Factors Associated with Early Neonatal and First-Year Mortality in Infants with Myelomeningocele in California from 2006 to 2011

Characteristics and first-year mortality, by lesion level, among infants with spina bifida in the New York State Birth Defects Registry, 2008-2017

BACKGROUND

Spina bifida is the most common neural tube defect. It has been associated with increased mortality, disability, and may require lifelong medical care. Higher-level lesions have been shown to be associated with increased mortality in infants with spina bifida.

METHODS

A study was conducted using data from infants with myelomeningocele and related spina bifida reported to the New York State Birth Defects Registry for birth years 2008 through 2017. Descriptive statistics were conducted. Cox regression was used to calculate adjusted hazard ratios for mortality by age one, by lesion level. Hazard ratios were adjusted for birthweight and maternal race/ethnicity.

RESULTS

Overall survival at age one was 90.7%. Cervical-level lesions had an increased risk of mortality compared to lumbar-level lesions (HR 8.32; 95% CI: 2.56, 27.05). No statistically significant associations were found for sacral-level lesions compared to lumbar-level lesions.

CONCLUSION

These results suggest that infants with cervical-level spina bifida have a higher risk of death by age one than those with other lesion levels.

Neonatal and infant mortality associated with spina bifida: A systematic review and meta-analysis

Objectives

A systematic review was conducted in high-income country settings to analyse: (i) spina bifida neonatal and IMRs over time, and (ii) clinical and socio-demographic factors associated with mortality in the first year after birth in infants affected by spina bifida.

Data sources

PubMed, Embase, Ovid, Web of Science, CINAHL, Scopus and the Cochrane Library were searched from 1^st January, 1990 to 31^st August, 2020 to review evidence.

Study selection

Population-based studies that provided data for spina bifida infant mortality and case fatality according to clinical and socio-demographical characteristics were included. Studies were excluded if they were conducted solely in tertiary centres. Spina bifida occulta or syndromal spina bifida were excluded where possible.

Data extraction and synthesis

Independent reviewers extracted data and assessed their quality using MOOSE guideline. Pooled mortality estimates were calculated using random-effects (+/- fixed effects) models meta-analyses. Heterogeneity between studies was assessed using the Cochrane Q test and I² statistics. Meta-regression was performed to examine the impact of year of birth cohort on spina bifida infant mortality.

Results

Twenty studies met the full inclusion criteria with a total study population of over 30 million liveborn infants and approximately 12,000 spina bifida-affected infants. Significant declines in spina bifida associated infant and neonatal mortality rates (e.g. 4.76% decrease in IMR per 100, 000 live births per year) and case fatality (e.g. 2.70% decrease in infant case fatality per year) were consistently observed over time. Preterm birth (RR 4.45; 2.30–8.60) and low birthweight (RR 4.77; 2.67–8.55) are the strongest risk factors associated with increased spina bifida infant case fatality.

Significance

Significant declines in spina bifida associated infant/neonatal mortality and case fatality were consistently observed, advances in treatment and mandatory folic acid food fortification both likely play an important role. Particular attention is warranted from clinicians caring for preterm and low birthweight babies affected by spina bifida.