Neural tube defects in newborns

OBJECTIVE: The aim of this study was to review cases of neural tube defect with special focus on presentation, epidemiology and clinical presentation. Management with complications and results of surgery were discussed.

METHODS: Ninety-three cases, born with neural tube defect (spina bifida aperta) were operated upon in our unit at King Hussein Medical Centre, Amman, Jordan, from June 1997 to October 2000. Data was retrospectively reviewed and analyzed.

RESULTS: Major neurological deficits were present in 28 cases (complete loss of function below the level of the lesion) and 19 cases were intact. Lesion size was less than 3.5 cm in 72 cases (77.4%); 3.5-7.5 cm in 15 cases (16.1%) and 6 cases were more than 7.5 cm. Seventy-two cases had an intact lesion before surgery while the other 21 cases ruptured either during delivery or soon later. For the site of lesion, 51 cases were lumbar, 22 cases were lumbosacral, 13 cases were thoracolumbar, 4 cases were thoracic and 3 cases were cervical. Early surgery was carried out for all cases, primary closure was possible in all cases. Nineteen cases had post-operative complications, wound infection (superficial) 6 cases (7%), leakage of cerebrospinal fluid 5 cases (5%), meningitis 3 cases (3%), skin necrosis 3 cases (3%) and 2 deaths.

CONCLUSION: Jordan has a large number of born spina bifida cases, as the practice of pregnancy termination is socially and religiously unacceptable. Our approach to management, is to repair all intact patients. For patients with major neurological deficits we advise the family on the natural history of the disease and postoperative status of the patient leaving the decision to the family. The presentation was similar to that described in literature.