Anemia of Prematurity - Portal Neonatal

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Steinbok noted that about 60% of children with NTDs attended normal classes, while 40% were in
special classes or operated below their grade level. Approximately 10-40% of children with
myelomeningocele are probably employable at some level, depending on the patient's intellectual
abilities, ambulation status, and environmental influences.
Latex allergies
Over the past 2 decades, allergy to latex has been recognized in an increasing number of children
with myelomeningocele. Up to 50% of children with myelomeningocele may be latex sensitive. This
appears to be a result of a massive immunoglobulin E (IgE) response to the antigen in latex that is
derived from the Heva brasiliensis plant. Most patients with myelomeningocele should be treated with
latex precautions when undergoing surgery. Surgeons and health care providers should work with
latex-free gloves and plastics so that they can avoid latex-induced anaphylaxis, which can be life
threatening. Medications such as corticosteroids, Benadryl, bronchodilators, and epinephrine should
be available as a precaution during surgery on these children.
Late complications
Neurosurgeons need to be wary of late-life neurologic deterioration in children and adults. The most
common deterioration seen is from a tethered spinal cord. A routine MRI reveals a spinal cord that
ends in the lumbar or sacral regions in almost all patients with myelomeningocele (see Image 3). This
is normal in many patients without any new neurologic complaints. Despite careful surgical closure of
the original neural placode, approximately 20% or more of all patients with myelomeningocele require
an untethering of their spinal cord later in their life. They may present with gait difficulty, back pain, leg
weakness, sensory loss, a new foot deformity, or simply a change in their urodynamic data or urinary
continence. These patients require a surgical exploration to free the neural placode and nerve roots
from the dorsal surface of their dura. Patients with tethered cords on MRI but no new complaints do
not require reexploration.
Diastematomyelia can be diagnosed using MRI or CT/myelogram. An enlarging syringomyelia can be
the result of a symptomatic CM II or retethering of the spinal cord. Many functional deteriorations
result from progressive orthopedic deformities such as scoliosis, pelvic obliquity, and limb deformities.
An orthopedic surgeon well versed in the care of patients with NTDs is required to execute a
reasonable plan to repair or stabilize treatable disorders.
In general, a multidisciplinary team consisting of neonatologist, pediatrician, pediatric neurosurgeon,
pediatric urologist, pediatric orthopedic surgeon, physical therapist, nurse, nutritionist, psychologist,
and teacher are required to direct the care of children with NTDs.
PICTURES Section 10 of 11
Picture 1. Neural tube defects in the neonatal period. Neonate with a lumbar myelomeningocele
with an L5 neurologic level. Note the diaphanous sac filled with cerebrospinal fluid and containing
fragile vessels in its membrane. Also, note the neural placode plastered to the dorsal surface of the
sac. This patient underwent closure of his back and an untethering of his neural placode. The neural
placode was circumnavigated and placed in the neural canal. A dural sleeve was fashioned in such
a way to reconstruct the neural tube geometry.