Variation in neonatal antibiotic management for patients undergoing fetal myelomeningocele repair across Children’s Hospitals Neonatal Consortium (CHNC) centers

OBJECTIVE: Limited data informing evidence-based regimens for antibiotic use in neonates undergoing fetal myelomeningocele (fMMC) repair have been published to date, and no standard of care has been established across centers. The goal of this study was to describe current neonatal antibiotic use practices following fMMC repair within the Children's Hospitals Neonatal Consortium (CHNC), a collaborative network of North American institutions with Level IV neonatal intensive care units. METHODS: We conducted a cross-sectional survey of site sponsors at all 48 CHNC centers from April 2024 to January 2025, and invited CHNC Fetal Therapy Focus Group members in May 2024, with one response requested per center. RESULTS: A neonatologist at 34 centers (center response rate = 71%) completed the survey, of which 30 (88%) reported performing fMMC repair surgery (15/34, 44%) or delivering/receiving fMMC neonates (15/34, 44%) at their center. One-quarter of responding centers (7/30, 23%) reported having an existing clinical protocol for antibiotic management for fMMC neonates after birth. Notably, there was heterogeneity across existing protocols with respect to criteria for antibiotic use, the specific antibiotics used, and the duration of use. Responding centers reported administering antibiotics with guidance from infectious disease, neurosurgery, and fetal specialists. Two responding centers (6%) reported performing beta-2 transferrin testing on dehisced wounds when there is a suspected cerebrospinal fluid (CSF) leak, while the majority did not do so (20/30, 67%), and the remainder did not know their institutional practice (7/30, 23%). CONCLUSIONS: Current antibiotic use in fMMC neonates after birth varies widely between centers in North America, highlighting the need for evidence-based data to inform the development of best practice guidelines.