Mengiste Frezer Girma, Shibeshi Mulugeta Sitot, Gechera Dagnachew Yohannes
Department of Pediatrics and Child Health, Hawassa University, Hawassa, Ethiopia.
Department of Neurosurgery, Hawassa University, Hawassa, Ethiopia.
Pediatric Health Med Ther. 2023 Sep 19;14:289-299. doi: 10.2147/PHMT.S421868. eCollection 2023.
There is a huge burden of neural tube defect (NTD) in Ethiopia, and surgical management is not readily available. We aimed to assess the clinical profile and hospital outcome of children with NTD that were operated in Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.
A retrospective cross-sectional study on 250 children with NTD that were treated in a tertiary hospital from March 2016 to May 2020 was conducted to describe the clinical profile and treatment outcome at discharge. Logistic regression analysis was carried out to evaluate factors that determine mortality.
Out of the 250 children, 50.4% were male. Myelomeningocele was the most common type of NTD (77.2%) followed by meningocele (10.4%). Only 3 mothers (1.2%) received periconceptional folic acid. Prenatal diagnosis of NTD was made in only 22 (8.8%) cases. 52.8% of the NTDs were ruptured at presentation and 50.8% had associated sepsis. At presentation, 42.4% were ≤72 hours of age and only 18 neonates (7.2%) were operated within 72 hours of admission. 54% had associated hydrocephalus, 31.6% had Chiari II malformation and 19.6% had club foot. Surgical site infection, post MMC repair hydrocephalus, and meningitis were seen in 8%, 14% and 16.8% of the participants, respectively. The mean duration of hospitalization was 24 ± 14.4 days. Twenty patients (8%) died before discharge from hospital. Prematurity [AOR: 26 (95% CI: 8.01, 86.04), P < 0.001] and the presence of meningitis [AOR: 3.8 (95% CI: 1.12,12.9), P = 0.03]were determinants of mortality.
NTDs are substantial health problem in this part of the country. Periconceptional folic acid supplementation is almost non-existent. Prenatal detection of NTDs is very low and management is delayed in the majority of cases. Myelomeningocele is the most common type of NTD. There is high in-hospital mortality, and prematurity and the presence of meningitis are its determinants.
埃塞俄比亚神经管缺陷（NTD）负担沉重，且手术治疗难以获得。我们旨在评估在埃塞俄比亚哈瓦萨市哈瓦萨大学综合专科医院接受手术的NTD患儿的临床特征及住院结局。
对2016年3月至2020年5月在一家三级医院接受治疗的250例NTD患儿进行回顾性横断面研究，以描述出院时的临床特征和治疗结局。进行逻辑回归分析以评估决定死亡率的因素。
250例患儿中，50.4%为男性。脊髓脊膜膨出是最常见的NTD类型（77.2%），其次是脑膜膨出（10.4%）。只有3名母亲（1.2%）在受孕前服用了叶酸。仅22例（8.8%）在产前诊断出NTD。52.8%的NTD在就诊时已破裂，50.8%伴有败血症。就诊时，42.4%的患儿年龄≤72小时，仅18例新生儿（7.2%）在入院后72小时内接受了手术。54%伴有脑积水，31.6%患有Chiari II畸形，19.6%患有马蹄内翻足。手术部位感染、脊髓脊膜膨出修复后脑积水和脑膜炎分别在8%、14%和16.8%的参与者中出现。平均住院时间为24±14.4天。20例患者（8%）在出院前死亡。早产[AOR：26（95%CI：8.01，86.04），P<0.001]和脑膜炎的存在[AOR：3.8（95%CI：1.12，12.9），P = 0.03]是死亡率的决定因素。
NTD在该国这一地区是严重的健康问题。受孕前补充叶酸几乎不存在。NTD的产前检测率极低，大多数病例的治疗延迟。脊髓脊膜膨出是最常见的NTD类型。住院死亡率很高，早产和脑膜炎的存在是其决定因素。
