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Observational Study
. 2020 Jul;36(7):1521-1527.
doi: 10.1007/s00381-020-04506-9. Epub 2020 Jan 23.

A perspective in the management of myelomeningocoele in the KwaZulu-Natal Province of South Africa

M N Mnguni  1 , B C Enicker  2 , T E Madiba  3
Affiliations
Observational Study

A perspective in the management of myelomeningocoele in the KwaZulu-Natal Province of South Africa

M N Mnguni et al. Childs Nerv Syst. 2020 Jul.

Abstract

Background: Myelomeningocoele (MMC) is common in the developing world. The purpose of this study was to investigate the clinical characteristics and management of myelomeningocoele and to identify factors contributing to outcomes.

Methods: This was a retrospective, observational study of consecutive children diagnosed with MMC managed in the Paediatric Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. Multiple logistic regression analysis identified clinical characteristics, demographics and surgical variables that were associated with outcome.

Results: A total of 309 children were managed during this period (M:F 1.3:1). The most common sites were lumbar, lumbo-sacral and sacral. Mean age at surgical repair was 4.7 ± 15.6 months. Two hundred and eight children had ventriculomegaly, of whom 158 had symptomatic hydrocephalus, requiring CSF diversion. Fifty-eight (21%) patients developed wound sepsis, of whom 13 (22%) developed meningitis (p = 0.001). The time to wound sepsis was 9.5 ± 3.6 days. The commonest organism isolated was Staphylococcus aureus followed by MRSA. Thirty-two patients (23%) developed shunt malfunction and three (11%) developed ETV malfunction. Twenty children (9%) demised during the admission period. Death was associated with meningitis (p < 0.0001), and meningitis itself was associated with wound sepsis (p < 0.0001). Hospital stay was 20.4 ± 16 days. Wound sepsis (p = 0.002) and meningitis (p < 0.0001), respectively, were associated with prolonged hospital stay.

Conclusion: There was a slight male preponderance and hydrocephalus occurred in two thirds of cases. Wound sepsis and meningitis were associated poor outcomes.

Keywords: Hydrocephalus; Management; Myelomeningocele; Spina bifida.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
This is a geospatial map showing the regions of KwaZulu-Natal Province from which the children with MMC emanated
Fig. 2
Fig. 2
This shows a comparison of the hospital stay in patients with and without wound sepsis. Hospital stay was 38.1 ± 22.3 days for children with wound sepsis and 20.4 ± 16.9 days for those without wound sepsis (p = 0.002)
Fig. 3
Fig. 3
This figure shows a comparison of the hospital stay in patients with and without meningitis. Hospital stay was 40.5 ± 29.7 days for patients with meningitis and 18.4 ± 22.3 days in patients with no meningitis (p < 0.0001)
See this image and copyright information in PMC

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