Open Fetal Versus Postnatal Repair of Spina Bifida Aperta—A Comparison of Neonatal Outcomes

OBJECTIVES: To compare the 30-day outcomes of infants undergoing fetal versus postnatal repair of open spina bifida (OSB) who met the equivalent eligibility criteria. METHOD: A retrospective study of consecutive patients who underwent OSB repair (2018-2022) by a consistent pediatric neurosurgical team. All met the MOMS trial fetal surgery criteria. Primary outcomes included cerebrospinal fluid (CSF) complications, motor function, wound complications and non-neurosurgical neonatal complications within 30 days of birth. RESULTS: Among 109 myelomeningocele repairs (82 fetal and 27 postnatal), postnatal repairs had higher mean birthweight (3116.8 vs. 2477.8 g; p < 0.01) and gestational age at delivery (38 + 1 vs. 34 + 4 weeks + days; p < 0.01). Neonates with fetal repair were less likely to require hydrocephalus treatment (9% vs. 56%, p < 0.01) or have CSF leak (1% vs. 19%, p < 0.01). Wound infection (5.2% vs. 14.8%; p = 0.10) and dehiscence (2.6% vs. 14.8%; p = 0.09) rates were comparable. Respiratory distress syndrome was more frequent with fetal surgery (43% vs. 4%; p < 0.004), although neonatal intensive care (NICU) admission (34% vs. 26%) and neonatal hospital stay were comparable (fetal repair: 15.2 days ± 2.1 vs. postnatal repair: 14.8 days ± 3.1, p = 0.91). CONCLUSIONS: Open fetal repair was associated with earlier delivery but with comparable NICU and hospital stay and lower hydrocephalus treatment rate at 1 month of age.