Abstract：
This study aimed to investigate prenatal predictors of the need for cerebrospinal fluid diversion in infants following prenatal repair of open spina bifida.
A systematic search was performed to identify relevant studies published from inception until June 2022 in the English language using the databases PubMed, Scopus, and Web of Science.
We included retrospective and prospective cohort studies and randomized controlled trials reporting on prenatal repair of open spina bifida.
The random-effects model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals. Heterogeneity was assessed using the I2 value.
A total of 9 studies including 948 pregnancies undergoing prenatal repair of open spina bifida were included in the final analysis. Prenatal factors that were significantly associated with the need for postnatal cerebrospinal fluid diversion were gestational age at surgery ≥25 weeks (odds ratio, 4.2; 95% confidence interval, 1.8-9.9; I2=54%; P=.001), myeloschisis (odds ratio, 2.2; 95% confidence interval, 1.1-4.1; I2=0.0%; P=.02), preoperative lateral ventricle width ≥15 mm (odds ratio, 4.5; 95% confidence interval, 2.9-6.9; I2=0.0%; P<.0001), predelivery lateral ventricle width (mm) (mean difference, 8.3; 95% confidence interval, 6.4-10.2; I2=0.0%; P<.0001), and preoperative lesion level at T12-L2 (odds ratio, 2.5; 95% confidence interval, 1.03-6.3; I2=68%; P=.04). Factors that significantly reduced the need for postnatal shunt placement were gestational age at surgery <25 weeks (odds ratio, 0.3; 95% confidence interval, 0.15-0.6; I2=67%; P=.001) and preoperative lateral ventricle width <15 mm (odds ratio, 0.3; 95% confidence interval, 0.2-0.4; I2=0.0%; P<.0001).
This study demonstrated that among fetuses that underwent surgical repair of open spina bifida, having gestational age at surgery of ≥25 weeks, preoperative lateral ventricle width of ≥15 mm, myeloschisis lesion type, and preoperative lesion level above L3 was predictive of the need for cerebrospinal fluid diversion during the first year of life.
A systematic search was performed to identify relevant studies published from inception until June 2022 in the English language using the databases PubMed, Scopus, and Web of Science.
We included retrospective and prospective cohort studies and randomized controlled trials reporting on prenatal repair of open spina bifida.
The random-effects model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals. Heterogeneity was assessed using the I2 value.
A total of 9 studies including 948 pregnancies undergoing prenatal repair of open spina bifida were included in the final analysis. Prenatal factors that were significantly associated with the need for postnatal cerebrospinal fluid diversion were gestational age at surgery ≥25 weeks (odds ratio, 4.2; 95% confidence interval, 1.8-9.9; I2=54%; P=.001), myeloschisis (odds ratio, 2.2; 95% confidence interval, 1.1-4.1; I2=0.0%; P=.02), preoperative lateral ventricle width ≥15 mm (odds ratio, 4.5; 95% confidence interval, 2.9-6.9; I2=0.0%; P<.0001), predelivery lateral ventricle width (mm) (mean difference, 8.3; 95% confidence interval, 6.4-10.2; I2=0.0%; P<.0001), and preoperative lesion level at T12-L2 (odds ratio, 2.5; 95% confidence interval, 1.03-6.3; I2=68%; P=.04). Factors that significantly reduced the need for postnatal shunt placement were gestational age at surgery <25 weeks (odds ratio, 0.3; 95% confidence interval, 0.15-0.6; I2=67%; P=.001) and preoperative lateral ventricle width <15 mm (odds ratio, 0.3; 95% confidence interval, 0.2-0.4; I2=0.0%; P<.0001).
This study demonstrated that among fetuses that underwent surgical repair of open spina bifida, having gestational age at surgery of ≥25 weeks, preoperative lateral ventricle width of ≥15 mm, myeloschisis lesion type, and preoperative lesion level above L3 was predictive of the need for cerebrospinal fluid diversion during the first year of life.
摘要：
目的：我们的目的是调查开放性脊柱裂（OSB）产前修复后婴儿是否需要脑脊液（CSF）分流的产前预测因素。
方法：使用数据库PubMed进行了系统搜索，以确定从开始到2022年6月以英语发表的相关研究，Scopus,和WebofScience。
方法：我们纳入了回顾性和前瞻性队列研究以及报告开放性脊柱裂（OSB）产前修复的随机对照试验。
方法：随机效应模型用于汇集均值差异或优势比（OR）和相应的95％置信区间（CI）。使用I2值评估异质性。
结果：共有9项研究，包括948例接受OSB产前修复的孕妇，包括在最终分析中。与出生后脑脊液转流需求显著相关的产前因素是手术≥25周时的胎龄(GA)(OR:4.2,95%CI1.8,9.9;I2=54%;P=0.001),骨髓分裂（OR：2.2；95%CI1.1，4.1；I2=0.0%，P=0.02),术前侧脑室(LV)宽度≥15mm(OR:4.5,95%CI2.9,6.9;I2=0.0%;P<0.0001),产前LV宽度（mm）（MD：8.3，95%CI6.4，10.2；I2=0.0%；P<0.0001），T12-L2的术前病变水平（OR2.5;95％CI1.03，6.3;I2=68％，P=0.04)。显著降低产后分流需要的因素是手术<25周时的GA(OR0.3,95%CI0.15,0.6;I267%;P=0.001)和术前LV宽度<15mm(OR0.3,0.2,0.4;I2=0.0%;P<0.0001)。
结论：这项研究表明，在接受手术OSB修复的胎儿中，那些在25周或以上的手术中患有GA的人，术前LV宽度15mm或更大，骨髓分裂类型的病变，术前病变水平高于L3可以预测在生命的第一年需要分流CSF。
方法：使用数据库PubMed进行了系统搜索，以确定从开始到2022年6月以英语发表的相关研究，Scopus,和WebofScience。
方法：我们纳入了回顾性和前瞻性队列研究以及报告开放性脊柱裂（OSB）产前修复的随机对照试验。
方法：随机效应模型用于汇集均值差异或优势比（OR）和相应的95％置信区间（CI）。使用I2值评估异质性。
结果：共有9项研究，包括948例接受OSB产前修复的孕妇，包括在最终分析中。与出生后脑脊液转流需求显著相关的产前因素是手术≥25周时的胎龄(GA)(OR:4.2,95%CI1.8,9.9;I2=54%;P=0.001),骨髓分裂（OR：2.2；95%CI1.1，4.1；I2=0.0%，P=0.02),术前侧脑室(LV)宽度≥15mm(OR:4.5,95%CI2.9,6.9;I2=0.0%;P<0.0001),产前LV宽度（mm）（MD：8.3，95%CI6.4，10.2；I2=0.0%；P<0.0001），T12-L2的术前病变水平（OR2.5;95％CI1.03，6.3;I2=68％，P=0.04)。显著降低产后分流需要的因素是手术<25周时的GA(OR0.3,95%CI0.15,0.6;I267%;P=0.001)和术前LV宽度<15mm(OR0.3,0.2,0.4;I2=0.0%;P<0.0001)。
结论：这项研究表明，在接受手术OSB修复的胎儿中，那些在25周或以上的手术中患有GA的人，术前LV宽度15mm或更大，骨髓分裂类型的病变，术前病变水平高于L3可以预测在生命的第一年需要分流CSF。
