Anemia of Prematurity - Portal Neonatal

Head ultrasound can be performed during the neonatal period to evaluate the extent of ventricular
enlargement. Initially, the ventricles may be normal or only slightly enlarged. However, after the NTD
is closed surgically, the ventricles often enlarge. Incidence of hydrocephalus associated with
myelomeningocele ranges from 80-95%. In 2 studies performed in the 1980s and 1990s,
approximately 85-90% of all patients with NTD required a VP shunt for progressive hydrocephalus.
The highest incidence in shunt dependence occurs in thoracic lesions; the lowest incidence occurs in
sacral lesions. The risk of shunt revision in this population may be no different from that of other
children with shunts. Approximately 40-50% of all children with NTDs require shunt revision in the first
year and approximately 10% every year after that.
An MRI may reveal defects in cellular migration in the cerebral cortices. These include gray matter
heterotopia, schizencephaly, gyral abnormalities, agenesis and thinning of the corpus callosum,
abnormal thalami, and abnormal white matter findings.
Meaningful surgical treatment of myelomeningocele was not undertaken until the invention of the
shunt valve by Holter in the 1950s. Prior to that, closure of a myelomeningocele was possible, but the
ensuing uncontrolled hydrocephalus decreased the chance of survival. In the 1980s, the US
Department of Health and Human Services issued the Baby Doe directive, stating that medical and
surgical treatment could not be withheld simply because a neonate is handicapped. Although the
directive was struck down, the decision to operate on NTD in neonates was already an accepted
practice in the United States. Furthermore, outcome studies by McClone, Shurtleff, and others
presented a more positive outcome than had previously been thought for these children.
Timing of myelomeningocele repair
In the 1960s, the birth of a patient with myelomeningocele was a neurosurgical emergency, and
immediate closure of the defect was required. Studies have subsequently shown that closure within
48 hours was both safe and effective. A study by Charney et al comparing delayed closure (3-7 d) to
immediate closure (