# Prenatal repair of myelomeningocele is associated with lower need for long-term feeding support

## TL;DR

Prenatal repair of myelomeningocele is linked to a reduced need for long-term feeding support compared to postnatal repair.

## Contribution

This study provides evidence that prenatal repair of myelomeningocele may improve feeding outcomes.

## Key findings

- 9.5% of infants with prenatal repair required a feeding tube at discharge, compared to 13.6% with postnatal repair.
- By 53 weeks corrected gestational age, prenatal repair was associated with decreased odds of needing a feeding tube.
- Prenatal repair may offer functional benefits by reversing hindbrain herniation.

## Abstract

Infants with myelomeningocele (MMC) are at risk of brainstem dysfunction secondary to symptomatic Chiari II malformation with hindbrain herniation (HH), which can manifest as feeding difficulties including aspiration and dysphagia. This study aims to investigate whether prenatal repair of MMC is associated with improved feeding outcomes compared to postnatal repair.

Retrospective observational study of 208 infants with MMC, 105 repaired prenatally and 103 repaired postnatally, from January 2011 to July 2022. Primary outcome was feeding tube at discharge and longitudinally through 12 months corrected gestational age (CGA).

9.5% of infants repaired prenatally and 13.6% repaired postnatally required feeding tube at discharge (p = 0.3585). By 53 weeks CGA, the prenatal repair group had decreased odds of requiring feeding tube (0.325 [95% CI 0.121, 0.872]).

Prenatal MMC repair was associated with decreased need for long-term feeding support, suggesting a potential functional benefit of prenatal repair related to reversal of HH.