www.jkns.or.kr http://dx.doi.org/10.3340/jkns.2012.51.6.359 J Korean Neurosurg Soc 51 : 359-362, 2012 Print ISSN 2005-3711 On-line ISSN 1598-7876 Copyright © 2012 The Korean Neurosurgical Society Clinical Article The Effect of Surgery Time on Prognosis in Newborns with Meningomyelocele Mehmet Yekta Oncel, M.D.,1 Ramazan Ozdemir, M.D.,1 Gokmen Kahilogulları, M.D.,2 Sadık Yurttutan, M.D.,1 Omer Erdeve, M.D.,3 Ugur Dilmen, M.D.1 Division of Neonatology,1 Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey Departments of Neuorsurgery,2 Pediatrics,3 Ankara University School of Medicine, Ankara, Turkey Objective : To investigate the effect of surgery time on prognosis of newborns with meningomyelocele. Methods : The records of neonates with meningomyelocele were retrospectively analyzed. Demographic and clinical characteristics as well as in- formation, timing of surgery, and durations of hospital stay and antibiotic therapy were recorded. Results : The records of 30 babies were included in the final analysis. Overall, the mean gestational age was 37.7±2.7 weeks, with a mean birth weight of 2967±755 g and head circumference of 35.8±3.8 cm. In terms of localization, 46.6% of the meningomyeloceles were lumbosacral, 40% were lumbar, 10% were thoracolumbar and 3.3% were thoracal. The mean size of the meningomyelocele sacs was 4.33±1.2 cm. Newborns underwent surgery on average of 8.2±5.9 days after birth, with an overall mean duration of hospital stay of 30±25.1 days. Patients were divided into two groups based on timing of surgery (group 1, ≤5 days; group 2, >5 days), and comparisons between groups revealed that earlier surgery was associated with significantly shorter durations of hospital stay (p<0.001) and antibiotic therapy (p<0.05). Conclusion : Early surgical intervention (≤5 days) was associated with a shorter duration of hospital stay and antibiotic therapy as well as a lower complication rate. We recommend that corrective surgery be undertaken as soon as reasonably possible. Key Words : Meningomyelocele · Surgery time · Prognosis · Newborn. INTRODUCTION Meningomyelocele (MMC) occurs as a result of failure of the neural canal to close posteriorly by the 26th day of gestation12). It is a devastating congenital defect of the central nervous sys- tem with no known cure, characterized by protrusion of the meninges and spinal cord through open vertebral arches lead- ing to paralysis. Varying degrees of mental retardation, bowel and bladder dysfunction as well as orthopedic disabilities also occur in association with this debilitating disorder10,18). The etiological mechanisms behind neural tube defects (NTDs) have yet to be completely elucidated, although their frequency has been reported to show variation depending on race, ethnic origin, geographical location and socioeconomic status6). Folic acid deficiency is one of best-documented risk factors for the development of NTDs17). The incidence of NTDs is high in Tur- key, affecting 3-9 newborns in every 1000 live births11,16). Al- though many studies have focused on prenatal measures to de- crease the frequency of MMC, research aimed at preventing the severe morbidity associated with this disorder is limited. The aim of this study was to evaluate the demographic and clinical characteristics as well as the frequency of associated anomalies in our MMC patient population, while also attempting to estab- lish the relationship between timing of surgery and duration of hospital stay. MATERIALS AND METHODS This retrospective study was conducted at Zekai Tahir Burak Maternity Teaching Hospital, situated in Ankara, with the ap- proval of the local ethics committee. The medical records of newborns diagnosed with MMC between January 2009 and May 2011 were systematically reviewed, and relevant data such as demographics, findings on physical examination, presence of • Received : December 22, 2011 • Revised : April 12, 2012 • Accepted : June 12, 2012 • Address for reprints : Mehmet Yekta Oncel, M.D. Division of Neonatology, Neonatal Intensive Care Unit, Zekai Tahir Burak Maternity Teaching Hospital, 06600, Cebeci, Ankara, Turkey Tel : +90-532-6315185, Fax : +90-312-3094702, E-mail : dryekta@gmail.com • This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 359