Profiles of patients with myelomeningocele admitted to the neonatal unit at Universitas Academic Hospital in Bloemfontein, South Africa

Abstract

Background. Myelomeningocele (MMC) is a common neural tube defect with significant sequelae. There are limited recent data on the mortality and morbidity of MMC in South Africa (SA). Objective. To describe the outcomes and characteristics of patients with MMC admitted to the neonatal unit at Universitas Academic Hospital (UAH) in Bloemfontein, SA. Methods. A retrospective, descriptive study which included 53 patients with MMC admitted to the neonatal unit between 1 January 2017 and 31 December 2019 was conducted. Electronic patient records were reviewed. Data included outcomes, length of stay, complications and maternal and infant characteristics. Results. The inpatient mortality rate was 11.3% (n=6/53). The median length of stay was 18 days. Notable MMC complications included hydrocephalus (88.7%; n=47/53), Chiari malformation type II (44.7%; n=21/47), lower-limb paralysis (84.9%; n=45/53), lower-limb deformities (60.4%; n=32/53), meningitis (52.8%; n=28/53), neuropathic bladder (37.7%; n=20/53) and loss of anal tone (41.5%; n=22/53). MMC repair was performed in 62.2% (n=33/53) and 27.3% (n=9/33) developed complications. Wound sepsis and breakdown were the most common complications (18.2%, n=6/33), with a median 8 days to complications. Antenatal sonar was not performed in 62% (n=31/50) of cases. MMC was detected antenatally in 20% of cases. Conclusion. The inpatient mortality rate in thisstudy was lower than the mortality rates reported in other low- and middle-income countries although significant morbidity was identified. A lack of quality antenatal care and access to antenatal sonars were barriers to early detection of MMC. Other healthcare system infrastructural failures may be contributory, which highlights the need for ongoing inter- sectoral collaboration for prevention, early detection and management of MMC to improve patient outcomes.