DEVELOPMENTAL OUTCOMES OF CHILDREN WITH MYELOMENINGOCELE - PRENATAL PREDICTORS

OBJECTIVE: The purpose of the current investigation was to determine c ognitive developmental outcomes for a cohort of children with prenatal ly detected myelomeningocele and to determine whether the variables of (1) severity of ventriculomegaly and (2) anatomic level of lesion wer e predictive of cognitive development. STUDY DESIGN: Prenatal ultrason ographic examinations were reviewed by a single perinatologist to dete rmine the degree of ventriculomegaly and the anatomic level of the les ion. Ventriculomegaly was defined as a lateral ventricular atrial widt h >10 mm. Anatomic level of lesion was defined as (1) thoracic, (2) hi gh lumbar, (3) midlumbar, (4) low lumbar-high sacral, or (5) sacral. C ognitive developmental quotients for surviving children were determine d by one of two developmental pediatricians with use of a modified ver sion of the Clinical Adaptive Test/Clinical Linguistic Auditory Milest one Scale, a measure of visual-motor and language abilities. RESULTS: The mean cognitive developmental quotient for subjects with absent to mild ventriculomegaly was 90.3 (range 54 to 120, SD 17.4), whereas the mean cognitive developmental quotient for those with moderate to seve re ventriculomegaly was 74.0 (range 65 to 100, SD 17.1) (p < 0.01). Th ere was a negative correlation between the degree of ventriculomegaly and the cognitive developmental quotient (r = -0.43, p < 0.025) and a positive correlation between the level of the lesion and the cognitive developmental quotient (r = 0.50, p < 0.01). CONCLUSIONS: The degree of ventriculomegaly determined on high-resolution prenatal ultrasonogr aphy is predictive of early cognitive development in children with mye lomeningocele, with worsening ventriculomegaly being associated with l ower cognitive developmental quotients. The anatomic level of the lesi on also has predictive value, with lower level lesions being associate d with more favorable cognitive outcomes. However, because of the high degree of variance in developmental quotients within the two ventricu lomegaly groups, we advise clinicians to use caution in the interpreta tion and use of our data.