Tirsit Abenezer, Bizuneh Yemisirach, Yesehak Bethelehem, Yigaramu Mahlet, Demetse Asrat, Mengesha Filmon, Masresha Samuel, Zenebe Eyob, Getahun Samuel, Laeke Tsegazeab, Moen Bente E, Lund-Johansen Morten, Mahesparan Rupavathana
Division of Neurosurgery, College of Health Science, Addis Ababa University, Ethiopia.
Department of Clinical Medicine, University of Bergen, Norway.
Brain Spine. 2023 Jul 26;3:101787. doi: 10.1016/j.bas.2023.101787. eCollection 2023.
Prevalence of neural tube defects (NTD) is high thus many children are born with a neural tube defect in Addis Ababa, and surgical closure is a commonly performed procedure at the pediatric neurosurgical specialty center.
The primary aim is to study the outcomes in children undergoing surgical closure of NTDs and to identify risk factors for readmission, complications and mortality.
Single-center prospective study of all surgically treated NTDs from April 2019 to May 2020.
A total of 228 children, mean age 11 days (median 4) underwent surgery during the study period. There were no in-hospital deaths. Perioperatively 11 (4.8%) children developed wound complications, none of them needed surgery and there was no perioperative mortality. The one-year follow-up rate was 62.7% (143/228) and neurological status remained stable since discharge in all. The readmission and reoperation rates were 38 % and 8 % and risk factors for readmission were hydrocephalus (80%) and open defects (88%). Hydrocephalus (P = 0.05) and younger age (P = 0.02) were identified as risk factors for mortality. The wound-related complication rate was 55% at and was associated with large defects (P = 0.04) and delayed closure due to late hospital presentation (P = 0.01).
The study reveals good perioperative surgical outcome and further need for systematic improvement in treatment and follow-up of NTD patients especially with hydrocephalus. We identified risk factors for wound-related complications, readmission and mortality.
神经管缺陷（NTD）的患病率很高，因此在亚的斯亚贝巴有许多儿童出生时患有神经管缺陷，而手术闭合是儿科神经外科专科中心常见的手术操作。
主要目的是研究接受神经管缺陷手术闭合的儿童的治疗结果，并确定再入院、并发症和死亡率的风险因素。
对2019年4月至2020年5月期间所有接受手术治疗的神经管缺陷患者进行单中心前瞻性研究。
在研究期间，共有228名儿童接受了手术，平均年龄11天（中位数4天）。无院内死亡病例。围手术期有11名（4.8%）儿童出现伤口并发症，均无需手术治疗，也无围手术期死亡病例。一年随访率为62.7%（143/228），所有患者出院后神经状态均保持稳定。再入院率和再次手术率分别为38%和8%，再入院的风险因素为脑积水（80%）和开放性缺陷（88%）。脑积水（P = 0.05）和年龄较小（P = 0.02）被确定为死亡的风险因素。伤口相关并发症发生率为55%，与大的缺损（P = 0.04）和因入院延迟导致的延迟闭合（P = 0.01）有关。
该研究显示围手术期手术效果良好，尤其对于脑积水患者，进一步需要系统改善神经管缺陷患者的治疗和随访。我们确定了伤口相关并发症、再入院和死亡的风险因素。
