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Papastefan ST, Bian Y, Singh M, Marriott WS, Ito JA, Fry J, Shaaban AF, Premkumar A. Neighborhood deprivation is not associated with abortion consideration or completion in patients with fetal myelomeningocele. Prenat Diagn 2024. [PMID: 38982329 DOI: 10.1002/pd.6633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/06/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate whether patient-level neighborhood deprivation index (NDI) was associated with termination of pregnancy consideration and completion in patients presenting with fetal myelomeningocele. METHODS This was a retrospective cohort analysis of patients with fetal myelomeningocele presenting to a fetal treatment center (FTC) in Illinois between 2018 and 2024. The exposure was NDI calculated from patient zip codes. The NDI was analyzed as both a dichotomous and ordinal exposure. The co-primary outcomes were abortion consideration prior to FTC consultation, ascertained by nurse intake, and abortion completion after consultation. Bivariate and log-binomial regression analyses were performed. Covariates were selected based on p < 0.10 on bivariate analyses. Otherwise, p < 0.05 indicated statistical significance. RESULTS A total of 157 participants were included. Evaluation of neighborhood deprivation as a dichotomous exposure revealed no association with abortion consideration or completion. AdditionallLy, no association was found on log binomial modeling after controlling for gestational age at presentation to the FTC and maternal race or ethnicity for abortion consideration (aRR 0.87, 95% CI 0.59-1.28) or completion (aRR 0.86, 95% CI 0.59-1.28). These results were similar when treating the NDI as an ordinal exposure. CONCLUSIONS Contrary to our hypothesis, NDI is not associated with abortion consideration or completion in patients with fetal myelomeningocele.
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Affiliation(s)
- Steven T Papastefan
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yuqi Bian
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Humanities and Bioethics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Manmeet Singh
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - William S Marriott
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Joyceline A Ito
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jessica Fry
- Neonatology and Palliative Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Aimen F Shaaban
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Section of Maternal Fetal Medicine, Pritzker School of Medicine at the University of Chicago, Chicago, Illinois, USA
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Kozel OA, Shao B, Sastry RA, Klinge PM, Svokos KA, Weil RJ. Postnatal Myelomeningocele Repair Rates: A Reflection of Their Milieu. World Neurosurg 2023; 180:241-242. [PMID: 37839570 DOI: 10.1016/j.wneu.2023.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
- Olivia A Kozel
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Belinda Shao
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rahul A Sastry
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Petra M Klinge
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Konstantina A Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robert J Weil
- Brain & Spine Center, Southcoast Health, North Dartmouth, Massachusetts, USA
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Best BJ, Cabacungan ET, Cohen SS, Kim I, Sherburne EC, Sawin KJ, Roach A, Foy AB. Trends in the early care of infants with myelomeningocele in the United States 2012-2018. Childs Nerv Syst 2023; 39:2413-2421. [PMID: 36308541 DOI: 10.1007/s00381-022-05704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The early care of children with spina bifida has changed with the increasing availability of fetal surgery and evidence that fetal repair improves the long-term outcomes of children with myelomeningocele. We sought to determine current trends in the prevalence and early care of children with myelomeningocele using a national administrative database. METHODS This is a retrospective, cross-sectional cohort study of infants with spina bifida admitted within the first 28 days of life using the 2012-2018 Healthcare Cost and Utilization Project National Inpatient Database. Patients with spina bifida were identified by ICD code and stratified into a cohort with a coded neonatal repair of the defect and those without a coded repair. This database had no identifier specific for fetal surgery, but it is likely that a substantial number of infants without a coded repair had fetal surgery. RESULTS We identified 5,090 patients with a coded repair and 5,715 without a coded repair. The overall prevalence of spina bifida was 3.94 per 10,000 live births. The percentage of patients without neonatal repair increased during the study period compared to those with repair (p = 0.0002). The cohort without neonatal repair had a higher risk of death (p < 0.001), prematurity (p < 0.001), and low birth weight (p < 0.001). More shunts were placed in patients who underwent neonatal repair (p < 0.001). Patients without neonatal repair were less likely to have public insurance (p = 0.0052) and more likely to reside in zip codes within the highest income quartile (p = 0.0002). CONCLUSIONS The prevalence of spina bifida from 2012 to 2018 was 3.94 per 10,000 live births, with an increasing number of patients without neonatal repair of the defect, suggesting increased utilization of fetal surgery. Patients without neonatal repair had a higher risk of death, prematurity, and low birth weight but were more likely to have commercial insurance and reside in high-income zip codes.
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Affiliation(s)
- Benjamin J Best
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA.
| | - Erwin T Cabacungan
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Neonatology, Department of Pediatrics, Children's Wisconsin, Milwaukee, WI, USA
| | - Susan S Cohen
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Neonatology, Department of Pediatrics, Children's Wisconsin, Milwaukee, WI, USA
| | - Irene Kim
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA
| | - Eileen C Sherburne
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Audrey Roach
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA
| | - Andrew B Foy
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA
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