Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

Bradko, Viachaslau; Castillo, Heidi; Janardhan, Shruthi; Dahl, Benny; Gandy, Kellen; Castillo, Jonathan

doi:10.14245/ns.1836342.171

Cited by 18 publications

(12 citation statements)

References 68 publications

(85 reference statements)

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“…These unfavorable outcomes are still highly prevalent also in HICs [9,19]. Thus, despite the achievement of advanced standards of care and the improvements in neonatological management and surgical techniques [8,25,26], they have been observed also in some of our patients.…”

Section: Discussionmentioning

confidence: 93%

Neonatal ten-year retrospective study on neural tube defects in a second level University Hospital

et al. 2020

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Background: Aim of this retrospective study was to describe clinical characteristics, diagnostic work-up, management and follow-up of newborns with neural tube defects (NTDs), admitted to the Mother and Child Department of the University Hospital of Palermo, in a ten years period. Methods: The medical records of 7 newborns (5 males and 2 females) admitted, over a 10-year period from January 2010 to March 2020, to our Department on the first day of life were reviewed. Analyzed data were related to familiar and/or maternal risk factors (consanguinity, maternal preexisting and/or gestational diseases, exposure to teratogen/infectious agents, lack of preconception folic acid supplement), demographic (ethnicity/origin, residence) and clinical features (eventual use of assisted reproduction techniques, prenatal diagnosis, gestational age, fetal presentation, type of delivery, birth weight, preoperative imaging, antibiotics and analgesics use, description of the surgery intervention, length of hospital stay, comorbidities, complications), and follow-up. Results: In our sample we observed a wide spectrum of NTDs: 3 newborns had open NTDs, namely myelomeningocele (2 lumbosacral, one of which associated with extradural lipoma, and 1 sacral), and 4 closed ones, including 2 with meningocele (occipital), 1 filar lipoma associated with dermal sinus, and 1 terminal myelocystocele. Our patients were discharged between 8 and 22 days of life. The neurodevelopmental follow-up showed a favorable outcome for 4 of the 7 patients, and the appearance over time of neurological impairment (motor and/or autonomic) in the newborns with open NTDs. Conclusions: This study describes familiar and/or maternal risk factors and demographic and clinical features of a single-center series of newborns with NTDs. It may provide a further outline of the actual phenotypic spectrum of these malformations, and new insights into epidemiological aspects and comprehensive management of the patients, including diagnostic work-up and follow-up evaluations.

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Section: Discussionmentioning

confidence: 93%

Neonatal ten-year retrospective study on neural tube defects in a second level University Hospital

et al. 2020

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“…Several similar activities have benefited from, and possibly been spawned by, EBM. These measures have included an emphasis on comparative research on the effectiveness [33] over or under assessment and treatment [34]. quality-of-care measurements [35], enhancing publication standards [36], guaranteeing that all investigations are registered [37,38], and minimizing waste in research production, such as the discontinuation of misdirected initiatives, which have become standard practice.…”

Section: Progress In the Status Of Evidence-based Medicinementioning

confidence: 99%

Evidence-Based Treatment, assisted by Mobile Technology to Deliver, and Evidence-Based Drugs in South Asian Countries

Wal¹,

Khandai²,

Vig³

et al. 2022

Arch Pharm Pract

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Individual clinical experience is combined with the best possible external clinical data from systematic research in the practice of evidencebased medicine. Data-based treatment is a complete approach to treating healthcare problems that allow the best available research evidence to be combined with clinical experience and patient choices. Evidence-based medicine's obligations to the medical industry and allied areas in terms of creating a platform for integrating research findings into healthcare delivery and raising awareness of the need to take individual patient preferences into account. In terms of culture and medical practice, South Asian countries are different. This region has little understanding of evidence-based medicine. Evidence-based medications have been adopted in some parts of South Asia, according to multiple survey data, while it is yet unknown in others. Treatments for mobile phones are fast expanding, and a preliminary study indicates that South Asian countries could benefit from this technology as well. People can benefit from digital healthcare initiatives in a variety of ways, including improved skill-training opportunities in real-world situations, continual assistance from medical practitioners, and better drug management. Evidence-based medications will become more accessible and successful as a result of the combination of Evidence-based medications with mobile technologies. It will also allow for a timelier deployment of Evidence-based medications.

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“…Occult spinal dysraphism can be of varied embryologic etiologies but mostly they are associated with tethering of the spinal cord. The most common occulta forms are lipomas, diastematomyelia, diplomyelia, split cord malformations and dermoid tumors (Bradko et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Spinal Dysraphism: Presentation, Management and Outcome of Patients undergoing Surgery

Gupta

Bhat

Sharma

et al. 2021

ijirms

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The development of the spinal cord can be summed up in three developmental stages: gastrulation (2–3 weeks), primary neurulation (3-4 weeks) and secondary neurulation (5–6 weeks). Any sort of deviance in any of these stages causes anomalies in spine and spinal cord; these anomalies are referred as spinal dysraphism. The approximated incidence of spinal dysraphism is about 1/1000 live births. The present study aims at varied presentations, management and surgical consequences in spinal dysraphism. Methods: A study on surgical treatment of spinal dysraphism was done over the period of 6 months from December 2019- May 2020 at GMC, Jammu. In the study at hand; the clinical aspects, management and surgical outcomes in case of spinal dysraphism were characterized. Results: A total of 30 patients of spinal dysraphism were operated with 70% males and 30% females. The age group selected for the study was between 0-3 years. In early post-operative period the most common symptoms were found to be meningitis (6%), minor wound infection (10%), major wound infections (14%) and 14% patients reported CSF leakage. Out of 30 patients who underwent surgery, 67% patients had good outcome, 20% reported satisfactory outcome and 13% reported poor outcome with an overall mortality rate of 13%. Conclusion: Spinal dysraphism is a complex disorder and requires a multidisciplinary approach for management. The present study suggests that surgery is the prominent treatment along with good post-operative care for the better life of the patient.

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Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

Cited by 18 publications

References 68 publications

Neonatal ten-year retrospective study on neural tube defects in a second level University Hospital

Neonatal ten-year retrospective study on neural tube defects in a second level University Hospital

Evidence-Based Treatment, assisted by Mobile Technology to Deliver, and Evidence-Based Drugs in South Asian Countries

Spinal Dysraphism: Presentation, Management and Outcome of Patients undergoing Surgery

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