In 2013 we surveyed the survivors (n=39, 18 males, 21 females; mean age 46y, range 43–49y) by postal questionnaire and telephone interview. We compared outcomes in those born with a neurological deficit in terms of sensory and motor levels of L1 and above versus L2 and below.ResultsTwo-thirds of the cohort (78/117) had died. Causes of death were cardiorespiratory (n=26), neurological (n=24), urological (n=22), or other (n=6). Only the urological deaths were related to level of the lesion: there were none in those with a sensory level of L2 or below (p<0.001). Birth findings also predicted survival: of the 57 infants with a neurological level of L1 or above, only 12% (n=7) survived compared with 55% (30/55) of the remainder (p<0.001).InterpretationThe increased mortality in those born with an extensive neurological deficit was mainly due to urological deaths. Neurological level, particularly the sensory level, is the best predictor of long-term outcome and should be assessed routinely at birth.What this paper addsIn open spina bifida, sensory level predicts urological life expectancy.Death due to urological causes only occurred in those with a sensory level of T6–L1.Neurological level predicts outcome better than cutaneous or radiological level.Sensory level should be assessed in all infants with open spina bifida.This article is commented on by Worley on pages 594–595 of this issue.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Neurological level at birth predicts survival to the mid‐40s and urological deaths in open spina bifida: a complete prospective cohort study

Oakeshott

Reid

Poulton

et al. 2015

Develop Med Child Neuro

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“…[1][2][3] Studies of children with spina bifida show that those most severely affected, who have the most extensive neurological deficit, are most likely to die of urological complications. [4][5][6][7] Continence is also related to neurological deficit, 8 particularly in terms of sensory level. 9 10 However, sensory testing is sometimes omitted from evaluation of urinary function and prognosis in open spina bifida because it can be difficult and occasionally confusing.…”

mentioning

confidence: 99%

Perineal sensation: an important predictor of long-term outcome in open spina bifida

Oakeshott

Hunt

Whitaker

et al. 2007

Archives of Disease in Childhood

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Objectives: To see if perineal sensation in infants with open spina bifida is associated with a better long-term outcome, particularly in terms of survival, renal-related deaths and incontinence. Methods: We conducted a prospective cohort study on a complete cohort of 117 consecutive patients with open spina bifida, whose backs were closed non-selectively at birth between 1963 and 1971. A meticulous neurological examination in infancy showed that 33 (28%) of them had perineal sensation, defined as intact sensation to pinprick in at least one dermatome on one side in the saddle area (S2-4). Data recorded within 48 h of birth and during six reviews between 1972 and 2002 were used. Details of deaths were obtained from medical records and from the Office of National Statistics. Results: By December 2005, 57% (67/117) of the cohort had died. There were 50 survivors with a mean age 38 years (range 35-41). More of those with perineal sensation survived than those without (23/33 v 27/84, p,0.001). This difference was mainly caused by 19 renal deaths in those lacking perineal sensation. Crucially there were no renal-related deaths in those with perineal sensation (0/33 v 19/84, p = 0.003). Among the survivors, those with perineal sensation were more likely than the remainder to be continent of urine and faeces (10/23 v 1/27, p,0.001 and 18/23 v 9/27, p = 0.002 respectively). They were also more likely to be able to walk at least 50 m (11/23 v 5/27, p = 0.027) and never to have had pressure sores (15/ 23 v 9/27, p = 0.025). Conclusions: A simple assessment of perineal sensation in infancy predicts long-term outcome in terms of survival, renal prognosis and incontinence in open spina bifida.

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“…Among those who would have died unoperated would have been the ones with the worst renal prognosis. As noted previously (3,6,9) the most severely afTeeted cases also had a worse renal prognosis. Where selection has been practised the overall mortality was higher (I, 2), the untreated cases generally dying in infancy, but the handicaps ofthe survivors were less severe (8,10,11).…”

Section: Discussionmentioning

confidence: 80%

A Study of Deaths and Handicap in a Consecutive Series of Spina Bifida Treated Unselectively from Birth

Gm¹

1983

Eur J Pediatr Surg

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In a consecutive series of spina bifida operated unselectively at birth 62% reached the twelfth birthday and 54% could be expected to reach the nineteenth. Many of the most severely affected cases survived; if they died the cause was usually renal failure. Bronchopneumonia was the main cause of death in infants and hydrocephalus in the older children. Girls outnumbered boys by 1:1.3 and, although they were more severely affected, their survival equalled the boys'. Awareness of the high survival rate which results from the treatment of spina bifida is important for the parents of a newborn baby. It is also a prerequisite in planning provision for the young adult.

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Sensory Level and Renal Prognosis in Myelomeningocele

Cited by 5 publications

References 3 publications

Neurological level at birth predicts survival to the mid‐40s and urological deaths in open spina bifida: a complete prospective cohort study

Neurological level at birth predicts survival to the mid‐40s and urological deaths in open spina bifida: a complete prospective cohort study

Perineal sensation: an important predictor of long-term outcome in open spina bifida

A Study of Deaths and Handicap in a Consecutive Series of Spina Bifida Treated Unselectively from Birth

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