Pediatric Myelomeningocele

Publication Date: August 1, 2019
Last Updated: March 14, 2022

RECOMMENDATIONS

Prenatal repair of MM is recommended for those fetuses who meet maternal and fetal Management of Myelomeningocele Study (MOMS) specified criteria for prenatal surgery to reduce the risk of developing shunt-dependent HC.

(Level I)
Differences between prenatal and postnatal repair with respect to the requirement for permanent cerebrospinal fluid diversion should be considered along with other relevant maternal and fetal factors when deciding upon a preferred method of MM closure.
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When possible, for prenatally diagnosed fetuses with MM who meet maternal and fetal MOMS inclusion criteria, prenatal closure of MM should be performed, which may improve ambulatory status for patients in the short term (at 30 mo of age). (Level II)
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Long term benefit for ambulatory status with prenatal closure is unknown. Children who have had either prenatal or postnatal closure should be carefully followed for the development of tethered spinal cord with the associated loss of ambulatory function. (Level III)
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There is insufficient evidence to confirm that closure of MMs within 48 hours decreases the risk of wound infection.

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It is recommended that if MM closure is delayed beyond 48 hours, antibiotics should be initiated. (Level III)
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Currently, there is insufficient data to conclude that ventricular size and morphology impact neurocognitive development.

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Continued surveillance for tethered cord syndrome and/or the development of inclusion cysts in children with prenatal and postnatal closure of MM is indicated, since there is evidence that prenatal closure increases the risk of recurrent tethered cord over the baseline rate seen with postnatal closure.

(Level II)
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Recommendation Grading

Overview

Title

Pediatric Myelomeningocele

Authoring Organizations

American Academy of Pediatrics

Child Neurology Society

Congress of Neurological Surgeons

Publication Month/Year

August 1, 2019

Last Updated Month/Year

January 31, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Child, Infant

Health Care Settings

Ambulatory, Childcare center, Hospital, Long term care, Operating and recovery room

Intended Users

Physician, nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D016136 - Spina Bifida Occulta

Keywords

Spina bifida, fetal, In utero, Myelomeningocele, Postnatal, Tethered cord syndrome, Guidelines