Prenatal predictors of ventriculoperitoneal shunt requirement and adverse perinatal outcomes in newborns with open spina bifida

Abstract

Objective

Spina bifida is a group of anomalies that, while non-lethal, require careful prenatal evaluation and prognosis prediction due to their association with common motor and cognitive problems. In this study, we investigated the need for postnatal ventriculoperitoneal shunting (VPS) in fetuses with open spina bifida and explored the relationship between adverse perinatal outcomes and prenatal ultrasonographic findings.

Methods

In this retrospective study, fetuses with open spina bifida that were diagnosed prenatally and resulted in a live birth were examined. The fetuses were divided into two groups: those who required VPS and those who did not require VPS in the postnatal period, and their prenatal clinical characteristics (lateral ventricle [LV] width, defect size, and defect level) and postnatal results (Apgar scores, length of hospital stay, lower extremity motor functions, bladder dysfunction, and epilepsy) were compared.

Results

Prenatal LV width, defect size, presence of hindbrain herniation, and defect level were significantly different between the groups (all P < 0.05). Similarly, a significant difference was seen when comparing adverse neonatal outcomes; with worse outcomes observed in the group requiring VPS. It was observed that LV width, sac size and hindbrain herniation predicted the need for VPS in univariate analyses (P = 0.002, P = 0.013, P: 0.004, respectively). However, defect level had no predictive effect on VPS requirement.

Conclusion

Larger prenatal LV width and sac size were associated with an increased need for postnatal VPS and were effective in predicting adverse perinatal outcomes. Utilizing this information in prenatal counseling and pregnancy management may prove beneficial.