FETAL MYELOMENINGOCELE - IS ANTENATAL ULTRASOUND USEFUL IN PREDICTINGNEONATAL OUTCOME

The objective of this study was to determine if an ultrasound examinat ion, when performed in the third trimester immediately preceding deliv ery, is useful in predicting outcome in infants with a myelomeningocel e. A retrospective review was undertaken of prenatal ultrasound record s and pediatric outcome data on fetuses with isolated myelomeningocele referred to our institution after 28 weeks' gestation during a three- year period. Macrocephaly proved to be the one antenatal ultrasound fi nding that most correlated with later poor outcomes in infants with my elomeningocele. Macrocephalic fetuses had a longer mean hospital stay after birth and were more likely to have significant respiratory and f eeding difficulties. No fetus with macrocephaly had a normal mental sc ore, and all had severe motor deficits on later follow-up testing. The ultrasound diagnosis of macrocephaly identified a group of fetuses wi th myelomeningocele, who were at highest risk of neonatal problems and developmental delay. Cesarean delivery and aggressive medical treatme nt of complications did not improve the outcome in these infants. This finding will be useful when counseling patients regarding route of de livery and in pediatric decisions regarding treatment of complications .