Estudo do prognóstico de crianças portadoras de espinha bífida, de acordo com as características topográficas da lesão ao nascimento

Abstract

INTRODUCTION: Neural tube closure defects are frequent congenital malformations that occur due to failure to close the embryonic neural tube around the twenty-eighth day of intrauterine life. Although neural tube closure defects have heterogeneous etiology, most cases are multifactorial. Neural tube closure defects present a variable clinical spectrum, which results in functional alterations of the backbone in varying degrees. OBJECTIVE: The aim of this study was to identify the association of the topography of the neural tube closure defects anatomical injury with the presence of neurogenic bladder with urinary retention, the presence of decompensated hydrocephalus (with the need for ventricle-peritoneal shunt) and motor sequel (ambulation) until the second year of life. PATIENTS AND METHODS: An analytical retrospective study of a historical series that included the analysis of 49 children who were born with myelomeningocele at Minas Gerais Federal University of Clinical Hospital, from 2013 to 2016. The analyzes were performed in the SPPS Software version 18 at the significance level of 5% (0,05). Descriptive analysis of the numerical data was performed by means of central tendency and dispersion, and for the categorical data, by means of frequencies and percentages. The intersection of variables to verify the association hypothesis was performed using Fischer's Exact Test. To verify the hypothesis of agreement between two categorical variables, the Kappas concordance test was applied and the Kruskal-Wallis test was used for numerical variables. The ANOVA test was also performed to compare the mean of a variable between three groups or more. The type of injury was assessed in two different ways, firt by the location of the defect and the second, by the number of altered vertebras. The prognosis was assessed through four binary variables which explain the absence or presence of meurogenic bladder with urinary retention, decompensated hydrocephality with the need for dvp and wandering. RESULTS: The level of vertebral injury was not considered in our study prognostic factor for hydrocephalus (P = 1.0); Ventricular-peritoneal shunt (P = 1.0), neurogenic bladder with urinary retention (P = 1.0); Functional neurological damage level (P = 1.0); and ambulation until the second year of life (P = 1.0). The anatomical injury of myelomeningocele in the skin of the newborn in the thoracolumbar region (P = 0.26) and in the sacral region (P = 0.32); were considered prognostic factors for corresponding vertebral injury in the same region. The functional neurological injury level of the studied children was not considered a prognostic factor for neurogenic bladder with urinary retention (P = 0.665), hydrocephalus (P = 0.306) or for the acquisition of ambulation up the second year of life (P = 0.529). CONCLUSION: In our study, the level of vertebral injury was not considered a prognostic factor for hydrocephalus, ventricle-peritoneal shunt, neurogenic bladder with urinary retention, functional neurological damage level or for the acquisition of ambulation until the second year of life. The level of functional neurological damage was not considered a prognostic factor for neurogenic bladder with urinary retention, hydrocephalus or for ambulation until the second year of life.